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Language: en
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 covet 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
the 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 a it's certainly something that uh
you're right i do think we should have
them today
we've now had almost
20 months of
living in anxiety uncertainty
uh being afraid for our health for our
family's health for our friends you know
shutdowns
economic instability everything has been
uncertain because this virus
and then there's this little test and
it's the first time for many people that
they are 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 more americans have had an
opportunity to go and buy them from you
know 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 you know
these tests should be public health
tools these tests are infectiousness
indicators they shouldn't be compared to
pcr
you know all of the these different
things and we could of course go through
and recap what those 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 the 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 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
you know 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
uh biden just came out the kova 19
action plan the other day and one of the
main pillars of it was testing and in
particular bringing rapid tests uh
scaling them up
so
on that front i think
finally there is success people are
actually understanding and
you know i haven't stopped beating this
drum
for far too long and i like hate rapid
tests now
so maybe it's good to step back uh
would you say most americans have not
taken a rapid 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 so maybe when 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 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 um
they're simple tests that
uh
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
the deep swabs that you know goes into
your brain
and uh and so it's not very
uncomfortable it's just like picking
your nose if you'll you know and and you
you put that swab and
you put that swab into
a little tube
and the tube has some liquid in it and
then you
pour 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 dress
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
uh you know one of the the major
differences is that a pcr test
gets a lot of
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 a hundred
thousand
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 trade-off 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
a 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 themselves 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 you know at that point you're
not even infectious even if you did
happen to be infectious when you first
ordered the test right
so it's really of the speed of these
tests and the accessibility and
distribution of them that makes them so
immensely powerful so this like 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 uh 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 just 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 right
and so we can have different viral loads
for example we can have
you can have a viral load of one or you
can have a viral load of a trillion and
a pcr test will tell 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 zero
percent 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 you know 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 iron
particles in you so i mean 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 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 what's the problem here
can you can you sort of explain what
does it mean to be a medical device why
is that an issue where is the fda
messing up
when we declare something as a medical
device and we evaluate it 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 in the eyes of the fda the pcr test
is the gold standard
uh medical device
and as a physician 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 99.9999
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's 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 i
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 result in a couple
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 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 covet 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 the reason it matters is
that these tests can be accessible if we
are okay with saying the real purpose of
a 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 happen 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 you
know round up all the people i was with
last night and so you guys have to
quarantine
for 14 days because you were with
michael who wasn't infectious yesterday
it's nonsensical to do that
it's a huge disincentive to actually get
tested that's exactly right huge
disincentive to get tested people you
know if it's too sensitive especially
with flights things like that like
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 it's potentially a
tenfold difference in terms of how long
your pc are 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 covered 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 ant a rapid 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 you know that 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 that's exactly right okay
so what
why
are we still here
so have you had conversations with folks
you said that there's a bunch of um
leaders that are kind of starting to
wake up to this idea but why is this
taking this 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 trump was still
president i would or or in the
transition
and i 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 you know and
this plan can stop shutdowns it can 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 of federal
government whoever it might be and i say
here's a plan like this this would work
they say you know what i get back is
this sounds really interesting michael
uh 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
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 you know it's not this isn't
like rocket science or the variance and
all those kinds of things
so the fda we can start to understand
why but also like
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
the 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
that's been 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 the in vitro 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 the medical claim
so we 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
that's why nobody's acted because no
because everyone says well there's no
other pathway so the fda
in vitro 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 not and they don't authorize or
review public health tests for 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 like 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
like it's obvious like it's public
health emergency it's a tool used for
public health it 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 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 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 you know if your test has been
used in europe for months and has
performed extremely well
then then we'll give you a certificate
by right you know 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 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
you 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 yeah
uh believe me i've tried i've tried to
