Kind: captions
Language: en
the following is a conversation with
michael minna he's a professor
at harvard doing research on infectious
disease and
immunology the most defining
characteristic of his approach
to science and biology is that of a
first principles thinker and engineer
focused not just on defining the problem
but finding
the solution in that spirit we talk
about
cheap rabbit at home testing which is a
solution to covet 19
that to me has become one of the most
obvious powerful
and doable solutions that frankly should
have been done months ago
and still should be done now as we talk
about its accuracy
is high for detecting actual
contagiousness and
hundreds of millions can be manufactured
quickly and relatively cheaply
in general i love engineering solutions
like these
even if government bureaucracies often
don't
it respects science and data it respects
our freedom
it respects our intelligence and basic
common sense
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this podcast as a side note let me say
that
i've always been solution oriented not
problem oriented
it saddens me to see that public
discourse disproportionately
focuses on the mistakes of those who
dared to build solutions
rather than applaud their attempt to do
so teddy roosevelt
said it well in his the man in the arena
speech over 100 years ago
i should say that both the critic and
the creator
are important but in my humble
estimation
there are too many now of the former and
not enough of the latter
so while we spread the derisive words of
the critic on social media
making it viral let's not forget that
this world is built
on the blood sweat and tears of those
who dare to create
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friedman
and now here's my conversation with
michael
minna what is the most beautiful
mysterious or surprising idea in the
biology of humans
or viruses that you've ever come across
in your work
sorry for the overly philosophical
question
wow well that's a great question you
know i love the pathogenesis of viruses
and one of the things that i've worked
on
a lot is trying to understand how
viruses interact with each other and
so pre all this covered stuff
it was uh i was really really dedicated
to understanding
uh how uh how viruses
impact uh other pathogens so how if
somebody gets an infection
with one thing or a vaccine does it
either benefit or harm you from other
things that
appear to be unrelated to in the
to most people and so one
one system which is highly detrimental
to humans but what i think is just
immensely fascinating is measles
and measles gets into a kid's body
the immune system picks it up and
essentially grabs the virus
and does exactly what it's supposed to
do which is to take this virus and bring
it into the immune system so the immune
system can learn from it
can develop an immune response to it but
instead measles plays a trick it gets
into the immune system
serves almost as a trojan horse and
instead of getting
eaten by these by these cells it just
takes them over
and it ends up proliferating in the very
cells that were supposed to
kill it and it just distributes
throughout the entire body gets into the
bone marrow kills off
children's immune memories and so it
essentially
what i've found and what my research has
found is that this one virus
was responsible for as much as half of
all the infectious disease deaths in
kids
before we started vaccinating against it
because it was just wiping out
children's immune memories to all
different pathogens which is
you know i think um just astounding it's
just amazing to
watch it spread throughout bodies we've
done the studies in monkeys and and you
can watch it just
destroy and obliterate people's immune
memories in the same way that you know
some parasite might destroy somebody's
brain
and it's is that a evolutionary
just coincidence or is there some kind
of advantage to this kind of
interactivity between
pathogen well i think in that sense it's
just coincidence uh it probably is a
it's a good way for measles to
uh it's a good way for measles to
essentially be able to
survive uh long enough to replicate in
the body it just replicates in the cells
that are meant to destroy it so
it's uh it's utilizing our immune cells
for its own replication
uh but in so doing it's destroying the
memories of all the other
the other immunological memories so but
there are other viruses so a different
system is influenza and uh
flu predisposes to severe bacterial
infections
and that i think is another coincidence
but i
but i also think that there are that
there are some evolutionary benefits
that bacteria may hijack
and sort of piggyback on viral
infections viruses can
they just grow so much quicker than
bacteria they replicate faster and so
there's
the system with viruses with flu and and
bacteria where
the influenza has these proteins that
cleave certain receptors
and the bacteria want to cleave those
same receptors i want to cleave the same
molecules that gave
entrance to those receptors so instead
the bacteria
found out like hey you know we could
just piggyback on these viruses
they'll do it a hundred or a thousand
times faster than we can
and so then they just piggy back on and
they let flu cleave all these cyalic
acids
and then the bacteria just glom on and
in the wake of it so
there's all different interactions
between pathogens that are just
remarkable so does this whole system of
viruses that interact with each other
and so damn good at getting inside our
bodies
does that fascinate you or terrify you
i'm very much a scientist and so
uh it fascinates me much more than it
terrifies me
but knowing enough i know just how well
you know we get the wrong virus um
in our population whether it's through
some random mutation or whether it's
this same covid19 virus and it
you know these things are tricky they're
able to mutate quickly they're able to
find new hosts and rearrange in the case
of influenza
so what terrifies me is just how easily
this particular pandemic could have been
so much worse this could have been a
virus that is
uh much worse than it is you know same
thing with h1n1 back in 2009
uh that terrifies me if a virus like
that was
much more detrimental uh you know that
would be
it could be much more devastating
although it's hard to say you know the
the human
species were well
i i hesitate to say that we're good at
responding to things because there are
some aspects that were
this particular virus stars cove too and
covet 19 has
found a sweet spot where where it's not
quite serious enough on an individual
level that humans just don't
we haven't seen much of a useful
response by many humans
like a lot of people even think it's a
hoax and so it's led us down this path
of
uh it's not quite serious enough to get
everyone to respond
immediately and with the most urgency
but it's
enough it's bad enough that you know
it's caused our economies to shut down
and collapse and so
um i think i know enough about virus
biology to be
terrified for humans that you know it
can it just takes one virus
just takes the wrong one to just
obliterate us or or
not obliterate us but but really do much
more damage than we've seen it's
fascinating to think that code 19 is
uh as a result of a virus evolving
together with like twitter
yeah like figuring out how we can sneak
past the defenses of the humans
so it's not bad enough and then the
misinformation all that kind of stuff
together is operating in such a way that
the virus can spread
effectively i wonder i mean obviously uh
a virus is not intelligent but there's a
uh there's a rhyme and a rhythm
to the way this whole evolutionary
process works and creates these
fascinating things that spread
throughout the entire civilization
absolutely it's um
yeah i'm i'm completely fascinated by
this
idea of social media in particular
how it replicates how it grows you know
i've been
how it inner how it like actually starts
interacting with the biology of the
virus masks
who's going to get vaccinated politics
like these seem so
external to virus biology but it's
become so
in intertwined and uh
and it's it's interesting and i actually
think we could find out that you know
the virus actually
becomes uh obviously not
uh intentionally but
you know we could find that choosing
people choosing not to wear masks
choosing
choosing not to counter this virus in a
regimented and sort of organized way
effectively gives the virus more
opportunity
to escape we can look at vaccines you
know we're about to
we're about to have one of the most
aggressive vaccination programs the
world has ever seen
but we are unfortunately doing it right
at the peak
of viral transmission when millions and
millions of people are still getting
infected
and when we do that that just gives this
virus so many more opportunities i mean
orders of magnitude
more opportunity to mutate around our
immune system
now if we were to vaccinate everyone
when there's not a lot of virus
then there's just not a lot of virus and
so there's not going to be as
many you know i don't even know how many
zeros are at the end of however many
viral particles there are in the world
right now you know
more than quadrillions you know and so
if you assume that at any given time
somebody might have trillions of virus
in them and
any given individual so then you know
multiply trillions by millions and yeah
you know you get a lot of viruses out
there and
and if you start applying pressure
ecological pressure to
this virus that that you know when it's
that abundant
cloud the opportunity for a virus to
sneak around
immunity especially when all the
vaccines are identical
essentially um it takes is one to mutate
and then jumps oh it takes one takes one
in the whole world you know and we have
to
we have to not forget that this
particular virus was one
it was one opportunity and it has spread
across the globe and there's no reason
that can't happen tomorrow
i knew you know it's scary
i have a million other questions in this
direction but i'd love to talk
about one of the most exciting aspects
of your work which is uh testing or
rapid testing
you wrote a great article in time
on november 17th this is like a month
ago
about rapid testing titled how we can
stop the spread of kobe 19 by christmas
let's jot down the fact that this is a
month ago so maybe your timeline would
be different but let's say in a month so
you've talked about this powerful idea
for
quite a while throughout the covid 19
pandemic
how do we stop the spread of covad19 in
a month
well we uh we use tests like these
you know so so the only reason the virus
continues spreading
is because people spread it to each
other this isn't
this isn't magic yes um and so
there's a few ways to stop the virus
from spreading to each other
and that is uh you either can vaccinate
everyone and
vaccinating everyone is a way to
immunologically prevent the virus from
growing inside of somebody and therefore
spreading
we don't know yet actually if this
vaccine if any of these vaccines are
going to
prevent onward transmission so
so that may or may not serve to be one
opportunity
certainly i think it will decrease
transmission but the other idea that we
have at our disposal now
we had it in may we added in june july
august september october november
and now it's december we still have it
we still choose not to use it in this
country and in much of the world
and that's rapid testing that is giving
it's empowering people to know
that they are infected and giving them
the opportunity to not spread it to
their loved ones
and their friends and neighbors and
whoever else
we could have done this we still can
today we could start
we have millions of these tests these
tests are
uh simple paper strip tests they are
uh inside of this thing is just a little
piece of paper
now and i can actually open it up here
there we go
so this this is how we do it right here
we have this little paper strip test
this is enough to let you know if you're
infectious
with somewhere around the order of 99
sensitivity
99 specificity you can know
if you have infectious virus in you if
we can get these out to everyone's homes
build these make 10 million 20 million
30 million of them a day
you know we make more bottles of dasani
water
every day we can make these little paper
strip tests
and if we do that and we get these into
people's homes that they can use them
twice a week
then we can know if we're infectious you
know is it perfect
absolutely not but is it near perfect
absolutely
you know and so if we can say hey the
the
transmission of this is you know for
every 100 people that get infected right
now
they go on to infect maybe 130
additional people and that's exponential
growth so 100 becomes 130.
a couple days later that 130 becomes uh
another another 165 people have now been
infected
and you know go over three weeks and 100
people become 500
people infected now it doesn't take much
to
have those hundred people not infect 130
but infect 90.
all we have to do is remove say 30 40 of
new infections
from continuing their spread and then
instead of exponential growth you have
exponential decay
so this doesn't need to be perfect we
don't have to go from 100 to zero
we just have to go and have those
hundred people infect 90
and those 90 people infect you know 82
whatever it might be and you do that for
a few weeks and boom you have now gone
instead of 100 to 500 you've gone from
100 to 20.
