Michael Mina: Rapid COVID Testing | Lex Fridman Podcast #235

the following is a conversation with. michael minna his second time on the. podcast he's a professor at harvard. doing research on infectious disease and. immunology. in my view the most powerful doable and. obvious solution to covet 19 from the. very beginning is rapid at-home testing. this is what michael has been talking. about and writing about since the. beginning of the pandemic. the accuracy of these tests is high for. the task of detecting contagiousness.

which is what matters. hundreds of millions can be manufactured. quickly and relatively cheaply privacy. and individual freedoms are preserved i. believe that if you give people the. power of information. information about whether they are. contagious or not they will do the right. thing. at scale all while respecting their. freedom and minimizing the destructive. effects of the pandemic on our health. and our economy. the solution was obvious in may of 2020.

it was obvious when michael and i spoke. the first time a year ago and it is. obvious today we talk about why it has. not yet been done and how we can still. do it this is the lex friedman podcast. to support it please check out our. sponsors in the description. and now here's my conversation with. michael minna. we spoke a year ago about rapid at-home. testing and i think you think. it should have been still should be a.

big part of the solution to covid. so let's recap where do things stand. today in terms of rapid at home testing. well. it's a it's certainly something that uh. you're right i do think we should have. them today. we've now had almost. 20 months of. living in anxiety uncertainty. uh being afraid for our health for our. family's health for our friends you know. shutdowns.

economic instability everything has been. uncertain because this virus. and then there's this little test and. it's the first time for many people that. they are they're using it and they're. feeling. empowered they're feeling like they can. control their little slice. of this pandemic so. as these tests have come out and more. and more more americans have had an. opportunity to go and buy them from you. know cvs or walgreens or wherever. they're at. i think that it's really shifting the.

tenor of the discussion. for a long time all of 2020 it was like. i often felt like it was me and a few. other people against the world you know. these tests should be public health. tools these tests are infectiousness. indicators they shouldn't be compared to. pcr. you know all of the these different. things and we could of course go through. and recap what those what the benefits. and the. metrics are that we should be looking at. but the point is. last year and most of this year.

was about educating scientists educating. public health leaders educating. physicians. to get them to understand. that there is a different reason to test. in a pandemic than purely diagnostics. and transmission blockade and severing. transmission chains the big one so now. i think we're at a point where people. are now understanding and they're. understanding because they are feeling. it they're holding it and they're doing. it they're seeing they're feeling the. delight of seeing a negative. and saying i feel more comfortable it's.

not perfect but it's pretty darn close. to perfect. to allowing me to go and see my mom. without mistakenly infecting her. you know or whatever the story might be. and now that that's happening i think. all of a sudden we're seeing a massive. change. politically for these tests. uh biden just came out the kova 19. action plan the other day and one of the. main pillars of it was testing and in. particular bringing rapid tests uh. scaling them up.

so. on that front i think. finally there is success people are. actually understanding and. you know i haven't stopped beating this. drum. for far too long and i like hate rapid. tests now. so maybe it's good to step back uh. would you say most americans have not. taken a rapid home test absolutely most. have definitely not taken a rapid test. so like. many of them probably don't know they. kind of. probably say testing. they have like memories of testing like.

pcr testing they have to go into. somewhere and they have to. like a. swab deep in their nose and that's the. experience so maybe when if you have to. travel like canada or something like. that you have to get tested that kind of. stuff so what are rapid at home tests. yeah so so the rapid at-home tests are. i like to call them paper strip tests. simple they're simple tests that i wish. i brought some today but i didn't um. they're simple tests that.

uh. you. swab at the moment most of them use a. swab that you just swab the front of. your nose so it's not one of the deep. the deep swabs that you know goes into. your brain. and uh and so it's not very. uncomfortable it's just like picking. your nose if you'll you know and and you. you put that swab and. you put that swab into. a little tube. and the tube has some liquid in it and. then you. pour put a few drops of that liquid onto.

a paper strip or you drop the paper. strip into the tube just like. one of those. indicators for the pool and if you dress. like a pregnancy test then if you get. two lines you're positive one line. you're negative. it's super simple it takes 30 seconds. once you know how to do it of hands-on. time and you wait around 10 minutes and. then you read the result. they are extraordinarily effective to. answer. one question am i infectious.

and that is the public health question. that we need to answer and consistently. ask. during this pandemic are you infectious. am i infectious because it's only when. we know that we're infectious that we. can be empowered to not mistakenly. infect others. the pcr test is a little different. and we can go into. the pros and cons but. uh you know one of the the major. differences is that a pcr test.

gets a lot of. a lot of people talking about the pcr. test say it's much more sensitive. and. at an analytical level it is it can. detect one molecule instead of a hundred. thousand. but for public health we don't want a. test that can detect one molecule in. fact that has created a net negative for. public health. we just want to know am i infectious and. to know that question to know if i'm.

infectious i only need a test. that is going to be positive. if i have a high viral load like a. million. and when you're and the virus grows so. fast it will grow from zero to a billion. in a day. so you don't really need even on the. front end of an infection you don't need. better sensitivity. if the trade-off is that you don't get. the result for one two or three days you. absolutely want a rapid result. that can tell you yes you're infectious. you're transmitting to others right now.

and i'm going to give you the results. right now so it is a much more effective. tool because it's fast because it's. accessible we can use them in the home. and there's some issues with using them. a home we can talk a little bit about. what those issues are like reporting and. how do you is everything on the honor. system if you have a test that you're. taking at home and you use it to go to. work. but they can be they can be accessible. pcr has to go into a lab it takes a lot. of time for somebody to get a pcr test.

they either have to go online and order. it it takes the next day for it to come. back. they swab themselves they ship it out. the next day and then they get a result. two days later. that's four days minimum for the most. part and you know at that point you're. not even infectious even if you did. happen to be infectious when you first. ordered the test right. so it's really of the speed of these. tests and the accessibility and. distribution of them that makes them so. immensely powerful so this like amazing. graphic you tweeted. it's. exactly what you're saying which is a. rapid antigen test.

answers the question am i currently. infectious and you have i think a. comparison of three different uh sorry. seven different tests based on the viral. load. and based on the viral load across these. different tests. you look at the likelihood of. infectiousness. so what is this graphic show we can. overlay that for people just i think. it's just really nice and really clear. yeah so what that's showing is that we. can never ask what's the sensitivity of.

a test and just let that be the answer. that's what the fda does currently. and that question doesn't mean anything. we have to say what is the sensitivity. of the test to detect what right. and so we can have different viral loads. for example we can have. you can have a viral load of one or you. can have a viral load of a trillion and. a pcr test will tell tell you that you. are positive regardless of whether it's. one or a trillion. now so we can't ask the question how.

sensitive is a rapid test compared to. pcr because that covers the whole gamut. what we really want to say is how. sensitive is the rapid test. to detect me if i am infectious. and that gets to about 97. or so. sensitive. if the question is how likely is it to. detect me if i'm a super spreader that's. a really important one to be able to. detect they're all about 100 sensitive. so if you have extraordinarily high. viral loads to the point where you might. be a super spreader these simple rapid.

tests will essentially always catch you. and tell you you're positive. and then as you go down the line if. you're no longer infectious at all. then these rapid tests might have a zero. percent sensitivity compared to pcr but. that's actually a good thing the fda and. others look at it as though it's a bad. thing because they average it all. together and say oh. this is only a 40 sensitive test. compared to pcr. but that's not the right way to look at. it you want to say well out of all of. the samples how many of them were not.

transmissible how many were mid moderate. high extremely high super spreader. and you should at the very least create. a weighted average based on. transmissibility potential. we don't do that you know and that's why. nobody in america has these tests. because that's why they're very rare. because we have slowed down their. authorization because of that. misunderstanding that they don't have to. be. 80 or 90 sensitive compared to any time. pcr positivity. they need to be 80 or 90 or more if.

you're infectious and for that question. they're like 95. up to 100 sensitive when you're most. infectious so you have a lot of iron. particles in you so i mean that's what. it means when you say viral load that. means you're going to be very infectious. the more you have the more infectious. you are and this test is. basically. very good at detecting when you're very. infectious. why don't we have. a rapid home test so you said there's a.