think of all the different approaches um
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
uh pooled testing
we have companies like ginkgo right
based out here in cambridge
that are
uh
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
uh 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 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 and all these
different labs
and the fda doesn't care at all you
don't need any ua 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 pub 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
and then 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 uh 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 or like you 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 yeah and if
there's no positive then all 20 or 25
students are
interpreting that their result is
negative
you know 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 and you
tell 25 people that your pool was
negative
then that's somehow different that's
public health not medicine it 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 like 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 stop 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 this just like
a weird role of the dice or is there a
better explanation
i think it's somewhat of a roll the dice
but i also think it's that testing
so
doctors
don't pretend to like really understand
much about like
fluid dynamics and you know how well
masks are working like that's like way
out of their realm
doctors
do believe that they understand all
aspects of the tests right
and so the greatest barriers to rapid
tests being brought to market or sort of
being being rolled out heavily and
supported as public health tools
uh 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
won this pandemic hit everyone called up
clinical uh laboratory folks and
microbiologists
and physicians to ask well what kind of
tests should we use that kind of thing
and there is no training in medical
school for this kind of public health
work like uh 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 uh if a physician is a tsa
agent
at the airport
you know 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 not a big
systematic problem of that of of the the
system
and we can't expect that tsa agent to
have ever even thought about that like
that's not on them they were trained to
look at a to look at the bag
and that's kind of like physicians
and i you know probably some physicians
will hear this and feel like i'm
insulting it i don't mean to be liking
you know the two professions and or
anything like that i what but the point
is 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 and early in the pandemic there
was like pissing matches between labs
who had the most sensitive pcr
and it just
distracted everything it really i was
trying to say pretty early like
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 they hand me a
pcr tube and they says they say like
return this you know by
noon or something before you before your
work day's 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 yeah you're
giving me free reign to walk around and
infect everyone in the school
and you're gonna give me my result to
tell me i did that in two days from now
it doesn't 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's supposed to
care about public health
is it the fda is there some other
organization yet to be created
is it like uh just like with the
military the reason we have civilian
leadership when 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 kovid
we'll mention you or will mention this
idea of rapid 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
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 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 tasking the cdc
to certify these tests or 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 company start 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 6 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 they
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 in
a domain that was outside of their
normal medical diagnostic regulatory
agencies
and they they literally just had
a very fast screening to say what are
the best tests they went through a huge
number of different tests they said okay
these are the 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 an uh public
health
test idea enable it but 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 you know these are
public health tools by definition
and and i do think that this is a 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 you know 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 kova dissolved
so how does that interplay
like why do we still need tests if we
have vaccines yeah i am i actually wrote
an op-ed in
new york times or wall street journal or
something that was titled why we still
need rapid tests with 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 when i was last here i would
imagine given the timing
but those first clinical trials came out
and everyone
you know jumped for joy that these
things were going to be the the end to
this pandemic
but we had really short-sighted vision
there by not recognizing two main
features one is
uh that they might not stop transmission
another i guess three another is that uh
new variants might come around that will
break through the vaccine protective
immunity and the third is that we
were not
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 you know 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 start 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
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 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 we just should be focusing
on that so in your eyes the solution
would look like this
you would have make enough tests where
every single person would 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
it's every household has a box of tests
in their cupboard
and if you haven't seen any cases in
your community for a long time stop
testing do waste water
testing to see if there's any rna coming
back
if you start to see rna in the waste
water 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
why don't what is in each household or
each person each household use one test
per week
and can you uh sorry to just pause
on that idea that's
really cool the the waste water testing
that's the thing so you can 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 uh 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 not that's a nice way to
paint like a map of the
the intensity uh of the virus okay so
when it
when it goes above a certain level
you can start
doing
much higher frequency testing per house
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 damn
pandemic and
and so we can monitor the waste water or
any other methods we can monitor the
hospitals in the clinics and if somebody
does come in with coveted 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 uncertain 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
uh identified stop the testing again
that's the nice thing that
everything changes when people have the
tests in their home
it becomes
dynamic it can become easy 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
ah what if somebody doesn't doesn't use
it or what if somebody lies like well
you 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 often times have their
have a problem wrapping their head
around
especially to the extent
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 and infect 95.