yes it's not very hard and so
the way to do that is to let people know
that they're infectious i mean i've
we're a perfect example right now i i
this morning i used these tests uh to
make sure that i wasn't infectious
is it perfect no but it reduced my odds
i already was at extremely low odds
because i spent my life quarantining
these days
well the interesting thing with this
test which uh with the testing in
general which is why i love
what you've been espousing is it's
really confusing to me that this has not
been
taken on as it's one an
actual solution that's those available
for a long time there's there doesn't
seem to have been
solutions uh proposed at a large scale
and a solution that it seems like a lot
of people would be able to get behind
there's some
politicization or fear of other
solutions that people
propose which is like lock down and
there's a worry you know especially in
the american spirit of freedom
like you can't tell me what to do the
thing about tests
is it like empowers you with information
essentially
yes so like you it's
it gives you more information about your
like your role in this pandemic and then
you can do whatever the hell you want
like it's all up to your ethics and and
so on so like
and it's it's obvious that with that
information people would be able to
protect their loved ones
and also do uh do their sort of
quote-unquote duty for their country
right it's protect the rest of the
country
that's exactly right i mean it's just
it's empowerment but you know this is a
problem
we have not put these into action in
large part because
we have a medical industry that doesn't
want to see them be used
we have a political and a regulatory
industry that doesn't want to see them
be used that sounds
crazy why wouldn't they want them to be
used we have a very paternalistic
approach to everything in this country
you know despite
this country kind of being founded on
this individualistic
ideal pull yourself up from your
bootstraps all that stuff
uh when it comes to public health we
have a bunch of
ivory tower academics who want data that
you know they want to see
perfection and we have this issue of
letting perfection get in the way of
actually doing something
at all you know doing something
effective and
so we keep comparing these tests for
example to the laboratory-based pcr test
and
sure this isn't a pcr test but this
doesn't cost a hundred dollars and it
doesn't take five days to get back
which means in every single scenario
this is the more effective test
and we have unfortunately a system
that's not about public health we have
entirely eroded any ideals of public
health in our country
for the biomedical complex you know this
medical industrial complex which
overrides everything
and that's why you know i'm just
can i swear on this podcast yes
i'm just so fucking pissed that these
tests don't exist meanwhile and everyone
says
you know how we couldn't make these you
know that we could never do it that
would be such a hard
a difficult problem meanwhile the
vaccine gets
we've we have at the same time that we
could have gotten these stupid little
paper strip tests out to every household
we have uh developed a brand new vaccine
we've gone through phase one phase two
phase three trials we've scaled up its
production
and now we have ups and fedex and all
the logistics in the world
getting freezers out to where they need
to be we have this immense
we see with when it comes to sort of
medicine you know something you're
injecting into somebody
then all of a sudden people say oh yes
we can yeah but you say
oh no that's that's too simple a
solution too cheap a solution no way
could we possibly do that
it's this faulty thinking in our country
which you know frankly is driven by
big money big you know the only time
when we actually think that we can do
something
that's maybe aggressive and complicated
is when there's billions and billions of
billions of dollars in it
you know and i mean on a difficult note
because this is part of your work from
before the corvaid
it does seem that i saw a statistic
currently
is that 40 percent would not be taken
off americans would not be taking a
vaccine
some some number like this so you also
have to acknowledge that
all the money that's been invested like
there doesn't appear to be a solution to
deal with like
the fear and distrust that people have i
bet
i don't know if you know this number but
for taking a strip
like a rapid test like this i bet you
people would say
like the percentage of people that
wouldn't take it is in the single digits
probably
i completely think so and you know
there's a lot of people who don't want
to get a test today
and that's because it gets sent to a lab
it gets reported
it has all the stuff and in our country
which
teaches people from the time they're
babies you know to keep their medical
data close to them we have hipaa we have
all these we have immense rules and
regulations to ensure the privacy of
people's
medical data and then a pandemic comes
around and we just assume that all that
the average person is going to wipe
all that away and say oh no i'm happy
giving out not just my own medical data
but also to tell
the authorities everyone who i've spent
my time with so that they all get a call
and are pissed at me for giving up their
names you know so people aren't getting
tested and they're definitely not giving
up
their contacts when it comes to contact
tracing and so for so many reasons that
approach is failing
uh not to even mention the delays in
testing and things like that and so
this is a whole different approach but
it's an approach that
empowers people and takes the power
a bit away from the people in charge you
know and that's what's that's what's
really grating on
on i think public health officials who
say no we need the data
so they're effectively saying if i can't
have the data i don't want the
individuals i don't want the public to
have their own data either
which is a terrible approach to a
pandemic where we can't
solve a public health crisis without
actively engaging the public it just
doesn't work
and uh you know and that's what we're
trying to do right now which is a
terrible
approach so first of all there's a you
have a really nice informative website
rapidtest.org
information on this i still can't
believe this is not more popular it's
ridiculous okay but uh
our our uh one of the uh
faqs you have is a rapid test too
expensive
so can can cost be brought down like i
pay
i take a weekly pcr test and i think i
pay 160 170 bucks
a week no i mean it's criminal
absolutely we can get costs this
this thing right here cost less than a
dollar to make
with everything combined plus the swabs
you know maybe it costs a dollar fifty
could be sold for uh frankly it could be
sold for three dollars and still make a
profit if they want to sell it for five
this one here this is a slightly more
complicated one but you can see it's
just got the exact same paper strip
inside
this is really it doesn't look like much
but it's kind of the cream of the crop
in terms of these
rapid tests this is the one that the us
government bought and it is doing
an amazing job it has a 99.9
uh sensitivity and specificity so it's
really
it's really good and so essentially the
way it works is you just
you use a swab you put the once you you
kind of use the swelling yourself you
put the swab into these little holes
here
you put some buffer on and you close it
and uh and a line will show up if it's
positive and
a line won't show up but it's negative
it takes 5-10 minutes
this whole thing the this this can be
made so cheap that the us government was
able to buy them
by 150 million of them from uh
abbott for five dollars a piece you know
so anyone who says that these are
expensive
we have the proof is right here this one
at its
you know it was abbott did not lose
money on this deal
you know they got 750 million dollars
for buy
for selling 150 million of these at five
bucks a piece
um all of these tests can do the same
so anyone who says that these should be
you know unfortunately what's happening
though is the fda is only authorizing
all of these tests as medical devices
so what happens when you if i'm a
medical company
if i'm if i'm a test production company
and i want to make this test
and i go through and and the fda at the
end of my
authorization the fda says okay
you know you now have a medical device
not a public health tool
but a medical device and that affords
you the ability to
charge insurance companies for it
why would i ever as a you know in our
capitalistic
uh economy and and sort of
infrastructure
why would i ever not sell this for
thirty dollars when insurance will pay
pay for it or a hundred dollars you know
it might only cost me 50 cents to make
but
but by pushing all of these tests
through a medical pathway at the fda
they what what extrudes out the other
side is an expensive medical device
that's erroneously expensive it doesn't
need to be
inflated in cost but the companies say
well i'd rather make fewer of them
and just sell them all for thirty
dollars a piece
then make tens of millions of them which
i could do
and sell them at a dollar uh marginal uh
uh profit you know and so
it's a problem with our with our whole
medical industry that we see
tests only as medical devices and uh you
know what i would like to see is for the
government in the same way that they
bought
150 million of these from abbott they
should be buying
you know all of these tests that they
should be buying 20 million a day
and getting them out to people's homes
this virus has cost
trillions of dollars to the american
people it's closed down restaurants and
stores and you know obviously the main
streets across america have shut have
shuttered
it's killing people it's killing our
economy it's killing lifestyles
and and this is an obvious solution to
me this is exciting this is like this is
a solution i wish uh
like in april or something like that uh
to
launch like the larger scale
manufacturing deployment of uh
tests doesn't matter what test they are
it's obviously the capitalist system
would create
cheaper and cheaper tests that that
would be hopefully driving down to one
dollar
so what are we talking about in america
there's i don't know
300 plus a million people
so that means you want to be testing
regularly
right so how many
do you think is possible to manufacture
will be the ultimate goal to manufacture
per month yep so if we want to slow this
virus and actually stop it from
transmitting achieve what i call herd
effects
like vaccine herd immunity hurt effects
are when you get that r value below one
through preventing onward transmission
if we want to do that with these tests
we need about 20 million to 40 million
of them
every day uh which is not a lot
in the united states in the united
states so we could do it there's other
ways you can have two people in a
household
uh swab each other you know swab
themselves rather
and then mix you know put the swabs into
the same tube and onto one test so you
can pool
so you can get a a 2 or 3x
gain inefficiency through pooling in the
household you could do that in schools
or offices too where everyone just uses
a swab you have a
there's two people like i mean even if
it's just standing in line
at a public testing site or something
you know you could just say okay
these two are the last people to test or
swab themselves they go into one
one thing and if it comes back positive
then you just do each person and you
know it's rapid
so you can just say to the people one of
you is positive
let's test you again um so there's ways
to get the efficiency gains much better
but let's say
i think that that the optimal number
right now that matches sort of what we
can produce
more or less today if we wanted is 20
million a day
right now one company that i don't have
their test here but one company is
already producing five million
tests themselves and shipping them
overseas
it's an american company based in
california called inova
and they are giving 5 million tests to
the uk
every day not to the you know
and this is just because there's no the
federal government hasn't authorized
these tests
without the support of the the
government so yeah so
essentially if the government just puts
some support behind it
then uh then yeah you can get 20 million
probably easy oh yeah this i mean just
here i have
three different companies these they all
look similar well this one's closed but
these are three different companies
right here this is a fourth
abbott you know this is a fifth this is
a sixth
these two are a little bit different do
you mind if in a little bit would you
take some of these
or yeah let's let's do it we can we can
uh we can absolutely
do that so you have a lot of tests in
front of you uh could you maybe explain
some of them
absolutely so there's a few different
classes of tests
that i just have here and there's more
tests there's many more different tests
out in the world too
these are these are one class of tests
these are
uh rapid antigen tests that are just the
most bare bones paper strip tests these
uh this is the type that i want to see
produced in the tens of millions every
day it's so simple
you know you don't even need the plastic
cartridge you can just you can just make
uh make the paper strip and you could
have a little a little tube like this
that
you know you just dunk the paper strip
into you don't actually need
the plastic which i'd actually prefer
because if we start making tens of
millions of these this becomes a lot of
waste so i'd rather not see this kind of
waste be out there and
there's a few companies quadel is making
a test called the quick view which is
just
just this it's uh they've gotten rid of
all the
all the plastic and for people who are
just listening to this we're looking at
some very small
tests that fit in the palm of your hand
and they're basically paper strips
fit into different containers and that's
hence the comment about the plastic
containers
these are just injection molded i think
and uh
you got it they're um you know they can
build them at high numbers but then they
have to like place them in there
appropriately and all this stuff so it
is a
it is a bottleneck or some somewhat of a
bottleneck in manufacturing
the actual bottleneck uh which the
government i think should use the
defense productions act to build up
is the there's a nitrocellulose membrane
laminated membrane on this
that allows uh the the material the the
the buffer and with the swab mixture to
flow across it
so the way these work they're called
lateral flow tests and
you take a swab you swab the the front
of your nose
you dunk that swab into some buffer and
then you
put a couple drops of that buffer onto
the lateral flow and just like
paper if you dip a piece of paper into a
cup of water
though the paper will pull the water up
through capillary action this actually
works very similarly it flows
through somewhat a capillary action
through this nitrocellulose membrane
and there's little antibodies on there
these little proteins that are very
specific in this case for antigens or
proteins of the virus
so these are antibodies similar to how
to the antibodies that our body makes
from our immune system but they're just
printed on these um lateral flow tests
and they're printed just like a little
a line so then you you slice these all
up into
individual ones and if there's any virus
on that buffer as it flows across
the antibodies grab that virus and it
creates a little reaction with some
colloids in here that cause it to turn
dark just like a pregnancy test