bit of confusion. fda is involved you've talked about you. continue to talk about. that. these at-home tests are classified as i. guess medical devices that's right and. so because of that fda is looking at. them differently. then they probably should be looked at. so. what what's the problem here. can you can you sort of explain what. does it mean to be a medical device why. is that an issue where is the fda. messing up.

when we declare something as a medical. device and we evaluate it as a medical. device then it makes sense that the. comparison if you're trying to get a new. one onto the market. that the comparison would be against a. gold standard medical device for that. purpose. so pcr. is currently the gold standard or at. least. in. the in the eyes of the fda the pcr test. is the gold standard. uh medical device. and as a physician that's because it's.

so sensitive. as a physician. i have one patient in front of me at a. time. and that patient comes to me and i don't. have to care about the 99.9999. of people. in the world who are not. in front of me i only care about that. one patient. and so when i get a sample from that. patient and that patient's saying doc. you know i don't feel well i haven't. been feeling well for the last few weeks. do you think this is covid. well for that question i want to have.

the absolute best sensitivity test. regardless of what it means for. transmissibility because my patient. isn't sitting in my office saying doc do. you think i'm infectious. they're saying doc do you think i have. recently been or am infected. and these are totally different things. one. is medicine. and if the patient's infected you know i. the time isn't of the essence because. they're sitting there in my office i can. say look. i'm sorry you're not feeling well let's. get a pcr test on you we'll be able to. tell you if you have any.

evidence that there has been recently an. infection inside of you. and you'll get the result in a couple. days. and it might be expensive and so. insurance is going to pay for it and. you're just one person and so i don't. really care how many resources it takes. to get you this answer. on the other hand. there's rapid there's public health. testing and public health testing is. it has to account for all of the people. you're not seeing as well as the person. you're testing at the moment so.

accessibility becomes a central theme. frequency of tests it has to account for. all the days that you're not sitting. there in front of your doctor's office. getting a test as well as the one you. are so it has to say how frequently what. if you're infected tomorrow but you're. at the doctor's office today getting a. negative covet test. that pcr test at the doctor's office. today is going to do nothing. to let you know that you get exposed and. infected tomorrow the only way to know. that is to be testing yourself. frequently.

so. and the the reason it matters is. that these tests can be accessible if we. are okay with saying the real purpose of. a of a. public health test is to answer the. question am i infectious. the reason we want to answer that is if. you're infectious that's when you. isolate. we actually don't want to isolate. positive pcr pcr-positive individuals. who are no longer infectious. that's bad public health practice like. if i haven't been infectious for three.

weeks i don't want to have somebody tell. me that i need to. go and isolate for 10 days just because. i happen to use a pcr test. today three weeks after i was infectious. and furthermore i definitely don't want. the public health agency to come and you. know round up all the people i was with. last night and so you guys have to. quarantine. for 14 days because you were with. michael who wasn't infectious yesterday. it's nonsensical to do that. it's a huge disincentive to actually get. tested that's exactly right huge.

disincentive to get tested people you. know if it's too sensitive especially. with flights things like that like. we shouldn't be stopping people from. taking a flight if they haven't been. infectious for 60 days and to be clear. people are only infectious for i don't. know somewhere between three and seven. days. but can be positive on a pcr test for. 30 to 70 days. so i mean it's it's potentially a. tenfold difference in terms of how long. your pc are positive. versus how long you're infectious.

so we don't want to be taking people. during those 30 to 70 days and saying. you need to isolate just because you go. and get a swab or you can't go on your. trip just because you had covered last. month. that's not good use of a test. so the reason we don't have these tools. right now is because. when we evaluate an ant a rapid test as. a medical device. the fda says. well this has to achieve the properties.

that we expect from a medical device. which again. doesn't have to take time into account. doesn't really have to take cost or. resources or scalability or access into. account it only takes sensitivity and. specificity to catch molecules. and so just. by definition i mean it is a. mathematical fact you know that that if. you have a perfect public health test. for covid which means that it would be. 100 sensitive. and 100 specific.

for contagious people or for the. infectious stage of an infection. then it literally can't it is an. impossibility for that test to achieve. an 80 sensitivity at a population level. against a medical device which is what. the fda asks for and that's because. you're only infectious for maybe 20. so. theoretically it should only have a 20. sensitivity. against the pcr while still being a.

perfect medical a perfect public health. test and the test is answering the. question am i infectious that's what. you're testing for not for the exact. counting of the viron particles in your. system that's that's exactly right okay. so what. why. are we still here. so have you had conversations with folks. you said that there's a bunch of um. leaders that are kind of starting to. wake up to this idea but why is this. taking this so long.

why don't we still have hundreds of. millions of at home tests. the reason it's taking long i think is. because every agency and government. is generally deferential to the fda and. in this context. i would argue that government hasn't. been particularly creative. so for example last year trump was still. president i would or or in the. transition. and i i recall talking to the white.

house a number of times and saying. here's a plan to give us our lives back. i think that was actually the title of. the atlantic article you know and. this plan can stop shutdowns it can it. can stop outbreaks it can allow society. to keep running and could have. prevented the outbreaks of last winter. and. fall and saved hundreds of thousands of. lives. so when i bring that to the white house. or to the government of federal. government whoever it might be and i say. here's a plan like this this would work.

they say you know what i get back is. this sounds really interesting michael. uh it looks like it checks out but. there's one problem we don't have the. test there's no scale. and that's kind of where it all dropped. it's like this defeatist attitude of. like oh don't have the test so. so we can't act on it but now it's. really changing. well and so that's really where things. have been and so nobody's paid attention. it's always been this like esoteric. thing. that yeah maybe one day we'll get around. to it but really it's not that important.

and the pandemic's going away but. this was like 100 predictable everything. that's happening today we predicted it. last year you know it's not this isn't. like rocket science or the variance and. all those kinds of things. so the fda we can start to understand. why but also like. one question i want to ask is it. possible to go around the fda yeah. so why has the fda not changed. and why has nobody tried to push the fda. to change like.

the i think what the real reason is the. fda. has one job around these tests and it is. to authorize them as medical devices. they haven't been charged with doing. anything else. so in their eyes they're doing exactly. what they're supposed to do. they're evaluating these tests as. medical devices and they're telling. company after company after company. sorry you don't make the cut. and the only way to make the cut is. really to kind of skew your clinical. trials to favor.

the rapid test being positive which. isn't really good practice we shouldn't. be trying to skew clinical trials. but that's kind of what's happened. that's been it's been forced upon the. companies to do that. and so. i think the fda truly believes from the. bottom of their heart that they are. doing the right thing here. and i would argue that to an extent they. are i've been pretty hard on the fda but. maybe the issue is a higher level issue. like the the in vitro diagnostics.

division is. they get applications and they evaluate. them and the applications are for. medical claims. that's however because there's been a. misunderstanding of these tests and the. companies only know to apply for these. as medical claims. because there is no. there's nothing else in this country to. apply for. except the medical claim. so we we don't have a public health. pathway to evaluate a test and authorize. a test it doesn't exist we have. defunded and devalued public health for.

so long. that we literally don't have a language. for it we don't have laws a language. words is it called a public health test. is it called something else i call it a. public health test because i'm trying to. create a new definition here. but that's why. that's why nobody's acted because no. because everyone says well there's no. other pathway so the fda. in vitro medical diagnostics division is. the only pathway so what i am trying to. do. is to say look.

the fda very clearly states. that they do not authorize or review. public health tools. and not and they don't authorize or. review public health tests for for covid. so. what i want the president of the united. states to do is to utilize executive. powers and take an executive action that. can simply state like one line one line. could potentially. change all of this.

and it's a pretty obvious and simple. line and it is that. any tools. used for public health. testing during this public health. emergency. will be designated as public health. tools. like it's obvious like it's public. health emergency it's a tool used for. public health it should be designated as. a public health tool. if we can do that if we can get that. language out there so that that's the. president's decision. then all of a sudden the fda is off the.