most people would say oh my god that's a
horrible you know that's a horrible
program you're still letting a hundred
people go and infect 95 people
but that's 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
massive differences here
and all
the only goal then is to get our below
one have 100 people in fact 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 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 you
know 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 it
was a very very reasonable generous
number for how much it cost 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
you know that's and they're still making
profit and so
so it's extremely cheap market
competition can drive these tests
uh 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
you know 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 vaccinate our 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 weeks
but when he says that that's essentially
saying okay companies need to make sure
that their people are testing so are you
gonna base it on the honor system
i would say you probably would not base
testing on the honor system if it's like
to uh 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
businesses 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 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 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
and um but you didn't have to test there
and they didn't base it on the honor
system every morning i'll i
scanned a qr code on the box and emed
which is a service that provides
test uh verification
popped up with a proctor right on my
phone or on my computer
and said okay
let's go through your tests like and
they watch you they videotape you 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 you
know they're but they're just verifying
that you actually do it
they verify the test they verify that
test results with you
and at the end of it you've then gotten
from 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
uh 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 the rapid
antigen test that you did without anyone
else watching except for this proctor on
your phone super simple
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 i think so the way that
um 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 and 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 like elta's long said
during this pandemic is
if i'm public health it's 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're negative
but that doesn't require reporting it
you can
like there might be um basically like an
id
that's only in possession you are the
only person in possession of that so you
literally show it exactly 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
e-med i think
and i might be wrong here
uh i believe that they take the test
result and because they are considered a
clia waived laboratory like a digital
laboratory
they report their results by law out to
uh 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 cleo wave
because it's over the counter then
you're not bound by clio 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
you know
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 are going to use the test and if
that means that they're not reporting
and if that's the only way that they
will use it is if it's not reported then
that's better than no test
and especially given that the
central to the vaccine hesitancy is a
distrust of authority in the distrust of
government so
you're asking
you're asking people to get tested
and report their
status
to a centralized authority when they're
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 uh
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 if you want 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 emed emails you
the 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 like 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
by having private companies
who want to
be the 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 it's really just such a hard
problem and i 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 like
i i really
am sort of serious that these tests are
simple to make but we've been using like
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 like we we should
be able to do that we just need a faster
machine a better machine yeah and a
quicker one and a few folks like you
mentioned know how to solve that problem
yeah i've had a lot of discussion with
uh with tesla folks you know with with
people that used to work a test 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 a thousand dollars no
it can cost ten dollars right and let's
figure out how to manufacture it those
those those folks are like the best in
the world they're doing that okay but um
what about this biden action plan
so it sounds like
the guy uh agrees with you vaccinate or
test
so
i think given that choice a lot of
people go test in america because
there's there's like a division it seems
like so what is this just uh politics is
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 sure is
so there's there's a number of pillars
to the action plan um 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 a hundred 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
um and
is going to reduce the cost of antigen
tests and scale them up and make 280
million tests
and put two billion dollars 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
um
the issue
at hand though is that now that the
president has said vaccinate or test
there's a problem inherent in that you
know 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 it's the
problem that i have with that vaccinate
or test idea
is it's great if you want to use it as a
coercive
uh
effort to get people vaccinated like 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 uh
i disagree with let me say
i disagree as opposed to doing great yes
science communication this weird
like people talking down to the populace
as if they're children trying to trick
them here have some candy uh this kind
like everyone with common sense
somebody told me i was having a
conversation like 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 so don't trick people into
taking a vaccine be honest and
communicate
transparently everything that's known
about the vaccine communicate the data
inspire people with uh
with uh transparency and like
real communication of all the
uncertainty around it and all the
difficult decisions of risk and all
those kinds of things and as opposed to
trying to trick them like children into
taking the vaccine anyway
yes but okay well i didn't have to say
it so there
but you're saying it should not be uh uh
like vaccinate or test this that's that
tradeoff doesn't mean exactly vaccinate
by saying vaccinate or test
is absolutely confusing
because it implies for anyone who's
thinking about it it is implying and and
i've seen this because i have business
leaders call me fortune 500 business
leaders who call me and say
what do i do like i have 8 000 employees
where am i going to get my tests you
know and 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
it's a pandemic of a virus you
know like
don't ever put it on the unvaccinated
who frankly are just scared they don't
know who to trust
and we haven't given them a lot of