um one line means negative it means a
control
strip worked and two lines mean positive
means uh
you know but if you get two lines it
just means you have virus there you're
very very likely to have virus there and
so
uh so they're super simple this is it is
the exact same technology as pregnancy
tests
it's uh the technology this particular
one from abbott
this has been used for other infectious
diseases
like malaria and and actually a number
of these companies have made malaria
tests that do the exact same thing so
they just co-opted their
the same form factor and uh and just
change the antibodies so it picks up
sars cof2 instead of other infections is
it also the abbott one is it also strip
yep yeah this abbott one here is uh
there's the in this case instead of
being put in a plastic sheath it's just
put in a cardboard thing and
literally glued on i mean it's it looks
like nothing you know it's just
it looks like a like i mean it's just
the simplest thing you could
you could imagine the exterior packaging
looks very apple like this nice
it does yeah yeah yeah so it's nice and
it comes in
this is the this is how they're packaged
you know so
and they don't have to you know this
these are coming in individual packages
against
again because they're really considered
individual medical devices
but you could package them in you know
bigger packets and stuff you you want to
be careful with humidity so they all
have a little
um one of those humidity removing things
and oxygen removing things
um so that's that this is one class
these antigen tests if we could just
pause for a second if it's okay
and uh could you just briefly say
what is an antigen test and what other
tests there are out there like
categories of tests
sure just really quick so the testing
landscape is a little bit complicated
but it's
but i'll break it down there's really
just three major classes of tests
uh we'll start with the first two the
the first two tests are just
looking for the virus or looking for
antibodies against the virus
so we've heard about serology tests or
maybe some people have heard about it
those are a different kind of test
they're looking to
see has somebody in the past does
somebody have an immune response against
the virus which would indicate that they
were infected or exposed to it
so we're not talking about the antibody
test so i'll just leave it at that those
uh they actually can look very similar
to this or they can be done
in a laboratory those are usually done
from blood
and they're looking for an immune
response to the virus so that's one
everything i'm talking about here is
looking for the virus itself not the
immune response to the virus
and so you there's two ways to look for
the virus you can either look for the
genetic code of the virus like the rna
just like the dna of somebody's human
cells
or you can look for the proteins
themselves the antigens of the prot of
the virus so
i like to differentiate them if you were
a
a pcr test that looks for rna
in let's say let's say if we made it
against humans it would be looking for
the dna inside of our cells that would
be actually looking for our genetic code
uh the equivalent to an antigen test is
sort of a
a test that like actually is looking for
our eyes or our nose or physical
features of our body that would
uh delineate okay this is this is uh
michael for example
in and so so you're either looking for
this a sequence or you're looking for a
structure
uh the pcr test that a lot of people
have gotten now and they're done in labs
usually
are looking for the sequence of the
virus which is rna
this test here by a company called
detect
this is one of jonathan rothberg's
companies um
he's the guy who helped create modern
day sequencing
and all kinds of other things so this
detect device
that's the name of the company this is
actually a rapid rna detection device so
it's almost it's like a pcr-like
test and we could even do it here it's
really it's
it's a beautiful test in my opinion it
works exceedingly well
it's going to be a little bit more
expensive so i think it could confirm
could be used as a confirmatory test for
these is there a greater accuracy to it
um yes i would say that there is a
greater accuracy there's also a downfall
though of pcr
and tests that look for rna they
can sometimes detect somebody uh who is
no longer infectious
so you have the the rna test then you
have these antigen tests
the antigen tests look for structures
but they're generally only going to turn
positive if people have actively
replicating virus in them
and so what happens after an infection
dissipates
you have you've just gone from having
sort of a spike so
if you get infected maybe three days
later the virus gets into exponential
growth
and it can replicate to trillions of
viruses inside the body
your immune system then kind of tackles
it and beats it down to nothing
but what ends up in the wake of that you
just had a battle you had this massive
battle that just took place inside your
upper respiratory tract
and because of that you've had trillions
and trillions of viruses
go to zero essentially but the rna
is still there it's just these remnants
in the same way that if you go to a
crime scene and blood was
was was sort of spread all over the
crime scene
you're going to find a lot of dna
there's tons of dna there's no people
anymore
but there's a lot of dna there same
thing happens here and so what's
happening with pcr testing
is when people go and use these
exceedingly high
sensitivity pcr tests people will stay
positive for
weeks or months after their infection
has subsided
which has caused a lot of problems in my
opinion it's problems that the cdc and
the fda and doctors don't want to deal
with
but i've tried to publish on it i've
tried to you know
suggest that this is an issue both to
new york times and others and now it's
unfortunately
kind of taken on a life of its own of
conspiracy theorists thinking no
um they call it a case stomach they say
oh you know pcr is
it's detecting people who are no longer
who are right false positive but they're
not false positives they're
they're late positives no longer
transmissible i think the way you
uh like what i saw on rapid tests.org
i really like the distinction between
diagnostic sensitivity and
contagiousness sensitivity
that's it's so
that website is so obvious uh
that it's painful because it's like yeah
that's what we should be talking about
is
how accurately is the test able to
detect
your contagiousness and you have
different plots that show that
actually there's you know um
that antigen test the tests we're
looking at today like rapid tests
actually really good at detecting
contagiousness absolutely
it all mixes back with this whole idea
that
of the medical industrial complex you
know in this country
and in most countries we have almost
entirely defunded
and devalued public health period you
know we just we just have
and uh and what that means is that
we don't even we don't have a language
for it we don't have a lexicon for it we
don't have a regulatory landscape for it
and so the only window we have to look
at a test
today is as a medical diagnostic test
and and that becomes very problematic
when we're trying to tackle
a public health threat in a public
health emergency
by definition and this is a public
health emergency that we're in
and yet we keep evaluating tests
as though the diagnostic benchmark is
the gold standard where if i'm a
physician
i am a physician so i'll put on that
physician hat for a moment
and if i have a doc if i have a patient
who comes to me and wants to
uh know if their symptoms are a result
of them
having covid then i want every shred of
evidence
that i can get to see does this person
currently or did they recently have
this infection inside of them and so in
that sense
the pcr test is the perfect test it's
really sensitive
it will find the rna if it's there at
all so that i could say you know
yeah you have a low amount of rna left
you might have been
you said your symptoms started two weeks
ago you probably
were infectious two weeks ago and and
you have lingering symptoms from it
but that's a that's a medical diagnosis
it's kind of like a detective recreating
a crime scene
they want to go back there and re re
create the pieces so that they can
um assign blame or whatever it might be
but that's not public health in public
health we need to only look forward
we don't want to go back and say well
was this person are there symptoms
because they had an infection two weeks
ago
in public health we just want to stop
the virus from spreading to the next
person and so that's where
we don't care if somebody was infected
two weeks ago
we only care about finding the people
who are infectious today
and unfortunately our regulatory
landscape
fails to apply that knowledge
to evaluate these tests as public health
tools they're only evaluating the tests
as medical tools and therefore we get
all kinds of
complaints that say this test which
detects 99
plus you know 99.8 percent of of current
infectious people
uh on by the fda's rubric they'll say no
no that's
it's only 50 percent sensitive and
that's because when you go out into the
world and you just compare this against
pcr positivity
most people who are pc are positive in
the world right now at any given time
are post infectious they're no longer
infectious because
you you might only be infectious for
five days but then you'll remain pcr
positive for
three or four or five weeks and so when
you go and just evaluate these tests and
you say okay this person's pcr positive
does the rapid antigen test detect that
more often than not it's no but that's
because those people
don't need isolation you know they
they're post infectious and this is a
it's become much more of a problem than
i think
uh even the fda themselves is
recognizing because they are unwilling
at this point to to look at this as a
public health problem requiring public
health tools
we'll definitely talk about this a
little bit more because the concern i
have is that like a bigger
pandemic comes along what are the
lessons we draw from this and how we
move forward let's talk about that in a
bit
but sort of can we can we discuss
further delay of the land here of the
different
tests before us absolutely so i talked
about pcr tests and those are done in
the lab
or they're done essentially with with a
rapid test like this the detect and we
can even try this in a moment
it goes into a little heater so you
might have one of these in a household
or
one of these in a nursing home or
something like that or in an airport
or you could have one that has 100
different outlets this is just to heat
the tube up
these are the rapid tests they are super
simple
no frills you just swab your nose and uh
you put the swab into a buffer and you
put the buffer on the test so we can use
these right now if you want yeah and we
can try it out and all the tests we're
talking about
they're usually swabbing the nose
like that's the that's still that i mean
yeah
there are some saliva tests coming about
and they these can all work potentially
with saliva they just have to be
recalibrated
uh but these these swabs are really not
bad this isn't the
the deep swab that goes like way back uh
into your nose or anything this is just
the
uh just a swab that you do yourself like
right in the front of your nose
um so if you want to do it yeah do you
mind if i sure yeah
yeah why don't we start with this one
because this is uh this is abbott's
binex now test and it's really it's
pretty simple
this is this the swab from the abba test
that's correct that's the swab from the
abba test
so what i'm going to do to start is i'm
going to take this buffer here which is
uh this is just the buffer that goes on
to this test so this is a brand new one
i just opened this
this test out i'm going to just take six
drops of this buffer
and put it right onto this test here
two three four five six
okay and now you're going to take that
swab open it up
yep and now just wipe it around inside
the into the front of your nose
do a few circles uh on each nostril
that looks good
this always makes me want to sneeze yeah
okay now i'm going to have you do it
yourself um
i'm getting emotional hold it parallel
to the test so put the test down on the
table yep and then go into that bottom
hole
yep and push forward so you can start to
see it in the other hole
there you go now turn if it's once it
hits up against the top
just turn it uh three times one two
three and sort of
yep and now you just close so pull off
that adhesive
sticker there and now you just close the
whole thing
and and that's it that's it
now what we will see uh
is we will see a line form
what's happening now is the the buffer
that you put in there
is uh now uh moving up onto the paper
strip test and it has the material from
the swab in there
and so what we'll see is a line will
form and that's going to be the control
line
and then we'll also see the the
ideally we'll see no line for the actual
test line
and that's because you should be
negative so one line will be positive
and
two lines will be negative it's very
cool there's this uh purple thing
creeping up
onto the control line that's perfect
that's what you want to be seeing
so you want to see that so right now you
essentially want to see
that that blue line turns pink or
purpley
color there's a blue line that's already
there printed
it should turn sort of a purple pink
color
and ideally there will be no additional
line
for the sample
and if there is that's the 99 point
whatever percent accuracy on that means
i
have i'm contagious that would mean that
you're likely contagious or you likely
have
uh infectious virus in you what we can
do because
one of the things that um that my plan
calls for
is because sometimes these tests can get
false positive results it's rare
maybe one percent or in the case of this
binex now this abbott test
point one percent so one in a thousand
one five hundred something like that can
be falsely positive
what i recommend is that when somebody
is a
positive on one of these you turn around
and you immediately test
on a different test you could either do
it on the same but for for as good
measure
you want to use a separate test that
is somewhat orthogonal meaning that it
shouldn't turn falsely positive
for the same reason this particular test
here
this detect test because it is looking
for the rna
and not the antigen this is an amazingly
accurate test and it's sort of a perfect
uh gold standard or confirmatory test
for any of these antigen tests so one of
the recommendations that i've had
especially if people start using
antigen tests before you get onto a
plane or you know as what i call
entrance screening if somebody's
positive
you don't immediately tell them you're
positive go isolate for 10 days
you tell them let's confirm on one of
these on a detect test
that is a because it's completely
orthogonal
it's looking for the rna instead of the
antigen
there's no reason no biological reason
that both of these should be falsely
positive
so if one's falsely positive and the
other one is negative
especially because this one's more
sensitive uh
then i would trust this as a
confirmatory test if this one's negative
then
the antigen test you know would be
considered falsely positive
it does look like there's only a single
line so this is very exciting news
that's right yep it says wait 15 minutes
to see
both lines but in general if somebody's
really going to be positive
that line starts showing up within a
minute or two um
so you want to keep the whole we'll keep