hook. they're not trying to to cram a square. peg through a round hole. they can say look the antigen tests are. not on us anymore at least if they're. going to be used for public health like. when you test a thousand people at a. time or. test a school a school classroom if. they've been exposed this is public. health and so then the cdc could take it. over. the cdc could say okay. what are the metrics we are interested. in.

and they could say we're interested in a. test that can catch you if you're. infectious so you want high viral load. detection that's fast that's scalable. and hey you know if your test has been. used in europe for months and has. performed extremely well. then then we'll give you a certificate. by right you know immediately and that. could actually get. hundreds of millions of additional tests. into the united states tomorrow. so you need some kind of classification. from an fda from somebody to call it a. public health tool in order for it to be.

manufactured is it possible to just go. around all of this and just for somebody. to manufacture at scale. tests. well. you if you did that and you just called. them you put a claim on them that called. them public health tools. the fda has a very. weird view of this and they will tell. you that it's illegal that it's a crime. is there a way to say like elon musk did. with the flamethrower it's not a. flamethrower yeah.

uh believe me i've tried i've tried to. think of all the different approaches um. you know there's weird there's like. there's major inconsistencies here so. it's not like we don't have a precedent. for a public health test even during. this pandemic. there is a very strong precedent. uh pooled testing. we have companies like ginkgo right. based out here in cambridge. that are. uh. you know working with 100 different labs. around the country so that might mean. like not a ton of quality control over.

those labs. doing. uh i mean i don't want to say that they. don't i'm just saying the reality is if. you're working with that many labs it's. hard to say they're running pooled. testing. of millions and millions millions of. kids. so here you have a company that's. testing. in each pool five to 25 kids at a time. millions of kids in a pretty distributed. way across the country and all these. different labs. and the fda doesn't care at all you.

don't need any ua it doesn't need a. regulatory authority. it's collection on site it's getting. shipped to a lab there's no oversight of. it. so why does that have no oversight but a. rapid test for pub for the exact same. purpose. you're just giving people immediate. results instead of two-day delayed. pooled pcr results so it's a much more. effective tool. why is the rapid test used for the same. purpose. not designated as a public health tool. but requiring.

fda authorization. it's a ridiculous reason. and it's because the fda says that if a. test. and this is actually cms that says this. and then the fda adopts it. if a test alters your. behavior if you get a single result and. it's going to alter your behavior. then that is a medical device. but. the thing that i find ridiculous is like. okay but you can give a pooled test that.

alters 25 people's behavior at once. and that's not falling like that's more. risky one person turns positive in the. pool and 25 people have to be. quarantined. and uh how do they evaluate the accuracy. so for people who don't know a pooled. test. is you're testing a small fraction of. the people. and. if one of them is positive then you. basically say we have to retest. everybody in the pool or like you yeah. so you take let's say you have a school.

and each classroom you might have 20. kids each swab their nose in a classroom. and all those swabs go into a single. tube. and then you rinse that tube out with. some saline and you run a pcr test on. that tube of 25 samples or 20 samples. and so if that tube turns positive in. the pcr test. then all 20 or 25 of those students. are now having to quarantine yeah and if. there's no positive then all 20 or 25. students are.

interpreting that their result is. negative. you know so it really is ridiculous. decision by the fda to say that. if the test itself only tests one sample. at a time it's medicine. because it will tell you one person at a. time if you're positive or if you're. negative but if you do it as a pool and. you and you. tell 25 people that your pool was. negative. then that's somehow different that's. public health not medicine it it doesn't. make there's no logic there was it just. personalities and accidents of history.

or something like that for example. you talk about the. public health tools and cdc you look at. masks. so masks were decided to somehow be an. effective tool. to help with the pandemic like so i'm. sure the evidence that was used there. was probably not as strong as the. evidence supporting antigen rapid tests. i was. very much reading a lot of research on. masks it's tricky it's really tricky to. show how well they stop the transmission.

of a virus especially when you don't. fully understand how the virus is. transmitted or the viral load required. all that kind of stuff but then the cdc. pretty quickly decided masks or whatever. there's some oscillations back and forth. but then they quickly decided all. everybody decided masks is a good tool. so masks being decided a good tool and. then. rapid antigen tests not a good tool is. that just like certain personalities who. didn't speak up in a meeting or who did. speak up in a meeting is this just like.

a weird role of the dice or is there a. better explanation. i think it's somewhat of a roll the dice. but i also think it's that testing. so. doctors. don't pretend to like really understand. much about like. fluid dynamics and you know how well. masks are working like that's like way. out of their realm. doctors. do believe that they understand all. aspects of the tests right.

and so the greatest barriers to rapid. tests being brought to market or sort of. being being rolled out heavily and. supported as public health tools. uh the greatest barriers came from. physicians saying. hell no we can't use a test that's not. as sensitive as a pcr. and. look at what happens if you use this. antigen test and not a pcr test you get. people. who are showing a positive on a pcr.

negative on an antigen. and they just assume that that was a. false negative on the antigen. for public health i would call it a. false positive on the pcr test but this. type of thinking. literally does not exist in medicine and. i think the biggest problem here is that. we. placed physicians in decision making. power. we have. won this pandemic hit everyone called up. clinical uh laboratory folks and.

microbiologists. and physicians to ask well what kind of. tests should we use that kind of thing. and there is no training in medical. school for this kind of public health. work like uh you have to optimize on the. right qualities of a test. that have nothing to do with medicine. and then sometimes if not frequently. they're actually at odds and i'll give. an example. why the physicians you could see why the. physicians would have been against it.

from their perspective. and they say uh if a physician is a tsa. agent. at the airport. you know a tsa agent their role at any. given time. and the role they think that the. instruments need to play is i want you. to scan the bag as well as possible this. is the only bag that i'm interested in. at the moment. and this is my lane this is my bag. i want to make sure that my instrument's. doing i don't want the crappy instrument. in my lane i want to make sure that i'm. doing everything i can but.

what those tsa agents don't have to. worry about is well how many other. instruments are there in this airport is. anyone getting through. the lines here without going through. security the average tsa agent doesn't. have to worry about that they literally. have one job to do and it's pay. attention to this lane. if there's a big gap in the security. line and people are flowing through. without going through security that's. not on the tsa agent that's not a big. systematic problem of that of of the the. system.

and we can't expect that tsa agent to. have ever even thought about that like. that's not on them they were trained to. look at a to look at the bag. and that's kind of like physicians. and i you know probably some physicians. will hear this and feel like i'm. insulting it i don't mean to be liking. you know the two professions and or. anything like that i what but the point. is is that. a physician has one duty do no harm to. this patient. time isn't of the essence scale how many. tests can my hospital perform in a day.

how many tests can my county or country. perform in a day that's not a. physician's training to think like that. at all. and so what has happened is doctors got. on board early and said oh hell no we've. seen these antigen tests before they're. not particularly sensitive compared to. pcr and and early in the pandemic there. was like pissing matches between labs. who had the most sensitive pcr. and it just. distracted everything it really i was.

trying to say pretty early like. we don't need sensitivity we just need. frequency we just need scale we need to. think differently because our only goal. if we're doing. frequent routine testing of asymptomatic. people. is not medicine it's to say do you need. to isolate now. and if you have a pcr test that's taking. three days to return and you're like if. i was currently spreading virus before i. walked in here. and you handed me this actually happened. to me today when i walked into harvard. today was my first day back into harvard.

since february of 2020. i go in i. scan my badge and they they hand me a. pcr tube and they says they say like. return this you know by. noon or something before you before your. work day's done. and i'm looking at it i'm like. what is this going to do like what if. i'm super spreader right now yeah you're. giving me free reign to walk around and. infect everyone in the school. and you're gonna give me my result to. tell me i did that in two days from now. it doesn't doesn't really make sense so.

who is supposed to be so it's. understandable that doctors kind of feel. that way just like you said do no harm. who's supposed to. care about public health. is it the fda is there some other. organization yet to be created. is it like uh just like with the. military the reason we have civilian. leadership when when you talk about war. is it the president that's supposed to. do like override fda override doctors. override. and basically politicians in.