reason to trust public health to be
frank
so i agree i mean now that you've opened
the door i'll just say my piece like
absolutely we need to be the most honest
we can with all of this this
this is confusing language to say
vaccinator tests we need to say we need
to be very upfront that says and say
look vaccines aren't 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's that wanes
somewhat over time you know this is
biology i'm sorry i'm you know this is
just what it is
and 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
and
as a population we need to figure out
okay we have to stop transmission if
that's our goal
so 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
so i i'm just not a fan of that language
i think we should be being very very
clear like you said and up front about
what are the
limitations of the test of the vaccine
and of the test and we should be very
clear that like you know it can only
help the american public
in aggregate is extremely intelligent to
you know they will figure out
when you say that vaccine breakthrough
cases are rare and then they start
seeing
story after story of like whole parties
of people or vaccines have outbreaks and
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 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
uh for one thing when it's not for the
other and so the other so to get back to
the action plan
vaccinate or test i think
and and the re and the increase in rapid
tests i do think it was a bold move i
think it
i i would say that it was the most
prominent
sort of display
encouraging display of the fact that
rapid tests are
indeed
effective public health tools
my real concern now with with is that
280 million tests that's like less than
one per person per year in the united
states so that's not
the way that he said and delivered it
and 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 on
the shelves at cvs and walgreens and
amazon or whatever so 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 and then there's
vaccinate or test
and that's going to bring millions and
millions of people who are not currently
testing to have to start testing so
that's going to overwhelm our pcr labs
and it's going to create five-day delays
again with pcr if not longer
because we'll have backlogs
and so the only real solution to this is
to just scale up the tests that are
actually scalable
and that's these simple rapid tests and
it's not even to scale them up
through production and manufacturing
here
it's to open the doors so 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 millions of
tests in the billions of tests in the
united states
because they don't want to play the the
the game that the fda is currently
requiring of them
so we have an opportunity and i i am
very encouraged that the president
actually did put these into the action
plan and i do want to say for the record
that i'm
supportive of it in principle
but i think now
now we actually are in a in like a the
timer has been set and we have to deal
with the crisis before it happens
otherwise there could be some real
political
points taken off you know i do worry
that the president if he doesn't pull
through with this and really make the
test available we end up getting into
this other test crisis this fall
there could be political consequences to
that and the reason is like these rapid
tests are so personal they become
emotional almost they're so 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 like anger like in
the blame and so 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
and
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
so 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 and 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 right because
all of a sudden we just politicized it
we just
brought it with this thing that was
fully bipartisan
really by part i mean i've talked to the
fully 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 it just
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 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 i have to part right and that
is where
we go wrong it's i have to get tested or
vaccinated
you know screw that i am independent you
know whatever and
and 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 to just deliver
packages
to every home in america by now easily
if we were smart about it you know we
could have done it the most unpleasant
thing about covet is the uncertainty and
that's what leads to fear on both the um
uh vaccine hesitant it's the answer into
about the vaccine
and uh
people who are
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
and i think
testing allows you to uh remove a lot of
that uncertainty like you you gain back
confidence that you can operate in this
world
and not get infected and you become like
a nicer person i i find myself every
time i get tested i become a nicer
person to others because i know i'm not
putting a danger i'm not putting people
in danger
it's a it's a heavy burden to carry to
worry
am i infectious like i was out last
night but i do want to go see my mom
today you know like am i infectious i
don't know and this has created massive
anxiety
and i can't tell i completely agree that
it is
it's a relieving feeling and and it's an
amazing feeling to be in a room
when and i did this in the middle of the
pandemic when everyone was supposed to
be wearing a mask indoors
at every one rapid test you know and i
said everyone should wrap a test before
you walk into this room
and it was a wonderful experiment
because everyone was just so relaxed
yeah you know the other the alternative
is everyone nobody tests and everyone
wears a mask
you have a mask that maybe gives you 20
maybe protection
during if you're all in the same room
together if that
or you have a rapid test program
wherever in rapid test before and that
gives you like 95 to 100 protection not
100 but close
and 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
and restaurants like
restaurants are scary right now because
you just don't know who might be
infectious and nobody's masked
and
like 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
and i mean at the end of the day covet
and our response to covet is a re is a
it's truly an information problem
you know we 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
you know and yeah 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 what can people do
to help
god it's it's amazing to think
you're asking me this question
and this video will go out to you know
the web and all the people that watch
you and uh last year
in july maybe something like that june i
forget exactly what it was i was on
twitter this week in virology
um shout out to two of those guys are
awesome they are awesome i love i love
twiv
and they asked me the exact same
question towards the end i said this
makes so much sense you know why
wouldn't we do this what can people do
and so i said
oh you know just send me an email like
write to me i'm sure you could find my
email somewhere online
and uh and get in touch and i will you
know and and we can try to figure out
how to
uh make something happen yeah bad idea
very smart
way too many emails i didn't 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 rapid
test.org where we did
automate the process of writing letters
to um congressional members and and