watching it for the whole 15 minutes as
it's sitting there but
uh i would say you're knowing that
you've had pcr tests recently
and all that you know the odds are
pretty good odds are very packaging very
iphone like i'm
i'm i'm digging this sexy packaging i'm
a sucker for good packaging okay
so then there's this there's this test
here which is you know
this is another you know it's funny this
let me open this up and show you this is
a really nice test it's another antigen
test works the exact same way as this
essentially but what you can see is it's
got like
lights in it and a power button and
stuff this is called an alum test
which is you know fine and it's a really
nice test to be honest but
it um but it has to pair with an iphone
and and so it's good as i think that
this is going to become
this is there's a lot of use for this
from a medical perspective you know
where you want good reporting this can
because it pairs with an iphone
uh it can immediately send uh
send the report to a department of
health whereas these paper strip tests
that
they're just paper they don't report
anything unless you want to report it
okay so i'm going to just pick it up and
pick it apart and so you can see
is there's like fluorescent readers and
little lasers and leds and stuff in
there
you can actually see the lights going
off wow and there's a paper strip test
right inside there but you can see that
there's like a whole circuit board and
and all this stuff right and so
this is the kind of thing that you know
the fda is looking for
um for like home use and and things like
that because it's kind of foolproof
like you you can't go wrong with it it
pairs with an iphone so you need
bluetooth so it's going to be more
limited it's a great test don't get me
wrong it's as good as any of these
but you know when you compare this thing
with a battery
and a circuit board and all this stuff
it's got its purpose but you know it's
not a public health tool
i don't want to see this made in the
tens of millions a day yeah and thrown
away
um ga likes that kind of stuff fba loves
this stuff you know because they can't
get
it out of their mind that this is a
public health crisis you know we need
we need i mean just look at the
difference here something like flashing
lights is essential got batteries it's
got a bluetooth thing
it's a great test but you know it's to
be honest it's not
any better than this one yeah and so
you know i i want this one um it's nice
and all
the form factor is nice but and it's
really nice that it goes to bluetooth
but it goes against the principle of
just uh 20 million a day
exactly the easy solution everybody has
it you can manufacture
and probably you could have probably
scaled this up in a couple of weeks
oh absolutely these companies i mean the
rest of the world has these
they can be scaled up they already exist
you know sd biosensors one company's
making tens of millions a day
not coming to the united states but
going all over europe going all over
um southeast asia and east asia so they
exist the us
is just you know we can't get out of our
own way i wonder
why somebody i don't know if you were
paying attention but somebody like an
elon musk
type character so he was really into
doing some like obvious
engineering solution like this uh at
home
rapid test seems like a very elon musk
thing to do i don't know if you saw but
i i had a little twitter conversation
with elon musk
does he not like what was he do you know
what his thoughts are on rapid testing
well he was using a slightly different
one one of these but that requires an
instrument called the bd veritar
and he got a false positive or no i
shouldn't say he didn't necessarily get
a false positive he got discrepant
results he did this
test four times he got two positives two
negatives
um but then he got a pcr test and it was
a very low positive
result so i think what happened is he
just tested himself
at the tail end of and this was actually
right before he was about to send those
it was the day of essentially that he
was sending the astronauts up to the
space station the other day
so he used uh he was using these rapid
tests because he wanted to make sure
that he was good to go in and
um he got discrepant results ultimately
they were correct
but you know two or negative two are
positive but what what really happened
once he got his he shared his pcr
results and they were very low
positive so really what was happening is
my guess is he found himself
right at the edge of his positivity of
his infectiousness and so
you know the test worked out was
supposed to work it
probably had he used it two days earlier
it would have been screaming positive
you know he wouldn't have gotten
discrepant results
but he found himself right at the edge
by the time he used the test
so the pcr would always pick it up
because it's still because it will still
stay positive then for weeks potentially
but the rapid antigen test was starting
to
to falter not in a bad way but just
he probably was really no longer
particularly infectious and so it was
kind of when it gets to be a very low
viral load it becomes stochastic
it's fascinating there's this duality so
one you can think from an individual's
individual perspective it's unclear when
you take four and a half
are positive half a negative like what
are you supposed to do
but from a societal perspective it seems
like if just one of them is positive
just stay home for for a couple days for
for a while so when you're a ceo of a
company you're launching astronauts to
space you may not want to
rely absolutely on the antigen test
as a as a thing by which you steer your
decisions
of like 10 000 plus people companies but
us individuals just living in the world
if you can
if it comes up positive then
you make decisions based on that and
then that scales really nicely to an
entire society of hundreds of millions
of people
and that's how you get that virus to
stop spreading
that's exactly right you don't have to
catch every single one and
and the nice thing is that these will
these will catch
the people who are most infectious so
with the elon musk
it generally that test we don't have the
counter factual we don't have
his results from three days earlier when
he was probably most infectious
uh but my guess is the fact that it was
catching two out of the four even when
he was down at a ct value a really
really very very low viral load on the
pcr test
suggests that it was doing its job
and you just wanna and the nice thing is
because these can be produced at such
scale
uh getting up getting one positive
doesn't immediately
have to mean 10 days of isolation
that's the cdc's more conservative
stance to say
if you're positive on any test stay home
for 10 days and isolate but
here people would just have more tests
so the recommendation should be
test daily if you turn positive test
daily
until you've been negative for 24 48
hours and then go back to work
and the nice thing there is you know
right now people just aren't testing
because they don't want to take 10 days
off
they're not getting paid for it so they
can't take 10 days off do you know what
uh
elon thinks about this idea of rapid
testing for everybody
so i i understood i need to look at that
whole twitter thread
so i understand his perhaps criticism of
uh he had like a conspiratorial tone for
my
vague look at it of like what's going on
here with these tests
uh but what does he actually think about
this very practical to me
engineering solution of just deploying
rapid tests to everybody
it seems like that's a way to open up
the economy in april
well to be honest i've been trying to
get in touch with him again
i think take somebody like elon musk
with the engineering prowess within his
ranks you know to
easily easily build these at the tens of
millions a day
he could build the machines from scratch
you know a lot of the companies they buy
the machines from
south korea or taiwan i believe uh
we don't have to like we can build these
machines they're simple to build
get put somebody like elon musk on it
you know take some of his best engineers
and say look
the us needs a solution in two weeks
build these machines you know figure it
out he'll do it he could do it this is a
guy who
who is literally he has started multiple
entirely new industries
he has the capital to do it without the
us government if he wanted to
and you know what it would the return on
investment
uh and for him would be huge but frankly
the return on investment in the
country would be hundreds of billions of
dollars
because it means we could get society
open so i know that he
his first experience with these rapid
tests was confusing
which is um how i ended up having this
twitter kind of conversation with him
very briefly
but i think that if if he understood
sort of a little bit more and i think he
does i really
really love to talk to him about it
because i think he could totally change
the course of this pandemic in the
united states
single-handedly you know he loves grand
things yeah
i think out of all the solutions i've
seen this is uh this is the obvious
like engineering solution to uh
at least a pandemic of this scale i i
love that you say the engineering
solution so this is something i've been
really trying to
i'm an engineer uh you know my previous
history was
all engineering and that's really how i
think um i then went into medicine and
phd world but
um but but i
i think that the world like one of the
major catastrophes or one of the major
problems is that we have physicians
making the decisions about public health
and a pandemic when really we need
engineers
this is an engineering problem and so
what i've been trying to do i actually
really want to you know start a whole
new new field called public health
engineering
you know and so i've been i'm loving it
eventually i want to try to bring it to
mit and get mit to want to start a new
department
or something um that's that's a doubly
awesome idea
that okay i love this i love every
aspect i love everything
you're talking about now a lot of people
believe because
vaccines started being deployed
currently
that you know we are no longer in need
of a solution
we're no longer in need of
slowing the spread of the virus to me as
i understand it seems like this is
the most important time to have
something
like a rapid testing solution can you
kind of break that apart
uh what's the role of rapid testing
current in the next
you know what is it three four months
maybe
is even more this the vaccine rollout
isn't going to be
as peachy as everyone is hoping you know
and i hate to be the deputy downer here
but
um there's a lot of unknowns with this
vaccine
you've already mentioned one which is
there's a lot of people who just don't
want to get the vaccine
uh you know i hope that that might
change as things move forward and people
see their neighbors getting it and their
family getting in there and it's safe
and all
we don't know how effective the vaccine
is going to be after two or three months
we've only measured it
in the first two or three months which
is a massive problem
which we can go into biologically
because there's reasons to
very good reasons to believe that the
efficacy could fall way down after two
or three months
we don't know if it's going to stop
transmission and if it doesn't stop
transmission
then we're not then there's you know
herd immunity is much much more
difficult to get
because that's all based on transmission
blockade
and uh and frankly we don't know how
easily we're going to be able to roll it
out some of the vaccines need
really significant cold chains have very
short half-lives outside of that cold
chain
uh we need to organize massive
uh uh numbers of people to be able to
distribute these most hospitals today
are saying that they're not
uh equipped to hire the right people to
be even administering
uh enough of these vaccines and then a
lot of the hospitals are frustrated
because they're getting much lower
smaller allocations than they were
expecting so i think right now like you
say
right now is the best time you know
besides three or four or five or six
months ago
right now is the best time to get these
rapid tests out and we need to
i mean the country has the capacity to
build them we have we're
shipping them overseas right now we just
need to flip a switch
get the fda to recognize that there's
more important things than diagnostic
medicine
which is the effectiveness of the public
health program
when we're dealing with a pandemic they
need to
authorize these as public health tools
or you know
frankly the president could
you know there's a lot of other ways to
get these tests to not have to go
through the normal fda authorization
program but maybe have the nih and the
cdc
give a stamp of approval and if we could
we could get these out tomorrow and
that's where that article came from you
know how we can stop
the the spread of this virus by
christmas we could you know now it's
getting
late and so uh we have to keep updating
that time frame maybe putting christmas
in the title wasn't i should have said
how we can stop the spread of this virus
in a month yeah it would be
a little bit more timeless but uh but we
could do it you know we really could do
it and that's the most frustrating part
here is that
uh we're just choosing not to as a
country we're choosing to bankrupt our
society
because some people at the fda and other
places just can't seem to get their head
around the fact that this is a public
health problem not a bunch of medical
problems
is there a way to change that policy
wise so this is
this is a much bigger thing that you're
speaking to which i
i love in terms of the uh mit
uh engineering approach to public health
is there a way to push this is this is
this a political thing like where some
andrew yang type characters need to like
uh start screaming about it
is it uh more of an elon musk thing
where people just need to build it
and then on on twitter start talking
crap to
the politicians who are not doing it
what it what what what do you
what are the ideas here uh i think it's
a little both
uh i i think it's political on the one
hand and i've certainly been talking to
congress a lot
talking to senators are they receptive
oh yeah i mean that's the crazy thing
everyone but the fda is receptive i mean
it's it's astounding i mean i advise
you know informally i advise the
president and the president-elect's
teams
i talked to congress i talked to
senators
governors you know and then all the way
down to
you know mayors of towns and and things
and um
i help i mean months ago i held a
roundtable discussion with mayor
garcetti
as the mayor of l.a and i brought all
the uh
all the companies who make these things
this was in like july or august or
something i brought all the companies to
the table and said okay how can we get
these out
and unfortunately it it went nowhere
because the fda
won't authorize them as public health
tools um
the nice thing is that this is one of
the nice and frustrating things this is
one of the few bipartisan things
that i know of and like you said it's
it's a real solution
yeah lockdowns aren't a solution they're
they're a
emergency band-aid to a catastrophe
that's currently happening they're not a
solution
and they're definitely not a public
health solution if we're taking a more
holistic view of public health which
includes
people's well-being it includes their
psychological well-being their financial
well-being
you know just stopping a virus if it
means that all those other things get
thrown under the bus
is not a public health solution it's a
it's a