representing the people in the state of. emergency make big public health. decisions like who is supposed to do it. besides you on twitter. it's like. most people really thinking about. solutions to kovid. we'll mention you or will mention this. idea of rapid home testing. and it's it's you watch that happening. this discussion that this is an obvious. part of the solution and the solution is. not happening. so who is supposed to implement this.

idea. i think the cdc that it should start. there. override the fda. well i don't even think it needs to. override it and that's why i think these. should just be designated as a different. tool. so that the company is it's not. overriding it's just saying look this. isn't even this isn't in your. jurisdiction to the fda this is just a. a public health tool but the problem is. the centers for medicaid medicare. services designates any tool just like. fda they designate these as medical. devices purely because they could change.

somebody's behavior based on the result. of one test. so to change that at this point unless. you get cms buy-in you know we don't. have there is no designation as a public. health tool. but the president. can just say. these are public health tools these are. not to be. regulated as medical devices if their. goal is not medicine but public health. and if he does it he does have the. authority to do that as president and to.

say. i'm tasking the cdc. to certify these tests or or authorize. them for use in the united states and. you know he has to say something like. that he can't come out and say these are. public health tools have free reign. just you know any company start start. shipping them in the us because that. would create pandemonia and we'd have a. lot of bad tests. but there's a lot of really good tests. out there we just are taking like 6 to. 12 months to run trials they're failing.

because they can't keep up with pcr. and. if the president were to do this then. the cdc could take it over and they. could say okay. it's on us we're going to decide. the uk actually did this they. early on they said okay. they laid out a very clear regimen they. said this is how we are going to. evaluate. rapid antigen tests because they're. public health tools they did it in a in. a domain that was outside of their. normal medical diagnostic regulatory. agencies.

and they they literally just had. a very fast screening to say what are. the best tests they went through a huge. number of different tests they said okay. these are the this is the rank order of. which tests are good which are bad which. are scalable which are not. and they were able to start deploying. them in weeks not years so i think the. cdc really needs to take charge the. problem is when it comes to like law. if everyone currently perceives this as. like. fully within the domain of the fda and.

they've never heard of such an uh public. health. test idea enable it but but the fda. itself has created the idea by saying we. don't regulate public health tools. so the word is out there the fda has. said we don't regulate them so that. gives the president an opportunity to. say okay. these are those you know these are. public health tools by definition. and and i do think that this is a kind. of a crisis and it's a crisis of testing. but it's also a crisis of like.

really we're going to go through this. whole pandemic and never figure this. thing out. that's just really sad you know if we. get through this and don't figure out. how to evaluate a damn rapid test. so. how do vaccines. play with this so one of the things that. when people discuss solutions to covid. there's a sense that. once you have a vaccine kova dissolved. so how does that interplay. like why do we still need tests if we.

have vaccines yeah i am i actually wrote. an op-ed in. new york times or wall street journal or. something that was titled why we still. need rapid tests with with vaccines. and. the real reason is because we have. evaluated our vaccines based on their. ability to stop disease. in fact most of the trials didn't. evaluate them based on their ability to. stop transmission. they didn't even evaluate that at all no. less put it as one of the metrics for.

authorization. and. with a virus like this it would be a bit. naive to think that it's really going to. stop transmission well. i think a lot of excitement happened. right after the first clinical trials. and i'm sure we were talking about it. when when i was last here i would. imagine given the timing. but those first clinical trials came out. and everyone. you know jumped for joy that these. things were going to be the the end to. this pandemic. but we had really short-sighted vision.

there by not recognizing two main. features one is. uh that they might not stop transmission. another i guess three another is that uh. new variants might come around that will. break through the vaccine protective. immunity and the third is that we. were not. we were measuring the efficacy of these. vaccines during the peak of their. performance in the first few months. after people got vaccinated. and that gives a skewed view of just how. effective these are going to be long. term so what happened.

with the vaccines is that. everyone got very comfortable this. including the cdc saying. if you've been vaccinated you know this. is the end of the pandemic for you. and let's keep it up. but then delta comes along and waning. immunity comes along and both of these. things compound exactly as anticipated. to get breakthrough cases. and unfortunately what we're seeing now. is the cdc and the administration went. so all in on saying that.

breakthrough cases are rare that. transmission doesn't really happen if. you're vaccinated without great data. especially with delta that once people. started seeing breakthrough cases. they start interpreting that as a. failure of the vaccine the vaccines are. still working to keep people out of the. hospital. for the most part. but. they're not working to stop transmission. and if our goal is to stop transmission. which until we decide as a society that. we have different goals.

like we're okay with people getting ill. and letting transmission go because we. don't want to worry about it anymore. we're not there yet so until we decide. we're not going to stop transmission we. need other avenues besides the vaccine. because it's. it's not doing it it also means that. herd immunity isn't going to happen and. unfortunately as long as we keep letting. spread happen in the context of. vaccinated people. we're kind of giving this virus a boot. camp of exactly what it needs to. do and mutate to get around our.

vaccine-derived antibodies that makes me. very nervous so the more we can do to. stop spread. in the unvaccinated in the elderly. vaccinated and in other people. the better we we just should be focusing. on that so in your eyes the solution. would look like this. you would have make enough tests where. every single person would get tested. every single day. i think that that would be. i don't want to do that actually i want. to do a variation on that i think what.

we should do is have a dynamical testing. program. it doesn't have to be. complicated. it's every household has a box of tests. in their cupboard. and if you haven't seen any cases in. your community for a long time stop. testing do waste water. testing to see if there's any rna coming. back. if you start to see rna in the waste. water that represents the virus and. you're still wanting to stop outbreaks. you say hey. you know those tests that are in your.

cupboards households in this county. why don't what is in each household or. each person each household use one test. per week. and can you uh sorry to just pause. on that idea that's. really cool the the waste water testing. that's the thing so you can you can get. a sense of how prevalent the virus is in. a particular community by testing the. wastewater that's exactly right and so. the viral load associated uh the viral. load that you can find in the community. represents the prevalence of the virus.

in the community which is really quite. nice that's not that's a nice way to. paint like a map of the. the intensity uh of the virus okay so. when it. when it goes above a certain level. you can start. doing. much higher frequency testing per house. in each household that's right so i. don't want people to be in testing. purgatory like that's not what i want i. just want us to get through this damn. pandemic and. and so we can monitor the waste water or.

any other methods we can monitor the. hospitals in the clinics and if somebody. does come in with coveted like symptoms. and then a few other people come in you. realize okay we got spread happening in. our community. send out a text message put it on the. news put in the newspaper whatever you. need to do. tell people tell families use your test. and if the cases get worse. because you're just doing it once a week. that's not going to stop transmission. but it's going to enable you to identify. where outbreaks are happening. if you start to find outbreaks in.

pockets. then the rule is simply okay let's. squash the outbreak real fast so. everyone in that area uncertain zip code. or whatever it might be. test every two days. you know for seven days or every day for. seven days. and you'll get rid of the outbreak. we can do that and if you've now gone. again you know a week or two with no. cases. uh identified stop the testing again. that's the nice thing that. everything changes when people have the. tests in their home.

it becomes. dynamic it can become easy send a text. message take your test today. if some people don't do it that's fine. the only goal. is to get r below one and you stop the. outbreak. people think it has to be near perfect i. always hear people say. ah what if somebody doesn't doesn't use. it or what if somebody lies like well. you you have 98 of people testing or. even 50 that's a whole lot better. and you know another big difference that. people i think often times have their.

have a problem wrapping their head. around. especially to the extent. physicians who are used to really. like who are used to different kinds of. metrics is that. all we have to do to completely stop an. outbreak from spreading in a community. is to get for every hundred infected. people. to get them to go on and infect 95. most people would say oh my god that's a. horrible you know that's a horrible. program you're still letting a hundred. people go and infect 95 people.

but that's for a virus like this that's. a massive public health win if you can. get 100 people to infect 90 most people. doctors i would say like a lot of people. would say that sounds like a failure to. be honest. but if you do that for multiple days in. a row. then in a couple of weeks you've gone. from a big outbreak to a very very small. outbreak. and on the other hand if you don't do. that if you allow 100 people to just. infect 140 people. because you're not doing the testing.