elected representatives
so that helps
fast forward to today what can what can
people do
i honestly don't know like 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 so 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 a sim something as simple as
designating these powerful public health
tools as public health tools allow the
cdc
and the nih or whoever it must be or 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 ten new
tests authorized
you know this doesn't have to be a six
to twelve month endeavor this could be a
two day endeavor we actually did it i
judged the rapid test x prize
and it went great we actually got
incredible metrics about how well does
each test work
and no clinical trials you know just a
couple days worth of work in the lab and
boom and if we actually systematize it
would be an hour so in the lab you know
so
simple so i don't know i mean i don't
know how to really impact change i've
thankfully you know 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 um 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 we gotta
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 um
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 look at newborns
and say okay how does a baby get out of
their high risk
time period
they get exposed they get like 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 all already
but
one exposure doesn't do it i mean over
the course of the first few years of
life kids get exposed to chronoviruses
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 over abundant 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
you know i hate to say it but tons of
people are getting exposed to delta
right now who don't know it
tons
and
uh if you're vaccinated you don't know
it as my point there
and you know 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 you know will
add to our level of protection later on
and so yeah but the question is how long
that whole process takes i think you
know 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 they're
immunity like variants and stuff right
now 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 your 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 hurt immunity
over like it'll be very quick
so you know
that that's the intuition but
it seems like that's not
happening it seems like we're in this
constant state
of uh fear-mongering for different
reasons it's almost um
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
uh integrated into uh the division
that's so effective at uh
monetizing social media for example and
so it's like all right
so how do you get out of that mm-hmm
because you can always kind of present
certain kinds of numbers about number of
cases or
how
full hospitals are and 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
this information it's information yeah
and 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 like that's just
information like you said glow green the
problem with the virus you don't have
you don't see you're walking around and
everybody is a potential
uh
like infectious
creature and so if you see the world as
a potential potential for infection
you're going to be terrified of that
exactly right and that is what has
happened and i and that's why i've been
pushing so hard for 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 affect others
and the other great thing about them is
again a 10-day isolation period
especially for a vaccinated person but
in either case
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 yeah especially if we're
vaccinated why are we telling people the
only reason the cdc ever and the wha
suggested a 10-day
isolation or a 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 other week that we're
asking people to isolate people would
probably be much more likely to comply
if they only have 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 you know
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 you know and then you get to
day four and boom you start being
negative
that's a much more tolerable thing
because you are you are being able to
make that decision based on
true data that is empowering you and it
really does change
changes everything like because it's all
fear and
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 uh
i guess pressure
local politicians
federal write articles write articles
with the title like dear potus yeah you
know please designate these as public
health tools or just start talking about
in the media talk it talk about social
media anywhere
testing is a public health good
testing is a public health good we all
like it should not be considered a
medical device
i shouldn't have to pay
to keep you safe like testing should
generally be free for that matter like
subsidized by the government
these tools exist they we should all and
i think the more people that generate
noise to just say
a public health test is a public health
tool
you know
period like it's 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 sandra perchai
though those folks that
have power to really
do like large-scale manufacturing also
influence
governments will pay attention and
that's that's the hope enough people
talk about it i think business leaders
like business leaders obviously have so
much power here yeah
you know they they pay the lobbyists who
you know make things happen like let's
be honest there's people who pull levers
that are not the politicians themselves
and 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 and i hope that
all them hear this message to say
let's let's ask the president or the
people around the president to
designate these as public health tools
change the system
and 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 you spent time
as a buddhist monk
we like
didn't spend much time talking about i
just would love to talk to you about
about it a little bit more
maybe
as uh by way of advice
how do you recommend people can
integrate meditation into their lives
or how does one meditate
i i think for me meditation was
um
really an active effort um
which sounds weird because most people
think of meditation as like they la in
the absence of activity
um
but just like anything uh 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 a interview i'm not
even recording this just you and i talk
um
it is
you know most people are
uh meditating to like bring some balance
and bring some sanity to their life and
just like be able to control their
feelings and emotions a little bit more
and for that purpose like
i think the best way to to you know 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 you
know whatever and that 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 um
believe in rebirth in the way that uh
you know
in a buddhist sense and that like you
actually get
born multiple times i think we my
personal feeling is we die and we're
vanished you know um that's just me
um and
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
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 you know i
loved it it was you know but it's a it's
kind of a dangerous slope because you
can kind of get caught up in it and like
really start
going from okay i'm trying to quiet my
mind to almost being like addicted to
quiet in 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 you know it and