it's a myopic or or very uh tunnel
visioned approach to a viral
virus that's spreading uh this is
a simple solution with essentially no
downfall
you know there is no nothing bad about
this it's just giving people
uh a result and it's bipartisan
you know the most conservative and the
most liberal people everyone just wants
to know their status you know nobody
wants to
have to wait in line for four hours to
find out their status on monday
uh a week later on saturday you know it
just doesn't make any sense it's a
useless test at that point
and everyone recognizes that so why why
do you think
like the mayor of la why do you think
politicians are going for these
um from my perspective
like kind of half-assed lockdowns which
is not
so i have seen good evidence that like a
complete lockdown can work
but that's in in theory it's like
communism in theory can work
like theoretically speaking but it just
doesn't at least in this country
we don't i think it's just impossible to
have complete lockdown
and still politicians are going for
these kind of
lockdowns that everybody hates
that's really destroy really hurting
small businesses
um like why are they going big
businesses and
yeah all businesses uh but like
basically
not just hurting yeah they're destroying
small businesses right
uh which is going to have potentially
i mean long-lasting yeah i've been
reading
as i don't shut up about the the rise
and fall of the third reich and
you know there there's economic effects
uh
that uh take a decade to you know
there's going to be long lasting effects
that may uh may be destructive to the
very fabric of this nation so
why are they doing it and why are they
not using the solution is there is there
any intuition i mean you've said that
fda has a stranglehold i guess on this
whole
public health problem is that is that
all it is
that's honestly it's pretty much all it
is
um the companies so the somebody like
mayor garcetti or governor baker
cuomo newsom any of the uh dewine i
i've talked to you know i've talked to a
lot of governors in this country at this
point
uh and and of course the federal
government including
including the president's own teams you
know and and uh
and the heads of the nih the heads of
the cdc about this
the problem is the tests don't exist
in this country at the level that we
need them to right now
to make that kind of policy to make that
kind of program
they could but they don't and so
what that means is that when mayor
garcetti says okay what are my actual
options today
despite these sounding like a great idea
he looks around and he says
well they're not authorized you know
they don't exist right now for
at-home use and from his perspective
he's not
about to pick that fight with the fda
and it turns out nobody is
why why are people afraid of it seems
like a easy structure
to fight it's like well it's not a so
they don't see it as a fight they think
that the fda is the end-all be-all
everyone thinks the fda is the end-all
be-all
and and so they just def everyone is
deferential
including the heads of all the other
government agencies because that is
their role
but what everyone is failing to see is
that the fda doesn't even have a mandate
or a remit
to evaluate these tests as public health
tools so they're just falling in this
weird gray zone
where the fda is saying look we evaluate
medical products
that's the only thing that i meant like
tim stenzel head of in vitro diagnostics
at the fda
he's doing what he's what his job is
which is to evaluate public
uh which is to evaluate medical tools
unfortunately um this is where i think
the cdc has really blundered
they haven't made the right distinction
to say look
okay the fda is evaluating these for
doctors to use and all that
uh but you know we're the cdc and we're
the public health agency of this country
and we recognize that
these tools uh require a different
authorization pathway and a different
use
this is a difference to medical devices
and public health
and i guess fda is not designed for this
public health especially in emergency
situations
and they they they actually explicitly
say that i mean when i go and talk to
tim
you know he's a very reasonable guy but
when i talk to him
he says look we don't we just do not
uh evaluate a public health tool if
you're telling me this is a public
health tool great go and use it
and uh and so i say okay
great we'll go and use it and then uh
the comment is but
you know does it give a result back to
somebody i say well
yes of course it gives a result back to
somebody it's being done in their home
so well then it's defined as a medical
tool can't use it
so it's stuck in this gray zone where we
unfortunately there's this weird
definition that any tool
any any test that gives a result back to
an individual
is defined by cms centers for medica
medicaid services as a medical device
requiring medical authorization but then
you go and ask it gets crazier because
then you go and ask
seema verma the head of cms
you know okay can these be authorized as
uh as public health tools and not fall
under your definition of a medical
device
so then the fda doesn't have to be the
ones authorizing it as a public health
tool
and sema verma says oh well we don't we
don't have any jurisdiction over
over uh point of care and uh and sort of
rapid devices like this we only have
jurisdiction over lab devices
so it's like nobody has ownership over
it which means that they just keep they
stay in this purgatory of
of not being approved and so this is
where i think
frankly it needs a president it needs a
presidential order to just unlock them
to say
this is more important than you know
having a prescription and
in fact i mean really what's happening
now because there is this
sense that tests are public health tools
even if they're not being defined as
such
the fda now is pretty much not only are
they not
authorizing these as public health tools
what they're doing by by authorizing
what are effectively public health tools
as medical devices
they're just diluting down the practice
of medicine right
i mean his answer right now
unfortunately is
well i don't know why you you want these
to be sort of available to everyone
without a prescription we've already
said that a doctor can write a whole
prescription for a for a whole
college campus it's like well if you're
going in that direction then that's no
longer medicine
having a doctor write a prescription for
a college campus for everyone on the
campus to have repeat testing
now now we're just in the territory of
of eroding medicine
and eroding all of the legal rules and
reasons that we have prescriptions in
the first place
so it's just everything about it is just
destructive
instead of just making a simple solute
solution which is
these are okay as public health tools as
long as they meet x and y metrics
go and cdc can put their stamp of
approval on them what do you think uh
sorry if i'm stuck on this yeah your
mention of mit
and uh public health engineering right
i mean it has a sense of i talked to
computational biology folks
it's always exciting to see computer
scientists start entering the space of
biology and there's actually a lot of
exciting things that happen because of
that
trying to understand the fundamentals of
biology
so from the engineering approach to
public health
what kind of problems do you think can
be tackled what kind of disciplines are
involved
like do you have ideas on this uh in
this space oh yeah
i mean i can speak to to one of the
major
activities that i want to do so what i
normally do in my research lab is
develop technologies that
uh can take a drop of somebody's blood
or some saliva
and profile for hundreds of thousands of
different antibodies against
every single pathogen that somebody
could be possibly exposed to
so this is all new technology that we've
been developing more from a
from a bioengineering perspective but
then i
use a lot of the mathematics uh
tools to a interpret that but what i
really want to do for example to kind of
kick off this new field of
what i consider public health
engineering is to create
maybe it's a little ambitious but create
a
a weather system for viruses i want us
to be able to open up
our iphones plug in our zip code and get
a better sense get a probability of why
my kid has
a runny nose today is it coved is it a
rhinovirus an adenovirus or is it flu
and you know we can do that we can start
building
the rules of virus spread across the
globe
both for pandemic preparedness but also
for
just everyday use in the same way that
people used to think that predicting the
weather was going to be impossible
of course we know that's not impossible
now is it always perfect no but does it
offer does it you know completely change
the way that we go about our days
absolutely you know i i envision for
example right now
we open up our iphone we plug in a zip
code
and if it tells us it's going to rain
today we bring an umbrella
so you know in the future it tells us
hey you know there's a lot of
stars cove too in your community instead
of grabbing your umbrella you grab your
mask
you know we don't have to have masks all
the time
but if we know the rules of the game
that these viruses play by
we can start preparing for those and you
know every year
we go into every flu season blindfolded
with our hands tied behind our back just
saying
i hope this isn't a bad flu season this
year why don't i mean this is
you know we're in the 21st century
you know it's becoming you know i mean
we have the tools at our disposal now to
not
have that attitude this isn't like 1920s
you know we can we we can just say hey
this is going to be a bad flu season
this year let's
act accordingly and with a targeted
approach
you know we don't uh for example we
don't just use our umbrellas
all day long every single day in case it
might rain
we don't board up our homes every single
day in cases of hurricane we
wait and if we know that there's one
coming then we act for a
a small period of time accordingly and
then
we go back and we've prepared ourselves
in like these little bursts
to not have it uh ruin our days i can't
tell you how exciting
that vision of the future is uh i think
that's
incredible and it seems like it should
be within our reach
the just these like weather maps of
viruses
floating about the earth and and it
seems obvious it's one of those things
where
right now it seems like maybe impossible
and then looking back like 20 years from
now will
wonder like why the hell this hasn't
been done away earlier
though one difference between weather
maybe i don't know if you have
interesting ideas in this space the
difference between weather
and viruses is it includes the
collection of the data includes the
human body
potentially and that means
that there is some as with the contact
tracing
question there's some concern about
privacy yeah
there seems to be this dance that's
really complicated um
you know with facebook getting a lot of
flack
for basically misusing people's data or
you know just whether it's perception or
reality there's certainly a lot of
reality to it too
where they're not good stewards of our
private data so there's this weird
place where it's like obvious that if
we do if we collect a lot of data about
human beings
and maintain privacy and maintain all
like basic respect for that data just
like honestly common sense respect for
the data
that we can do a lot of amazing things
for the world like
a weather map for viruses is there a way
forward to
gain trust of people um or to do this
to do this well do you have ideas here
how big is this problem
i think it's it's a central problem
there's a couple central problems that
need to be solved one
how do you get all the samples that's
not actually too difficult i'm actually
i have a
pilot project going right now with uh
getting samples from across all the
united states
uh tens of thousands of samples every
week are flowing into my lab
and we process them so it's taking the
so it's
taking like one of the basically uh the
this biology here
in chemistry and converting that into
numbers that's exactly right so what
we're doing for example there's a lot of
people who go to the hospital every day
a lot of people who donate blood uh
people who donate plasma so one of the
projects that i have
i'll get to the privacy question in a
moment but this so what i want to do is
the the name that i've given this is
global a global immunological
observatory you know there's no reason
not to have that
good name i've said you know instead of
saying well how do we possibly get
enough
people on board to send in samples all
the time
well just go to the source you know so
there's a company in massachusetts that
makes
80 percent of all the instruments that
are used globally
to to collect plasma from plasma donors
so i went to this company heminetics
and said you know is there a way you
have 80 percent of the global market
on plasma donations uh
can we start getting plasma samples from
healthy
people that use your machines so that
hooked me up with this company called
octopharma an octaform has a huge reach
and saddle and offices all over the
country where they're just collecting
people's plasma
they actually pay people for their
plasma and then that gets distributed to
hospitals and all this stuff is
anonymous plasma
so i've just been collecting anonymous
samples um
and we're processing them in this case
for covid
antibodies to watch from january up
through december we're able to
uh watch how the virus uh entered into
the united states and how it
how it's transmitting every day you know
across the u.s
uh so we're we're getting those results
uh
organized now and we're gonna start
start putting them publicly on
online soon to start making at least a
very rough map of covid
but that's the type of thinking that i
have in terms of like how do you
actually capture
huge numbers of specimens you can't
ask everyone to participate on sort of a
i mean you
may maybe could if you have the right
tools and you can offer individuals
something in return like 23andme does
you know that's a great way to get
people to give specimens and they get
results back so
with these technologies that i've been
building along with some collaborators
at harvard we can
come up with tools that people might
actually want so i can offer you
your immunological history i can say
give me a drop of your blood on a filter
paper mail it in
and i will be able to tell you every
infectious disease you've ever
encountered and maybe even when you
encountered it roughly
i could tell you do you have covet
antibodies right now do you have lyme
disease antibodies right now flu
tripoli and all these different viruses
also peanut allergies
you know milk allergies anything you
know if it if your immune system makes
a response to it we can detect that
response
so all of a sudden we have this very
valuable technology that on the one hand
gives people maybe information they
might want to know about themselves
but on the other hand becomes this
amazingly rich
source of big data you know to enter
into this global immunological
observatory sort of mathematical
framework to start building these maps
these epidemiological tools but you
asked about privacy
and absolutely that's essential to keep
in mind
uh first and foremost so privacy can be
uh you can keep these samples 100
anonymous
uh they are just when i get them they
show up with nothing they're literally
just
tubes i know a date that they were
collected and a zip code that they're
collected from or
or or even just sort of a county level
uh id uh with an irb and with ethical