then instead of having 20 people at the. end of those four weeks with the testing. you literally would have 600. massive differences here. and all. the only goal then is to get our below. one have 100 people in fact less than. 100 and you stop the outbreaks and. everyone stays safe. from everything you've seen how cheap. can these things get from like in the. past year. in in terms of the developments you've. seen with the various test manufacturers. how cheap can it be to make a test to.

manufacture a test so there's the. manufacturing process that could be 50. cents maybe less. it's hard to get it's hard to really. have eyeballs inside these companies you. know in terms of where they're producing. them in china. and taiwan a number of other places. some of them are produced here in the. united states too but 50 cents say it. was a very very reasonable generous. number for how much it cost per test. you look at a place with high market. competition that has actually authorized. a lot of these tests like germany.

germany has 60 70 some different. companies of high quality rapid tests. authorized. you can go there and buy it for 80 cents. you know that's and they're still making. profit and so. so it's extremely cheap market. competition can drive these tests. uh way down in terms of cost. i think one of the most important. features. of a rapid test program is what do you. do with the result is it going to. be used for you to gain entry to school.

or work. is it going to be reported to the public. health agencies. you know all of these the primary mode. should be just get people test but. really if you're going to be using it. for a workplace thing like what biden is. now saying vaccinate our test which is. going to lead to a crisis if we don't. fix this soon because we're going to. massive demand for testing in the next. couple weeks. but when he says that that's essentially. saying okay companies need to make sure. that their people are testing so are you. gonna base it on the honor system. i would say you probably would not base.

testing on the honor system if it's like. to uh take somebody who would otherwise. be quarantined from in school and so you. can go to school as long as your test is. negative so test to stay program is a. big thing that i've been pushing for and. others have. businesses bringing people into work who. need to test. they need to have verification. but they don't want to like set up. nursing stations in their lobbies or in. the school parking lot or whatever like. everyone's tired of that we need to.

bring the test into the home but that. means we need the technology to enable. it. and so i was at a conference recently. do you know mike milken milken institute. he's a. very wealthy billionaire but he's done a. lot of philanthropy and he hosts a. conference to raise money for prostate. cancer. research i was at this conference. recently francis collins a number of. other people were there. and every morning we all had to test in. the morning which i thought was a great. idea obviously before we walked into.

that conference. and um but you didn't have to test there. and they didn't base it on the honor. system every morning i'll i. scanned a qr code on the box and emed. which is a service that provides. test uh verification. popped up with a proctor right on my. phone or on my computer. and said okay. let's go through your tests like and. they watch you they videotape you using. the test so it's all recorded it's all a. reportable. type of test.

and at the end of it just from your home. you don't actually see the proctor you. know they're but they're just verifying. that you actually do it. they verify the test they verify that. test results with you. and at the end of it you've then gotten. from from your couch or from your car. wherever you are. an actual verified laboratory report. that can be. considered proof that you yourself use. the test and you yourself got a negative. so the tools are out here. if we want to use them at scale and in.

fact the cdc uses emed now to. enable people to come back into the. united states. uh through an antigen test so before you. get on your flight you're sitting in the. airport in heathrow or wherever you are. you can get on your computer use your. emed test. and you get the negative and that and. cdc will accept that tsa will accept you. to come back into the us with the rapid. antigen test that you did without anyone. else watching except for this proctor on. your phone super simple. how much private information is being. collected so like this you know people.

have. in the united states. the american way they have a hesitancy. on the overreach of government in things. like vaccine. passports. like using. any mechanism any mechanism of. verification that's controlled by. government can lead to overreach by said. government so there's a concern of that. do you. see there a way of achieving.

testing that's verified but does not. violate people's privacy or sense of. freedom. absolutely i i think so the way that. um right now in the united states. they're requesting that. these tests get that the results get. delivered to public health agencies but. i've long held that. while that's ideal it should never be. the thing that holds up somebody being. allowed to know their own status. but if you are going to work. and you have to let your boss or your.

manager whomever know that you were. negative that day or if you're going to. school. i think it's going to be hard to. maintain complete privacy. in that situation because they need to. know your name but sure i mean could you. cut off the public health reporting. yes you could but i worry i mean can you. opt out maybe you could opt out that. should be a feature i want to opt out of. the public health reporting because. for whatever reason otherwise i'm not.

going to do the test and but that means. that okay then you're not going to go to. work so right now there's this serious. tension and. i am very uncomfortable with. the idea that we force anyone to do. anything but. there is a tension between these two. things for sure and how do you balance. that during a public health. emergency. i think first and foremost let people. everyone has a right to know their. status. the fact that we have made it hard for. people to know their status on their.

terms i think is a travesty i mean it's. just so. terrible that we have. prioritized. us knowing at the expense of you know. essentially what like elta's long said. during this pandemic is. if i'm public health it's if i can't. know then you can't know your status. like that's not the right way to look at. public health we need to engage the. public and if some of them don't want to. participate in the public health part. but want to know. their status. by default they are participating in.

public health whether they know it or. not because they're not going to go get. their mom sick by mistake. at least most people wouldn't and then. also you can create systems where. you can. individuals can form relationships based. on their status. without ever reporting it to a. centralized place so. you can go to i don't know. a local business owner might. require that you show. that you're negative.

but that doesn't require reporting it. you can. like there might be um basically like an. id. that's only in possession you are the. only person in possession of that so you. literally show it exactly here's a test. i took it's negative and nobody else. knows about that test so that could very. well be done even through a company like. e-med i think. and i might be wrong here. uh i believe that they take the test. result and because they are considered a. clia waived laboratory like a digital.

laboratory. they report their results by law out to. uh the public health agencies. but let's say there was something a. little different let's say you were. verifying an over-the-counter test. and it doesn't have to be a cleo wave. because it's over the counter then. you're not bound by clio rules. and. you could create the same service but. that just doesn't report out to the. public health agencies it gives people. the option. to opt in or out of public health. reporting and. you know.

i know that public health people. get a little queasy when i talk about. this but. as a public health person myself like. yes of course i would prefer that the. data be available to evaluate to know. where the cases are. but first and foremost i want to make. sure that the people using the test. are are going to use the test and if. that means that they're not reporting. and if that's the only way that they. will use it is if it's not reported then. that's better than no test. and especially given that the.

central to the vaccine hesitancy is a. distrust of authority in the distrust of. government so. you're asking. you're asking people to get tested. and report their. status. to a centralized authority when they're. clearly. do not trust that authority it doesn't. make any sense it seems like a perfect. solution. to let people who are hesitant on the. vaccine to uh. get their own status and have full.

control of that information and opt-in. provide that information if they wish to. but they have the full control of it and. have the freedom to do that information. what they want i fully agree with that i. really do i think we can have the. verified services. and we could have the privacy if you. want if you want if you need to go into. a restaurant and there's a rule that you. have to be a negative test. have it on your phone and only your. phone and it's okay like emed emails you. the the lab report you have it you can. say look that's my name i use it this.

morning negative. and in that case you'd want something. that just is there and is not. going anywhere else and i think that. those services like i think they can. exist. and it's a struggle because for those. companies. they don't want to fall out of favor. with the cdc or with the fda. and so this is a big problem in our. marketplace in general by having. by having private companies. who want to. be the be the public health agents of.

this pandemic. we lose a lot of control because the. companies ultimately have to do what's. going to make them money so they survive. and keep performing the service it's. really it's really just such a hard. problem and i this is why last time i. was here i'm guessing. i was probably really pushing for the. government. to be producing these tests. i think i would have still been pushing. for that you know at this point i've. decided okay the government's clearly. not going to do that i've been thinking. i really want elon musk to produce the.

tests like. i i really. am sort of serious that these tests are. simple to make but we've been using like. machines to make them that have been. around for a long time. scale is an issue right now. kind of really it's the eua process and. getting the companies to be allowed to. market in the us that's the issue but. let's just say scale is the issue and. one company wants to make 20 million. tests a day. these aren't that hard like we we should. be able to do that we just need a faster.