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 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
you say well
so you don't even have an attachment to
self like to you to ego to cause do you
feel like a conscious being or no like
the goal you never attained it but you
know i know is that the goal just that
would be 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 it's 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 don't care it's there i don't care if
it gets lost if it's shredded
then that is 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
you understand
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
this is not necessarily
the the buddhist ideal is somehow
obviously
the ideal you should strive for
but the actual access exercise and
meditation that they the buddhist monks
use seems like um
seems like a great tool
for becoming aware of your own mind
and that seems to be important for
appreciating life or some some kind of
uh 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
um back in the capitalist western world
where there's meetings and
that's right i mean i stopped i 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
and it just really
it was really interesting in sri lanka
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 i just
said that 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 uh feeling i
think or just awareness to to say oh i
do have the cap 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 um
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
[Music]
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 uh this 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
the sensation like minimizing amount of
thoughts in your mind and then uh
beginning to really appreciate the
sensation
yeah you weren't writing a book on the
on free will right
and uh 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
tsunamis you see uh pain you see
especially um
uh 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 i do think that
that's you know and they're two totally
valid ways to live life
um they are
generally i think they're ingrained in
us pretty early in society right and
it's hard to escape yeah what about uh
just in general becoming detached from
possessions
like minimalism
in uh not having many things so the the
capitalist world
kind of
pushes you towards having possessions
and
deriving joy from more and more and
better possessions
have you um
have you returned back to the joys of
that world
or do you find yourself
enjoying
the minimalist life
uh 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
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
um 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 it just
and 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 yeah and not worry
about anything do i actually have that
in reality
no
um 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 um 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 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 um
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
if you love each other it doesn't take
much money to be happy together
and for me i i personally value that
freedom of having the freedom to always
pursue your happiness as opposed to
being burdened by material possessions
that uh
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
right in the moment i completely
completely agree with that
so in looking at our failure
at scale
to
to engineer to manufacture to deploy
tests
how do you feel about our prospect as a
human civilization
are you optimistic
so this pandemic
it is
what it is
it um hurt a lot of people both
it took lives
but it also hurt a lot of businesses and
a lot of people economically
but uh 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
i think what are you most worried about
i it's it's one of those things so
existential that i don't worry about it
um
but i do think i mean let's in the
united states for example so you asked
about the human civilization but let's
talk about like a american society for a
moment
i do think that like 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 when
whether that's the pandemic or whether
that's climate change
i think it's extraordinary that we
we are not taking these things seriously
yeah 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 read
i tend to think if you just look at the
progress of human history
that the people
who do good in the world
out power the people that are the
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 i don't you know
but it seems like the people who build
who create solutions who um
yeah who innovate and who just put
like
both on the emotional level so love out
there and
like
on the actual engineering level tools
that make for higher quality of life i
think those win out if you look at human
history
um 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 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's what you said like
unless there's like some
significant peak of bad you know the
the problem with bad
is that it can happen like that you know
good
you can 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 than 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 like
and
and that takes some combination of
innovation
letting people know that these electric
cars exist it's kind of rapid tests too
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 it's a paradigm shift
yeah
it becomes uh 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 uh
channeled people's desire to do good
and i think over time that's that's
exactly what people uh
will do but yeah this i mean both on the
natural side the pandemic you know
there's still biology at play there's
still viruses out there trying to help
us there's accidents uh there's nuclear
weapons there's unintended consequences
of tools whether it's on the
nanotechnology side or the artificial
intelligence side then there's the
natural things like meteors and all that
that kind of stuff and yeah 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 real threat before us
we kind of step up
i don't know but
maybe you have to believe that
um until the very end
yeah
that's
that's right it will oh i mean we'll
have to see i guess you know neither
well
ideally we won't be alive to see that
[Laughter]
well no michael i'm glad we talk again
because um
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
it's an engineering solution on the
individual level something people can do
on the government level is 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 you know telling that story pushing
that message bravely boldly i really
really appreciate the work you're doing
man and i'm i i will do in my small way
uh the same
to try to help out and everybody else
should too until we get
hundreds of millions of tests in
people's hands uh it's an obvious
solution we should have had a long time
ago
and um
i like solutions not problems and this
is obviously a solution so thank you for
presenting it to the world and thank you
for talking about it
it's 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 uh so
let's hope we see a change
thanks for talking today
absolutely
thanks for listening to this
conversation with michael minna to
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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
you