approval and with the people's consent
we could maybe collect more data but
that would require
consent but then there's this other
approach which i'm really
excited about which is certainly going
to gain some scrutiny i think
but we'll have to figure out where where
it comes into play but i've been
recognizing that we can take somebody's
immunological profile
and we can make a biological fingerprint
out of it and it's actually stable
enough so that i could take your blood
let's say i don't know who you are
but um you sent me a drop of blood
a year ago and then you send me a drop
of blood today
i don't know that those two blood spots
are coming from the same person
they're just showing up in my lab uh but
i can
run the our technology over the and
it just gives me your immunological
history but your immunological history
is so unique to you and the way that
your body responds to these pathogens
is so unique to you that i can use that
to tether your two samples i don't know
who you are
i know nothing about you i only know
when those samples were
came out of a person but i can say oh
these two samples a year apart
actually belong to the same person yeah
so there's sufficient information that
immunological history to
to match the samples that's well for
from a privacy perspective that's really
exciting does that generally hold for
humans
so you're saying there's enough
uniqueness yep to match
yeah because it's very stochastic even
twins so this i believe you know we
haven't published this yet we will soon
you have a twin too right i do have a
twin i have an identical twin brother
which makes me interested in this
uh he looks very much like me that works
[Laughter]
and you know dna can't really tell us
apart
but this tool is one of the only tools
in the world that can tell twins apart
from each other could still be
accurate enough to say this blood you
know it's like 99.999 percent
uh uh accurate to to to say that these
two blood samples came from the same
individual
and it's because it's a combination both
of your immunological history
but also how your unique body uh
responds to a pathogen which is random
uh the way that we make antibodies is
is uh by and large it's got an element
of randomness to it
how the cells when they make an antibody
they chop up
the genetic code to say okay this is the
antibody that i'm going to form for this
pathogen and you might form if you get a
coronavirus for example
you might form hundreds of different
antibodies not just one antibody against
the spike protein but hundreds of
different antibodies
against all different parts of the virus
so that gives this really
rich resolution of information that when
i then do the same thing across hundreds
of different pathogens some of which
you've seen some of which you haven't
um it gives you an exceedingly unique
fingerprint that uh
that is sufficiently stable over years
and years and years to
essentially give you a barcode you know
and and i don't have to know who you are
but i can know that these two specimens
came from the same person somewhere out
in the world
that's so fascinating that there's this
trace your
life story in the space of viruses
in the space of uh pathogen like
like these or you know because there's
this entire universe of these
organisms that are trying to destroy
each other
and then your little trajectory through
that space leaves a trace
yep and then you can look at that trace
that's fascinating and that
i mean there's okay that data period is
just fascinating and
the vision of making that data
universally connected
to where you can make like infer things
and uh and just like with the weather is
really fascinating there's probably
artificial intelligence applications
there start making predictions start
finding
patterns exactly we're doing a lot of
that already and and that's how had we
had this going you know i've been trying
to get this funded for years now
and i've spoken to governments you know
everyone says cool idea
not going to do it you know why do we
need it
and of course now you know i mean i
wrote in 2015 about this
um why we would why this would be useful
and of course now we're seeing why it
would be useful
had we had this up and running uh in
had we had it going we were drawing
blood from you know or getting blood
samples from hospitals and clinics and
blood donors from new york city let's
just say
you know that could have we didn't run
the first pcr
test for coronavirus until
probably a month and a half or two
months after the virus started
transmitting in new york city
so it's like with the rain we didn't
start wearing umbrella or
taking out umbrellas exactly for two
months getting wet
but different than the rain we couldn't
actually see that it was spreading
right now and so andrew cuomo had no
choice but to leave the city open
you know there were hints that maybe the
virus was spreading in new york city
but you know he didn't have any data to
back it up no data
and so it was just week on week and week
and he didn't have any information to
really
go by to allow him to have the firepower
to say we're closing down the city
this is an emergency we have to stop
spread before it starts
uh and so they waited until the first
pcr tests
were coming about and then the moment
they started running a pcr test they
find out it's everywhere
you know and so that was a disaster
because of course new york city
you know it was just hit so bad because
nobody was
you know we were blind to it we didn't
have to be blind to it the nice thing
about this technology is
we wouldn't have with the exact same
technology we had in 2017
we could have detected this novel
coronavirus
spreading in new york city in 2020 not
because we changed not because we are
actually actively looking for this novel
coronavirus
but because we would see we would have
seen patterns in people's immune
responses using ai or just frankly using
our
just the raw data itself we could have
said hey it looks like there's
something that looks like known
coronavirus is spreading in new york but
there's gaps you know there's for some
reason people aren't developing an
immune response to this coronavirus that
seems to be spreading to these normal
things that
you know and it just looks the profile
looks different
and we could have seen that and
immediately especially since we had an
idea that
there was a novel coronavirus
circulating
in the world we could have very quickly
and easily seen hey
clearly we're seeing a spike of
something that looks like a known
coronavirus but people are responding
weirdly to it
our ai algorithms would have picked it
up and
just our basic heck you could put you
could have put it in an excel
spreadsheet we would have seen it
yeah so some basic visualization would
have shown
exactly we would have seen spikes and
they would have been kind of like
off you know immune responses that the
shape of them just looked a little bit
different
but they would have been growing and we
would have seen it and it could have
saved tens of thousands of lives in new
york city so
to me the fascinating question
everything we've talked about so both
the huge collection of data at scale
just super exciting and then the kind of
obvious at scale solution
to the current virus and future ones is
the
rapid testing can we talk about
the future of viruses that might be
threatening the uh our very existence
sure so do you think like a future
natural virus can um
have an order of magnitude greater
effect on human civilization than
anything we've ever seen
so something that either kills all
humans
or kills i don't know
60 70 percent of humans so some like
something
something um we can't even imagine is
that
is that something that you think is
possible because it seems to have not
have happened yet
so maybe like the entirety
whoever whoever the programmer is of the
simulation that
sort of launched the evolution for the
big bang
seems to not want to destroy us humans
or maybe that's the natural side effect
of the evolutionary process that uh
humans are useful but do you think it's
possible that the evolutionary process
will produce
a virus that will kill all humans i
think it could
i don't think it's likely and the reason
i don't think it's likely is um
well on the one hand it hasn't happened
yet
uh in part because mobility is
is uh is a recent phenomena
people weren't particularly mobile uh
until
uh fairly recently uh now of course now
that we have people flying back and
forth across the globe all the time
the chances of global pandemics has
escalated exponentially of course and so
on the one hand that's part of why it
hasn't happened yet we can look at
things like ebola
you know ebola we don't we haven't
generally had major
uh ebola epidemics in the past not
because ebola wasn't transmitting and
infecting humans
but because they were it was largely
affecting and infecting humans
in disconnected communities so you see
out in
uh in rural parts of africa for example
uh in western africa you might end up
having isolated ebola outbreaks
but there weren't connections that were
fast enough that would allow people to
then spread it
into the cities of course we saw back in
2014-15
a massive ebola outbreak that
wasn't because it was a new strain of
ebola but it was because there's
uh new inroads and connections between
the communities and people
got it to the city and so we saw it
start to spread
so that should be a little bit for you
know
foreshadowing of what's to come and now
we have this
pandemic we had 2009 we have this
uh there is a benefit um
or there is sort of a natural check and
this is a kind of latka voltaire
predator prey dynamic kind of systems
ecological systems and mathematics that
uh if you have something that's so
deadly
people will respond uh more
maybe with a greater panic a greater
sense of panic which alone could
you know destroy humanity but at the
same time like
we now know that we can lock down we
know that that's possible and so if this
was a worse virus that was actually
killing 60
of people as infecting we would lock
down very quickly
my biggest fear though is let's say that
was happening
you need serious lockdowns if you're
going to keep things going
so the only reason we were able to keep
things going during our lockdowns
is because it wasn't so bad that we were
still able to have people work
in the in the in the grocery stores
still people working the shipping to get
the food onto the shelves
so on the one hand we could probably
figure how to stop the virus
but can we stop the virus without
starving
you know and i'm not sure that that if
this was uh
another acute respiratory virus that say
had a slightly
say it transmitted the same way but say
it actually did worst damage to your
heart
but it was like a month later that
people start having heart attacks
uh in mass you know it's like not not
just one-offs but but really severe
well that could be a serious problem for
humanity
um so so in some ways i think that there
are lots of ways that we could end up
dying at the hand of a virus i mean
we're already seeing it just i mean my
fear is still
i think coronaviruses have demonstrated
a keen ability to destroy
uh or to to create outbreaks that can
potentially be deadly
to large numbers of people flu strains
though are still
by and large my concern so you think the
bad one might come from the the flu the
influenza
yeah they the the replication cycle
they're able to genetically recombine in
a way that coronal viruses
aren't they have segmented genomes which
means that they can just swap out whole
parts of their genomes no problem
repackage them and and then boom you
have a whole antigenic shift not a drift
what that means is that any on any
occasion any day of the
year you can have boom a new whole new
virus that didn't exist yesterday
and now with uh farming and and
industrial livestock
uh we're seeing animals and humans come
into contact much more
just the the uh the opportunities for an
influenza strain
that is unique and deadly to humans uh
increases
all the while tren transmission and
mobility has increased
it's just a matter of time in my opinion
what about from immunology perspective
of the idea of
engineering a virus so not just the
virus leaking from a lab or something
but actually being able to understand
the protein like the everything about
what makes a virus enough to be able to
figure out ways to uh
um maybe targeted or untargeted
attack by a first community
yeah yeah is there is that something
uh obviously that's somewhere on the
list
of concerns but is that anywhere close
uh
of the like the top 10 highlights along
with nuclear weapons and so on that we
should be worried about
or is the natural pandemic the really
the one that's
much greater concern i would say that
the former
that man-made viruses and
genetically engineered viruses
should be right up there with the
greatest concerns for humanity
right now uh you know we know that the
tools
for better or worse the tools for
creating a virus
are there you know yeah we can do it um
i mean heck you know the human the human
species is no longer vaccinated against
smallpox i didn't get a smallpox vaccine
you didn't get a smallpox vaccine at
least i don't think
and uh you know so if somebody wanted to
make smallpox
and and uh distribute it to the world in
some way
uh it could be exceedingly deadly
and uh and and detrimental to humans and
that's not even
um that's not even sort of using your
imagination
to create a new virus that's one that we
already have
unlike the past when smallpox would
circulate you had
large fractions of the community that
was already immune to it
and so it wouldn't spread or it would
spread a little bit slower but now we
have
essentially in a few years we'll have a
whole global population that is
susceptible
let's look at measles we have an entire
i mean measles
um i have uh you know there are some
researchers in the world right now which
for various reasons are working on
creating
a measles strain that evades immunity
it's not for bioterrorism at least
that's not the expectation it's for
using measles as an oncolytic virus to
kill cancer
and the only way you can really do that
is if your immune system doesn't
you know if you if you take a measles
virus and there's you know we don't have
to go into the details of why it would
work but it could work
measles likes to target um potentially
cancer cells
but to get your immune system not to
kill off the virus if you're trying to
use the virus to target it you maybe
want to make it
blind to the immune system but now
imagine we took
some virus like measles which has an r
out of 18 transmits extremely quickly
and now we have essentially let's say we
had a whole human race that is
susceptible to measles and this is a
virus that spreads
orders of magnitude easier than this
current virus
uh imagine if you were to plug something
toxic or detrimental into that virus and
release it to the world
so it's possible to be both accidental
and
intentional absolutely yeah an accident
so mark lipstick is a good colleague of
mine
at harvard uh we're both in the
he's the director of the center for
communicable disease dynamics where i'm
a faculty member
um he's spoken very very forcefully and
and uh and he's very outspoken about the
dangers of gain of function testing
where in the lab we are intentionally
creating viruses that are
exceedingly deadly uh under the auspices
of trying to learn about them so that
if the idea is that if we kind of
accelerate evolution and make these
really deadly viruses
in the lab we can be prepared for if
that virus ever