machine a better machine yeah and a. quicker one and a few folks like you. mentioned know how to solve that problem. yeah i've had a lot of discussion with. uh with tesla folks you know with with. people that used to work a test like jim. keller about how to make stuff much. cheaper much better that's basically. what tesla is world-class at and. it's like okay. does this. thing have to cost a thousand dollars no. it can cost ten dollars right and let's. figure out how to manufacture it those. those those folks are like the best in. the world they're doing that okay but um.

what about this biden action plan. so it sounds like. the guy uh agrees with you vaccinate or. test. so. i think given that choice a lot of. people go test in america because. there's there's like a division it seems. like so what is this just uh politics is. is this. just words or do you think this is. actually going to lead to something and. maybe can you explain what the action. plan sure is.

so there's there's a number of pillars. to the action plan um the two that i've. been most focused on i mean some of them. are we want to get everyone vaccinated. all these things and. one pillar is saying any. company in the united states that has. more than a hundred employees. is now required to. ensure that any unvaccinated individuals. in their workforce. test weekly.

another pillar is that. the president's going to. reduce the cost of pcr tests. by 35 which is pretty. moderate reduction. um and. is going to reduce the cost of antigen. tests and scale them up and make 280. million tests. and put two billion dollars into it. so those are the two that i found most. intriguing for the kind of mission that. i've been on which is to just educate.

people around hey we have really really. powerful public health tools we have yet. to deploy. um. the issue. at hand though is that now that the. president has said vaccinate or test. there's a problem inherent in that you. know it's essentially to coerce people. around vaccinated to get vaccinated. because vaccinator test doesn't make. sense when the vaccinated people can. transmit the virus just fine it should. be vaccinate and test exactly it's the.

problem that i have with that vaccinate. or test idea. is it's great if you want to use it as a. coercive. uh. effort to get people vaccinated like i'm. not going to wade into that argument. do i agree with it or not i'm just not. going to even put my uh. i disagree with let me say. i disagree as opposed to doing great yes. science communication this weird. like people talking down to the populace. as if they're children trying to trick.

them here have some candy uh this kind. like everyone with common sense. somebody told me i was having a. conversation like if the government is. going to give you money to take the. vaccine. people that were already hesitant about. the vaccine. are not going to trust whatever the heck. you're doing so don't trick people into. taking a vaccine be honest and. communicate. transparently everything that's known. about the vaccine communicate the data. inspire people with uh.

with uh transparency and like. real communication of all the. uncertainty around it and all the. difficult decisions of risk and all. those kinds of things and as opposed to. trying to trick them like children into. taking the vaccine anyway. yes but okay well i didn't have to say. it so there. but you're saying it should not be uh uh. like vaccinate or test this that's that. tradeoff doesn't mean exactly vaccinate.

by saying vaccinate or test. is absolutely confusing. because it implies for anyone who's. thinking about it it is implying and and. i've seen this because i have business. leaders call me fortune 500 business. leaders who call me and say. what do i do like i have 8 000 employees. where am i going to get my tests you. know and a lot of people are. saying they're calling this a pandemic. of the unvaccinated. these types of divisive. this divisive language doesn't help this. isn't a pandemic of the unvaccinated.

it's a pandemic of a virus you. know like. don't ever put it on the unvaccinated. who frankly are just scared they don't. know who to trust. and we haven't given them a lot of. reason to trust public health to be. frank. so i agree i mean now that you've opened. the door i'll just say my piece like. absolutely we need to be the most honest. we can with all of this this. this is confusing language to say. vaccinator tests we need to say we need.

to be very upfront that says and say. look vaccines aren't aren't stopping. transmission very well. unfortunately this is the world we have. we have delta we're going to have new. mutants. we have a vaccine that's that wanes. somewhat over time you know this is. biology i'm sorry i'm you know this is. just what it is. and then we say but. the vaccines are really protective for. your personal health they're going to. keep you out of the hospital this is. what you should care about as an. individual. and.

as a population we need to figure out. okay we have to stop transmission if. that's our goal. so we should use the tools that are. going to stop transmission if that's our. goal and saying vaccinate or test if our. goal is to actually stop transmission. that's confusing because vaccines are. not stopping it there may be mildly. lowering the risk of transmission. so i i'm just not a fan of that language. i think we should be being very very. clear like you said and up front about. what are the. limitations of the test of the vaccine.

and of the test and we should be very. clear that like you know it can only. help the american public. in aggregate is extremely intelligent to. you know they will figure out. when you say that vaccine breakthrough. cases are rare and then they start. seeing. story after story of like whole parties. of people or vaccines have outbreaks and. and everyone knows more people now who. are having breakthrough cases than they. knew who had regular cases before the. vaccine people start to wonder hmm.

well this is weird they say that the. vaccines are working breakthrough cases. are rare maybe the whole vaccine program. is failing entirely. and so it ends up shooting ourselves in. the foot if we try to. create false expectations because we. think it's going to be beneficial. uh for one thing when it's not for the. other and so the other so to get back to. the action plan. vaccinate or test i think. and and the re and the increase in rapid. tests i do think it was a bold move i. think it. i i would say that it was the most.

prominent. sort of display. encouraging display of the fact that. rapid tests are. indeed. effective public health tools. my real concern now with with is that. 280 million tests that's like less than. one per person per year in the united. states so that's not. the way that he said and delivered it. and what most people think of when they. hear the word 280 million you don't. usually put a lot of thought into what. does that number mean it sounds a big. number. most people are now going to be.

expecting that these tests are actually. going to be staying in stock on the on. the shelves at cvs and walgreens and. amazon or whatever so that's crisis. number one it's like now the expectation. is set for having rapid tests but. they're not going to scale that well. we won't have them and then there's. vaccinate or test. and that's going to bring millions and. millions of people who are not currently. testing to have to start testing so. that's going to overwhelm our pcr labs. and it's going to create five-day delays. again with pcr if not longer.

because we'll have backlogs. and so the only real solution to this is. to just scale up the tests that are. actually scalable. and that's these simple rapid tests and. it's not even to scale them up. through production and manufacturing. here. it's to open the doors so the companies. that already exist here and can scale. are allowed to do it and to bring in the. international market some of the biggest. diagnostic companies in the world. are not selling their. millions and millions and millions of. tests in the billions of tests in the.

united states. because they don't want to play the the. the game that the fda is currently. requiring of them. so we have an opportunity and i i am. very encouraged that the president. actually did put these into the action. plan and i do want to say for the record. that i'm. supportive of it in principle. but i think now. now we actually are in a in like a the. timer has been set and we have to deal. with the crisis before it happens. otherwise there could be some real. political. points taken off you know i do worry.

that the president if he doesn't pull. through with this and really make the. test available we end up getting into. this other test crisis this fall. there could be political consequences to. that and the reason is like these rapid. tests are so personal they become. emotional almost they're so they give. people that empowerment that i was. talking about earlier. and when people can't get that because. the shelves are out of stock. they actually feel frustrated and then. that converts into like anger like in. the blame and so i do think that we have.

to be really smart about. making a policy like this and then. ensuring that we can carry through. with what the average american is. actually expecting. and. speaking of politics one of the great. things about testing maybe you can. correct me but for my sense. it's one of the only solutions to covid. that has not yet been politicized. so masks and vaccines whether you like. it or not have been. heavily politicized where there's.

literally a red blue split. on the use of those. or like. proud. use effective use of those tools and it. seems like everybody i talked to about. testing everybody's on board red or blue. they are which is why. i am particularly concerned about the. vaccinate or test policy right because. all of a sudden we just politicized it. we just. brought it with this thing that was.

fully bipartisan. really by part i mean i've talked to the. fully the really right. side of congress and the super liberal. side of congress the senate the same. politicians governors. everywhere in this country have asked me. for support. around these rapid tests because it just. you can have it reported or not you can. have it in the home in the privacy of. your own home or not or you do it at. school these these tools are just so. powerful to identify infectious people.

they didn't have to be politicized. they still don't i don't think that the. action plan went so far that it's going. to politicize them but i do think. already it's starting to conjure up. emotion saying well now i have to. get tested i have to part right and that. is where. we go wrong it's i have to get tested or. vaccinated. you know screw that i am independent you. know whatever and. and i do worry that this thing that was. purely bipartisan that we could have.