comes about naturally or through
unnatural means
the concern though is okay that that's
one thing but what if
that virus got out on somebody's shoe
just what if
you know if the if the uh dead if the
effects of an
accident are potential potentially
catastrophic
is it worth taking the chances just to
be prepared
a little bit for something that may or
may not ever actually develop and so
uh it's a serious ethical quandary we're
in how to
both be prepared but also not uh
cause a catastrophic mistake
as a small tangent there's a recent
really exciting breakthrough
of alpha 2 of alpha fold 2
solving protein folding or achieving
state-of-the-art performance on protein
folding
and then i thought
proteins have a lot to do with viruses
it seems like
being able to use machine learning to
design
proteins that achieve certain kinds of
functions
will naturally allow you to use maybe
down the line not yet
but allow you to use machine learning to
design
basically viruses maybe like measles
like for good
which is like to attack cancer cells but
also for bad
is that is that uh is that a
is that a crazy thought
or is this a natural place where this
technology may go
i suppose as all technologies can which
is for good and for
bad do you think about the role of
machine learning in this
oh yeah absolutely i mean alpha fold
uh is amazing you know it's an amazing
algorithm
a series of algorithms and it does
demonstrate
to me it demonstrates just just how
powerful
you know everything in the world has
rules we just don't know the rules you
know we often don't know them but
you know our brain has rules how it
works everything is plus and minus
there's nothing in the world that's
really not
at its most basic level positive
negative
you know it's all obviously it's all
just charge
and and that means everything you can
figure it out
with enough computational power and
enough in this case i mean
machine learning and ai is just one way
to learn
rules uh it's an empirical way to learn
rules and it's
but it's a profoundly powerful way
and certainly now now that we are
getting to a point where we can
take a protein and know how it folds
uh given its sequence we can
reverse engineer then we can say okay
we want a protein to fold this way what
does the sequence need to be
we haven't done that yet so much but
it's just the next
iteration of all of this so let's say
somebody wants to develop a virus
it's going to start with somebody
wanting to develop a virus to to defeat
cancer
something good you know and so it would
start with a lot of money
from the federal government you know for
all the positives that will come out of
it
but we have to be really careful because
that will come about there's no doubt in
my mind that we will develop
we're already doing it we engineer
molecules all the time for
specific uses oftentimes we take them
from nature and then tweak them
but now we can supercharge it we can
accelerate that the pace of
discovery to not have it just be
discovery we have it be true
ground-up engineering let's say you're
trying to
make a new molecule to stabilize
somebody with
some retinal disease right so we
come up with some molecule that can
improve
the stability of somebody with retinal
degeneration
uh you know just a small tweak to that
to say make a virus that causes the
human race to become blind
you know i mean it sounds really
conspiracy theoryish but
uh but it's not you know it's we're
learning so much about biology and
there's always nefarious reasons i mean
heck look at
how ai and you know just google searches
those can be um you know they are every
single day
being leveraged by nefarious actors to
take advantage of people
to steal money to do whatever it might
be
eventually probably to create wars or
already to create wars and i mean i
don't think there's any question at this
point
behind disinformation campaigns and so
it's being leveraged this thing that
could
be wholly good you know it's always
going to be leveraged for bad and so how
do you balance that as a
species i'm not quite sure well the hope
is as you mentioned previously that
there's some
that we're able to also develop defense
mechanisms and there's something about
the human species that seems to keep
coming up with
like ways to just just like on the
deadline
just at the last moment of figuring out
how to avoid
destruction i think i'm
like eternally optimistic about the
human race not destroying ourselves
but you could do a lot of things that
would be very painful
yes well we're doing it already you know
just i mean we are seeing
how our regulation today right we did
this thing
it started as a good thing regulation of
medical products but now
it is uh you know unwillingly
and unintentionally harming us our
regulatory landscape
which was developed wholly for good in
our country
is getting in the way of us deploying a
tool
that could stop uh our economies from
having to be
sort of sputteringly closed that could
stop
deaths from happening at the rate that
they are and
it's um you know i think we will come to
a solution of course now we're going to
get the vaccine and it's going to make
people
lose track of like why we even bother
testing which is a bad idea but
um but we're already seeing that we have
this amazing capacity to
um to both do damage when we don't
intend to do damage
uh and and then also to pull up when we
need to pull up and you know
stop complete catastrophe and so uh it's
we are an interesting species in that
way that's for sure
so there's a lot of young folks
undergrads
grads uh they're also young uh listen to
this so
is there you've talked about a lot of
fascinating stuff that's like
there's ways that things are done
and there's actual solutions and they're
not always like intersecting
do you have advice for undergraduate
students or graduate students
or even people in high school now about
a life about career of how they might be
able to solve
real big problems in the world how they
should live their life
in order to have a chance to solve big
problems in the world
it's hard i i struggle a little bit
sometimes to give advice
because the advice that i give from my
own personal experience is necessarily
distinct from
the advice that would make other people
successful i have
um unending ambitions to make things
better
i suppose and i don't see i don't see
barricades where other people
sometimes see barricades um now even
just little things like uh when this
virus started
i'm a medical director at brigham a
women's hospital and so i oversee or
helped to oversee molecular virology
diagnostics
so when this virus started wearing my
epidemiology hat and wearing my sort of
viral
outbreak hat i recognized that this was
going to be a big virus that was
important
at a global level even if the cdc and
who weren't ready to admit that it was a
pandemic it was obvious in
january that it was a pandemic so i
started trying to get a test built
at the brigham which is one of harvard's
teaching hospitals
i you know the the first uh
encounters i had with the upper
administration of the hospital were
pretty much
no why would we do that that's silly who
are you
you know and i said well okay don't
believe me sure
um but i kept pushing on it uh and then
uh
eventually i got them to agree it was
really um
only a couple of weeks before the biogen
conference happened
we started building the test i think
they started looking abroad and saying
okay this is happening sure
like maybe he was right but
then i went a step further and i said um
we're not going to have enough tests
at the hospital and so uh so my ambition
was to get a better testing program
started
and um and so i figured what better
place to scale up testing than the broad
institute
broad institutes is amazing you know
very high throughput high efficiency
research institute that does a lot of
genomic sequencing things like that
so i went to the broad and i said hey
you know there's this coronavirus
that's obviously going to impact our
society greatly
can we start modifying your high
efficiency instruments and robots for
coronavirus testing everyone in my
in my uh orbit in the hospital world
just said that's ridiculous you know how
could you possibly
plan to do that it's impossible you know
and and
to me it was like the most dead simple
thing to do
right it didn't it but the the higher
ups and the people who think about you
know the
i think one of the most important things
is to recognize that most people in the
world
don't see solutions they just see
problems and it's because it's an easy
thing to do
thinking of problems and how things will
go wrong
is really easy because you're not coming
up with a brand new solution
and this to me was just a super simple
solution hey let's get the broad to help
build tests every single hospital
director you know told me no like it's
impossible my own superiors the ones i
report to in the hospital
said you know mike you know you're a new
faculty member
your ideas you know probably will would
be right but you're too naive and young
to
to know that it's impossible right you
know obviously now the broad
is the highest uh throughput laboratory
in the country and
yes you know and so i think my
recommendation to people
is as much as possible get out of the
mode of thinking about things as
problems
sometimes you piss people off i could
probably use a better filter sometimes
to try to like be
not so upfront with certain things but
but it's just so crucial to always
just see to just bring like think think
about things in new ways that that other
people haven't
because usually there's something else
out there and and one of the things that
has been most beneficial to me which
is that my my education was really broad
it was engineering and physics
and uh well and then i became a buddhist
monk for a while and so that gave me a
different perspective
but then it was medicine and immunology
and
and now i've brought all of it together
from a mathematics and biology and
medicine perspective and policy and
public health and i think that you know
i'm not the best in any one of these
things
i i recognize that there are going to be
geniuses out there who are just
worlds better than me at any one of
these things that i
try to work on but my superpower is
bringing them all together
you know and just thinking and that's i
think how you can really change
the world um you know i don't know that
i'll ever change the world
in the way that i hope um but that's how
you can have a chance
yeah that's how you can have a chance
exactly and um
and i think it's also what uh you know
this to me this rapid testing program
like
this is the most dead simple solution in
the world and this literally could
change the world
it could change the world it could
change and it is you know there's
countries that are doing it now the us
isn't but i've been advising many
countries on it and
and i would say that you know some of
the early papers that we put out
earlier on a lot of the things actually
are changing you don't always
unless you really look hard you don't
know where you're actually having an
effect
um sometimes it's more overt than than
other times
in april i published a paper that was
saying hey with the pcr values from
these
tests we need to really focus on the ct
values the actual quantitative values of
these lab-based pcr tests
at the time that all the physicians and
laboratory directors told me that was
stupid you know why would you do that
they're not accurate enough and and of
course now it's
headline news that you know florida they
just mandated
reporting out the ct values of these
tests because there's a real utility of
them
you can understand public health from it
you can understand better clinical
management
uh you know that was a simple solution
to a pretty
difficult problem uh and it is changing
the way that we approach
all of the lab testing in this country
is starting to it's taken a few months
but it's starting to change because
of that and you know that was just me
saying hey this is something we should
be focusing on
got some other people involved and other
people and and now people recognize hey
there's actual value
in this number that comes out of these
lab-based pcr tests so sometimes it does
grow
fairly quickly um but
i think the real answer if my only my
only answer i don't know
what you know i recognize that everyone
some people are going to be really
focused on
and have one small but deep skill set
i go the opposite direction i try to
bring bring things together and
um but the biggest thing i think is just
don't see problem don't
don't see barriers like just see like
there's always a solution to a barrier
if there's a barrier that literally
means a solution to it
that's why it's called a barrier and
just like you said most people will just
present to you only be thinking about it
and present to you with barriers
and so it's easy to start thinking
that's all there is in this world yeah
and just think big i mean god you know
there's nothing wrong with thinking big
elon musk thought big and you know and
then
thinking big builds on itself you know
you you get a billion dollars
from one big idea and then that allows
you to make three new big ideas and
there's a hunger for it if you think big
and you communicate that vision with the
world all the most brilliant
and like passionate people will just
like you'll attract them
and they'll come to you and then it
makes your life actually really exciting
the people i've met at like tesla and uh
neurolink
i mean there's just like this fire in
their eyes they just love life and uh
it's amazing i think to to be around
those people
i have to ask you about what was the
philosophy
the journey that took you to becoming a
buddhist monk
and what uh what were
what did you learn about life what did
you take away from that experience how
did you return back
to harvard and the world that's
unlike that experience i imagine yeah
well i was at dartmouth at the time
um uh well i went to sri lanka i was
already pretty interested in developing
countries and sort of under-resourced
areas
and uh i was doing a lot of engineering
work and i went there but i was also
starting to think maybe health was
something of interest
and so i went to sri lanka
because i had a long interest in
buddhism as well just kind of
interested in it as a thing which aspect
of the philosophy attracted you
i would say that the thing that
interested me most was
um was really this idea of kind of a
butterfly effect of like
uh you know what you do now
has ripple effects that extend out
beyond
what you can possibly imagine both in
your own life
and in other people's lives and in some
ways buddhism has none in some ways in a
pretty deep way buddhism has that as
part of its
underlying uh philosophy in terms of
rebirth and sort of
that your actions today propagate
uh to others but also propagate to to
sort of
uh what might happen in in your circle
of what's called samsara and rebirth and
um i don't i don't know that i subscribe
fully to this idea that uh
we are reborn uh which always was a
little bit of a
of a debate internally i suppose when i
was a monk um
but it but it has always been it was
that and then it was also meditation
um at the time i was a fairly elite
rower i was
you know rowing at the national level
and um
and rowing to me was very meditative it
was
um you know just there's
even if you're on a boat with other
people it's i mean on the one hand it's
like the extreme of like a team sport
but it's also
the extreme sort of focus and
concentration that requires
um that's required of it and so i was
always really into just meditative
type of things i was doing a lot of
pottery too which was also very
meditative and
and so buddhism just kind of really
really there are a lot of things about
meditating
that just appealed and so i moved to sri
lanka
planning to only be there for a couple
of months
but then i was shadowing in this medical
clinic and there was this physician who
was just really
i mean it's just kind of a horrible
situation um frankly this guy was
trained
decades earlier he was an older
physician and he was still just
practicing like these fairly barbaric
approaches to medicine because he had he
was a rural town
and he just didn't have a lot of um
he didn't have any updated training
frankly and so you know i just remember
this like girl
came in with like shrapnel in her hand
and his solution was to like
air it out and so he was like without
even
numbing her hand he was uh uh like
cutting it open more
with this idea that like the more oxygen
and and stuff you know
and it just i think there was something
about all of this and i was already
talking to these monks at the time each
i would be in this clinic in the morning
and i'd go
and uh my idea was to teach english to
these monks in the evening
uh turned out i'm a really bad english
teacher
so they just taught they they allowed me
just to sit with them and and meditate
and they were teaching me more about
buddhism than i could have possibly
taught them about english or
being an american or something um and uh
and and so i just slowly i just couldn't
take i
like couldn't handle being in that
clinic so more and more i just started
moving to
you know spending more and more time at
this monastery and then after about two
months i was supposed to come back to
the states and i decided i didn't want
to
so i moved to this monastery in the
mountains um
primarily because i didn't have the
money to like just keep living
so living in a monastery is free yeah
and so i
moved there and just started meditating
more and more and then months went by
and
and i it just really gravitated
i i gravitated to the whole to the whole
notion of it i mean it became
it sounds strange but you know
meditating almost just like anything
that you've put your mind to
became exciting you know it became like
there weren't enough
hours in the day to meditate and i would
do it for you know 18 hours a day
15 hours a day uh just sit there
and you and like i mean i hate sleeping
anyway
um but i wouldn't want to go to sleep
because i felt like i didn't accomplish
what i needed to accomplish in
meditation that day
which is so strange because there is no
end you know but it was always but there
are these
uh there are these steps that happen
during meditation that are very
prescribed in a way
buddha talked about them you know and
these are ancient writings which exist i
mean the writings are real they're
thousands of years old now and
um you know so whether it was buddha
writing them or
whoever you know there are lots of
different people have contributed to the
to these writings over the years and um
but they're very prescribed and they um
they tell you what you're going to go
through
and i didn't really focus too much on
them uh
i read a little bit about them but your
mind really does when you actually start
meditating
at that level like not an hour here and
there but like truly just spending your
days meditating
it becomes kind of like this other world
where it becomes exciting
and uh and you're actively working
you're actively
meditating not just kind of trying to
quiet things that's sort of just the
first stage
of trying to get your mind to focus most
people never get past that first stage
especially in our culture
could you briefly summarize what's
waiting beyond the stage of just
quieting the mind
is yeah it's hard for me to imagine that
there's
something that can be described as
exciting
on there yeah it's it's an interesting
question so i would say
um so the first thing the first step is
truly just to like be able to close your
eyes
focus on your breath and not have other
thoughts enter into your mind
that alone is just so hard to do like
i couldn't do it now if i wanted um
but i could then and um but once you get
past that stage
you start entering into like all these
other
you go through kind of i went through
this like pretty trippy stage
which is a little bit euphoric um where
you just kind of start
not hallucinating i mean it wasn't like
some crazy thing that would happen in a
movie where
but definitely just weird you start
getting to the stage where
um uh you you're able to quiet your mind
for so
long for hours at a time that um like
for me i started
uh getting really excited about this
idea of mindfulness
which is part of um it's part of
buddhism in general but it's part of
tehran and buddhism in particular for
this
in this way which was um uh you take
uh you start focusing on your daily
activities whether that's
sipping a cup of tea or walking
or you know sweeping around
uh i lived in on this mountainside and
this cottage thing is built into the
rock and
um you know so every morning i would
wake up early and sweep around it and
stuff because that's
just what we did um and you start to
you meditate on all those activities and
one of the things that was so exciting
which sounds completely ridiculous now
was just
um almost learning about your daily
activities in ways that you
never would have thought about before so
what is entire what
what's what's involved with like picking
up this glass of water
you know if i said okay i'm just going
to pick i'm going to take a drink of
water
to me right now it's a single activity
right you just
but um during a during meditation it's
not
a single activity it's a whole series of
activities of like little engineering
feats
um and feelings and it's it's gripping
the water
and it's feeling that the glass is cold
and it's lifting and it's moving and
dragging and dragging and and
you start to learn a whole new language
of life
and that to me was like this really
exhilarating thing
that um it was an exhilarating component
of meditation that
there was never enough time it's kind of
like learning a new computer language
like it gets really exciting when you
start coding and
all these new things you can do you you
learn how to
much to experience life in a much richer
way and so you never run out of ways to
go deeper and deeper and deeper in the
way you experience even just the
the drinking of the glass of water
that's that's exactly right and what
becomes kind of exhilarating is
um you start to be able to predict
things that you never
or i don't even know if prediction's
right word but i always think of the
matrix you know or
where um i forget who it was somebody
was shooting at
neo and he like leans backwards and he
dodges the bullets
um you know in some ways when you start
breaking every little action that your
hands do or that your feet do or
your body does down into all these
little actions that make up one what we
normally think of as an action
all of a sudden you can start to see
things almost in slow motion
i like to think of it very much like a
language
the first time somebody hears a foreign
language
uh it sounds really fast usually you
don't hear the spaces between words
and um and it just sounds like
just like a stream of consciousness it
just sounds like a stream of noises if
you've never heard the language before
and as you learn the language
you hear clear breaks between words and
it starts to gain context and
and all of a sudden like that what once
sounded very fast
slows down and it has meaning
that's our whole life there's this whole
language happening that we don't speak
generally but if you start to speak it
and if you start to learn it and you
start to say hey i'm picking up this
glass is actually 18 little movements
then all of a sudden like
it becomes extremely exciting and
exhilarating to just just breathe you
know breathing alone in the rise and
fall of your abdomen or the
way the air pushes in and out of your
nose becomes
almost interesting and what's really
neat is
is the world just starts slowing down
and
um i'll never forget that feeling and
it's the if there was one
euphoric feeling from meditation i want
to gain back
but i don't think i could without really
meditating like that again
and i don't think i will um was this
like slow motion of the world
it was finding the spaces between all
the movements the same way that the
spaces between all the words happen
and then it almost gives you this new
appreciation for everything
you know it's like it was really amazing
and so i think
um uh it came to an abrupt end though
when the tsunami hit
i was there in the indian ocean tsunami
hit in 2004
and it was like this dichotomy of being
a monk and
and you know just meditating in this
extraordinary
place um and then the tsunami hits and
kills 40 000 people in a few minutes on
the coast of this really small little
country in sri lanka
and um you know then i i
it like my whole world of being a monk
came crashing down
uh when i go to the coast
and i i mean that was just a devastating
visual sight an emotional sight but
the strangest thing happened which was
that everyone just wanted me to stay as
a monk
you know people in that culture they
wanted to
the monks largely fled from the
coastlines of those
you know and um and so then there i was
and people wanted me to be a monk they
wanted me to stay on the coast but be a
monk
and not help like not help in the in the
way that i
considered helping uh they wanted me
just to keep meditating so they could
bring me donna like
like offerings and get and have their
sort of karmic responsibilities
um uh attended to as well and so
uh that was really bizarre to me it was
like
how could i possibly just sit around
while all these
people half of everyone's family just
died
and so in any case i stopped being a
monk and i moved to this refugee camp
and lived there for another six months
or so and
just stayed there
not as a monk but tried to raise some
money from the us and tried to like
i didn't know what i was doing frankly i
was 22
and uh and i don't think i
appreciated at the time how much of a
role i was having in the
in that community's life
but but it's taken me a long many years
to process all of this
since then but uh i would say it's what
put me into the public health world see
living in that refugee camp and that
difference that happened you know from
being a monk to
being in this devastating environment
just really changed my whole view of
what sort of
why i was existing i suppose well
so there's this richness of life in a in
a single drink of water that you
experience
and then there's this power of nature
that's
it capable to take lives of thousands of
people
so given all that the absurdity of that
let me ask you
and the fact that you study things that
could kill
the entirety of human civilization what
do you think is the meaning of this all
what do you think is the meaning of life
this whole orchestra we got going on
does it have a meaning and maybe from
another perspective
as how does one live a meaningful life
if such is possible
well you know from what i've seen uh
i don't think there's a single answer to
that by any stretch one of the most
interesting things about buddhism to me
is that
the human existence is part of suffering
which is very different from
judeo-christian existence which is that
human existence is
something to be is a very different
you know it's something to it's a
there's a richness to it
in buddhism it's just another one of
your lives
and it but it's your opportunity to
attain nirvana and uh become a monk for
example and meditate to attain nirvana
uh else you kind of just go back into
this i'm sorry the cycle of
of suffering and so you know
when i look at i mean in some ways the
notion of
life and what the purpose of life is
you know they're kind of completely
distinct this sort of western view of
life which is that this
life is the most precious thing in the
world versus
this is just another opportunity to try
to
get out of life i mean the whole notion
of nirvana and in buddhism it getting
out of this sort of cycle of suffering
is to vanish you know what if you could
if you could attain nirvana
you know throughout this life the idea
is that you don't get reborn
and so when i look at these two you know
on the one hand you have
christian you know christian faith and
other things that want to go to heaven
and like live forever in heaven
then you have this other whole half of
humans who
uh want nothing more than to get out of
the cycle of rebirth and just
poof you know not exist anymore the
cycle of suffering
yeah and so how do you reconcile those
two and i guess
do you have both of them in you do you
basically oscillate back and forth
i don't think i i think i just i look at
us in a
i think we're just a bunch of proteins
um
that you know we form and we they work
in this really
amazing way and they might work in a
bigger scale like there might be some
connections that we're not really clear
about but they're still biological i
believe that they're biological
how do these proteins become conscious
and why do they want to
help civilization by having at home
rapid tests at scale well i think um
i i don't have an answer to that one but
i i really do believe
i would it's just you know this is just
an evolution
of uh consciousness i don't
i don't personally think is my feeling
is that we're a bunch of pluses and
minuses that have just gotten so complex
that
they're able to make rich feelings rich
emotions and and i do believe though
you know on the one hand i sometimes
wake up some days
um my fiancee doesn't always love it but
you know i kind of think we're all just
a bunch of robots with like pretty
complicated
algorithms that we deal with yeah um
and you know in that sense like okay if
the world just blew up tomorrow
and no nothing was liv you know nothing
existed the day after that
it's just another blip in the universe
you know but at the same time
i don't know so that's kind of probably
my most core basic feeling about
life is like we're just a blip and we
may as well make the most of it while
we're here blipping
[Laughter]
but it's one hell of a fun blip though
it is it's it's an it's an amazing uh
uh you know blink of a of a of an eye in
time
michael this is you're one of the most
interesting people i've met one of the
most interesting conversations important
ones now
i'm going to publish it very soon i
really appreciate
taking the time i know how busy you are
it was really fun
thanks for talking today well thanks so
much this was a lot of fun
thanks for listening to this
conversation with michael minna and
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at lex friedman and now let me leave you
with some words from teddy roosevelt
it is not the critic who counts not the
man who points out how the strong man
stumbles
or where the doer of deeds could have
done them better
the credit belongs to the man who
actually is in the arena
whose face is marred by dust and sweat
and blood
who strives valiantly who errors
who come short again and again because
there is no effort without error and
shortcoming
but who does actually strive to do the
deeds
who knows great enthusiasms the great
devotions
who spends himself in a worthy cause who
at the best
knows in the end the triumph of high
achievement
and who at the worst if he fails at
least
fails while daring greatly so that his
place
shall never be with those cold and timid
souls
who neither know victory nor defeat
thank you for listening and hope to see
you next time