just scaled up months ago people would. have we could have delivered it to every. household didn't even have to. ask people to request to just deliver. packages. to every home in america by now easily. if we were smart about it you know we. could have done it the most unpleasant. thing about covet is the uncertainty and. that's what leads to fear on both the um. uh vaccine hesitant it's the answer into. about the vaccine. and uh. people who are. have taken the vaccine the uncertainty.

around like am i in danger walking. around can i go can i walk down the hall. like this fear of the world around you. and i think. testing allows you to uh remove a lot of. that uncertainty like you you gain back. confidence that you can operate in this. world. and not get infected and you become like. a nicer person i i find myself every. time i get tested i become a nicer. person to others because i know i'm not. putting a danger i'm not putting people.

in danger. it's a it's a heavy burden to carry to. worry. am i infectious like i was out last. night but i do want to go see my mom. today you know like am i infectious i. don't know and this has created massive. anxiety. and i can't tell i completely agree that. it is. it's a relieving feeling and and it's an. amazing feeling to be in a room. when and i did this in the middle of the. pandemic when everyone was supposed to. be wearing a mask indoors.

at every one rapid test you know and i. said everyone should wrap a test before. you walk into this room. and it was a wonderful experiment. because everyone was just so relaxed. yeah you know the other the alternative. is everyone nobody tests and everyone. wears a mask. you have a mask that maybe gives you 20. maybe protection. during if you're all in the same room. together if that. or you have a rapid test program. wherever in rapid test before and that.

gives you like 95 to 100 protection not. 100 but close. and all of a sudden that allows everyone. to take a big sigh and be like wow this. is the first time. i've seen people without masks indoors. in a long time and i feel pretty good. and restaurants like. restaurants are scary right now because. you just don't know who might be. infectious and nobody's masked. and. like wouldn't it be great to just go. into a restaurant where you know that. everyone just tested negative that day.

it just really reduces anxiety. it makes individuals feel empowered. and i mean at the end of the day covet. and our response to covet is a re is a. it's truly an information problem. you know we why do we quarantine anyone. why did we ever close anything down we. didn't close things down because. everyone is positive we closed things. down because we didn't know if anyone. was positive. we quarantine a whole classroom of kids. not because they're all positive but. because we don't know if one of them are.

positive and so we just quarantine. everyone when there's a positive in the. case in the in the classroom like one. day we'll then ask the whole classroom. not to come to school for 10 days. that's not. a biological problem that's an. information problem. and the crazy thing is we have the tool. to solve that information problem. it's literally our eyes on the virus. it's how we see this virus and if. everyone glowed green. when they were infectious we would have. never had to close down anyone any. society and we would have never had the.

outbreaks because we would have been. able to stay away from the green people. you know and yeah i like what you said. the quarantine is an information problem. that's absolutely right. what is there something you can say to. what people can do. like listening to this individuals do. you just. complain like loudly like why can't we. do this can you speak with your money. somehow. what what can people do. to help. god it's it's amazing to think. you're asking me this question.

and this video will go out to you know. the web and all the people that watch. you and uh last year. in july maybe something like that june i. forget exactly what it was i was on. twitter this week in virology. um shout out to two of those guys are. awesome they are awesome i love i love. twiv. and they asked me the exact same. question towards the end i said this. makes so much sense you know why. wouldn't we do this what can people do. and so i said. oh you know just send me an email like. write to me i'm sure you could find my.

email somewhere online. and uh and get in touch and i will you. know and and we can try to figure out. how to. uh make something happen yeah bad idea. very smart. way too many emails i didn't i feel bad. because i didn't end up getting back to. anyone because i just got inundated but. it did lead to the development of rapid. test.org where we did. automate the process of writing letters. to um congressional members and and. elected representatives.

so that helps. fast forward to today what can what can. people do. i honestly don't know like what can the. average person at this point do we have. tried everything the fda is immutable on. this. they will not change and we shouldn't. ask them to change because they have. decided that this is how they regulate. medical devices and they're going to. stick to it so what we need to do and. maybe this is something to do. is get if you know people. who have sway over politicians lobbyists.

whatever it might be. let people know to request. that the president literally the. president of the united states. uses executive powers. to just do a sim something as simple as. designating these powerful public health. tools as public health tools allow the. cdc. and the nih or whoever it must be or or. academic centers of excellence. designated by the cdc. to evaluate the tests.

in a very fast fashion with the. appropriate metrics that these tests. need to achieve for public health. and within two days we can have ten new. tests authorized. you know this doesn't have to be a six. to twelve month endeavor this could be a. two day endeavor we actually did it i. judged the rapid test x prize. and it went great we actually got. incredible metrics about how well does. each test work. and no clinical trials you know just a. couple days worth of work in the lab and.

boom and if we actually systematize it. would be an hour so in the lab you know. so. simple so i don't know i mean i don't. know how to really impact change i've. thankfully you know i have a platform. and i've been able to start talking with. people who are very close to the. president and the white house and um and. i do think that some change is finally. happening because the silver bullet of. the vaccine has not panned out to be the. silver bullet so now we gotta.

now i think. we're moving from a country that was a. vaccine only approach to. finally recognizing at the highest. levels that there's other tools. do you think it's possible to reopen. fully. without solving the testing problem. completely like do you think this. vaccine approach will get us to reopen. fully. i do yeah i think over time though. i mean if we a lot of people ask me like. what's what's like happening like what's.

the end game here like where does this. end. and um. it's actually not a mystery the end game. is we will grow out of this virus. and by that i mean. you and i. and. most people who are watching this are. adults right. adults don't like to get infected with a. virus for the very first time as adults. babies are okay with it and so what we. have to do to understand how we're.

getting out of this virus. is to look at babies look at newborns. and say okay how does a baby get out of. their high risk. time period. they get exposed they get like exposed. multiple times or vaccinated of course. and eventually. they get exposed enough that they build. up this nice cushion of immunity that's. sufficiently diverse that they can. battle whatever gets thrown at them. because they've seen it all already. but. one exposure doesn't do it i mean over. the course of the first few years of.

life kids get exposed to chronoviruses. tons of times lots of different viruses. they get. so unfortunately what's happening with. us why this is so bad for us is that as. we're adults. we don't regenerate tissue very well we. have like over abundant inflammatory. response we have all these problems that. when we get an infection for the first. time. it sucks it harms us it causes us. problems but over time just like a baby. we're going to start building up our. immunity through vaccines and exposures. you know i hate to say it but tons of.

people are getting exposed to delta. right now who don't know it. tons. and. uh if you're vaccinated you don't know. it as my point there. and you know at the end of the day this. is actually i do not want this to be. misconstrued as like saying go get. infected but the fact that people are. getting infected you know will. add to our level of protection later on. and so yeah but the question is how long. that whole process takes i think you. know my guess is probably by the end of.

next year early 2023 we will probably. start looking at this as though it is. not a particularly dangerous virus for. most people the elderly though it will. still be but that's because they're. immunity like variants and stuff right. now other people say this statement you. just said a year ago about this spring. right well that probably was not wise. well i mean it's because your the. intuition is like okay. now that there's a vaccine you're either. going to take the vaccine or get. infected and then it'll be hurt immunity.

over like it'll be very quick. so you know. that that's the intuition but. it seems like that's not. happening it seems like we're in this. constant state. of uh fear-mongering for different. reasons it's almost um. it's almost like the virus got. deeply integrated not into just our. biology but. in the game of politics and. in the fear mongering around the news.

because the virus now started being. together with the vaccine and the masks. and it started getting. uh integrated into uh the division. that's so effective at uh. monetizing social media for example and. so it's like all right. so how do you get out of that mm-hmm. because you can always kind of present. certain kinds of numbers about number of. cases or. how. full hospitals are and and start making. claims about that we're still this is as.

bad as it's ever been those kinds of. statements. and so i'm not sure exactly what the way. out is except the same way out as it was. originally which is testing. this information it's information yeah. and and i think we can do that we can. keep outbreaks suppressed with testing. because it's information like people. keep thinking of tests as big medical. things they're not they're information. it can allow us to control things just. like. we drive down.

a road and. we look at the cars and we don't hit. other cars because we have the. information that they're in the lane. next to us. and they're moving over like that's just. information like you said glow green the. problem with the virus you don't have. you don't see you're walking around and. everybody is a potential. uh. like infectious. creature and so if you see the world as. a potential potential for infection. you're going to be terrified of that. exactly right and that is what has. happened and i and that's why i've been.

pushing so hard for for these tests. because they can allow people if you use. them at a community level you can have. enough people know that they're positive. enough people are good people that they. won't go out and affect others. and the other great thing about them is. again a 10-day isolation period. especially for a vaccinated person but. in either case. is also an information problem we don't. have to isolate for 10 days if we're. infected what if we're only infectious. for two yeah especially if we're. vaccinated why are we telling people the.

only reason the cdc ever and the wha. suggested a 10-day. isolation or a 14-day quarantine is. because we didn't know when people. stopped being infectious. there's actually some people stay. infectious for 14 days it's rare. but there's a lot of people who stay. infectious for like four. and that's a whole other week that we're. asking people to isolate people would. probably be much more likely to comply. if they only have to isolate as long as. they wake up each morning and see two. lines. because you're actually seeing it for.

your own two eyes you're being empowered. to make your own decision you're not. being told you need to isolate for 10. days and you're sitting there thinking. oh i feel fine i don't know why you know. there's a lot of asymptomatic spread but. if you see the two lines. every day then you actually get to. you're doing a little experiment for. yourself to prove to yourself. today i'm still infectious let's hope. it's tomorrow come on immune system you. can do this you know and then you get to. day four and boom you start being. negative. that's a much more tolerable thing. because you are you are being able to.

make that decision based on. true data that is empowering you and it. really does change. changes everything like because it's all. fear and. and empowerment and these are empowering. devices. well i wanted to have this conversation. with you because obviously it's a great. solution let's keep talking about it. people who listen to this should uh. i guess pressure. local politicians. federal write articles write articles.

with the title like dear potus yeah you. know please designate these as public. health tools or just start talking about. in the media talk it talk about social. media anywhere. testing is a public health good. testing is a public health good we all. like it should not be considered a. medical device. i shouldn't have to pay. to keep you safe like testing should. generally be free for that matter like. subsidized by the government. these tools exist they we should all and.

i think the more people that generate. noise to just say. a public health test is a public health. tool. you know. period like it's you can't even argue. with it. yeah i think. if you talk about it enough then certain. people that have even a bigger platform. like elon musk sandra perchai. though those folks that. have power to really. do like large-scale manufacturing also. influence.

governments will pay attention and. that's that's the hope enough people. talk about it i think business leaders. like business leaders obviously have so. much power here yeah. you know they they pay the lobbyists who. you know make things happen like let's. be honest there's people who pull levers. that are not the politicians themselves. and i do think. business leaders have so much to gain. from these tools to keep their. businesses safe to not have to. quarantine and lock down and i hope that. all them hear this message to say. let's let's ask the president or the.

people around the president to. designate these as public health tools. change the system. and if you can't change every aspect of. the system then figure out how to change. the system enough so that you're doing. everything in a safe way. that is not endangering anyone but it is. only protective yeah. you mentioned last time you spent time. as a buddhist monk. we like. didn't spend much time talking about i. just would love to talk to you about. about it a little bit more.

maybe. as uh by way of advice. how do you recommend people can. integrate meditation into their lives. or how does one meditate. i i think for me meditation was. um. really an active effort um. which sounds weird because most people. think of meditation as like they la in. the absence of activity. um.

but just like anything uh meditation is. it requires exercise. in this case it requires exercise and. quieting your mind. and the whole. well there's a lot of different reasons. people meditate. most people watching this. podcast or this show what is this called. i don't know is this a interview i'm not. even recording this just you and i talk. um. it is. you know most people are.

uh meditating to like bring some balance. and bring some sanity to their life and. just like be able to control their. feelings and emotions a little bit more. and for that purpose like. i think the best way to to you know what. meditation is if you can call it what. you will it's just getting some alone. time some time to think or not think you. know whatever and that looks different. for each person for me. it was a very active effort to try to. quiet my mind. with the explicit intent to detach from.

things. from lots of things and it's actually it. sounds weird in our culture here to talk. about detachment as a goal. detachment from loved ones detachment. from objects is kind of. easy to reconcile like people understand. that yeah i don't want to be too. attached to my car or whatever. but detachment from a loved one is like. a very hard thing because we want to do. the opposite usually we want to love a. loved one. but in. a lot of buddhist thought.

it is those attachments that keep people. in this cycle of rebirth now i don't. personally um. believe in rebirth in the way that uh. you know. in a buddhist sense and that like you. actually get. born multiple times i think we my. personal feeling is we die and we're. vanished you know um that's just me. um and. but i still really found meditation to.

be extraordinarily powerful. to. feel control over a whole different part. of my body that i never thought that. it could be controlled. your mind like you close your eyes. and most of us immediately start seeing. blotches and. we start thinking about things and. and it's an amazing feeling to start. getting to the point where you can. actually. actually quiet your mind and close.

your mind down so that you can just. have peace like silence of your mind for. a long period of time and you know i. loved it it was you know but it's a it's. kind of a dangerous slope because you. can kind of get caught up in it and like. really start. going from okay i'm trying to quiet my. mind to almost being like addicted to. quiet in your mind. and it was a very active exercise every. day 15 hours a day to just. practice quieting my mind. and eventually i could you know it and.

and. in buddhism there's a whole lot of. stages that you go through to. once you hit that point where you can. quiet your mind then there's. like other. psychological things that happen and. eventually the the end goal for a. buddhist monk who's spending their life. meditating in the forest. is to achieve nirvana is to have. an absence of any attachment to the. point where. you're not even attached to your own. foot or your own leg you can cut it off.

and. you say well. so you don't even have an attachment to. self like to you to ego to cause do you. feel like a conscious being or no like. the goal you never attained it but you. know i know is that the goal just that. would be so the goal is. you have to first look at it through the. eyes of samsara which is the cycle of. rebirth. which is suffering it's a cycle of. suffering it's how it's viewed and the. idea is like if i really love this hat.

and then the hat gets lost i'm sad so. that makes me suffer. and if i hate this hat and i see it then. it makes me sad or mad and that you know. it's an emotion but if i have if i'm. completely ambivalent about that hat. i don't care it's there i don't care if. it gets lost if it's shredded. then that is invokes no emotional rise. out of me good or bad and so the idea is. to find the balance there where. you are so detached from everything that. you're not getting a rise negative or.

positive and. you know this is really it's really such. a distinct. thing. in a relative to our normal lives here. in america where. we live for rises you know you want. happiness and joy and then you also you. know nobody wants sadness but like when. you come out of sadness you feel happy. you understand. either way it averages out right and if. it doesn't average out then you're. you know you're in a bad spot like that. would be. things like major depressive disorder.

where you're truly not averaging out but. if you're living a pretty happy life. that's why there's no right or wrong you. can go up and down and you average out. or you can just. go that straight line. this is not necessarily. the the buddhist ideal is somehow. obviously. the ideal you should strive for. but the actual access exercise and. meditation that they the buddhist monks. use seems like um. seems like a great tool.

for becoming aware of your own mind. and that seems to be important for. appreciating life or some some kind of. uh experiencing life. on a deeper level. i i think so i mean that's my. my personal opinion is yes and that i. think it. i don't meditate anymore. um back in the capitalist western world. where there's meetings and.

that's right i mean i stopped i i was a. monk and then the tsunami hit. and i lived in a refugee camp and i was. that was the indian ocean tsunami in. 2004. and it just really. it was really interesting in sri lanka. they wanted me i asked well what can i. do to help. it was it was a horrible horrible. you know hell on earth. experience in many ways but. when i said what can i do to help. the answer was well you could meditate.

like that's how you know be keep keep. doing what you're doing like that's how. you. that's how we can get good karma and to. me coming from like western roots. i just couldn't deal with that i i just. said that that doesn't make sense to me. why would i just sit and meditate when. there's so much devastation happening. here and and so i kind of stopped. meditating then and then never really. recovered from that time in the refugee. camp. but. i do feel like i understand or like i am. aware of of a part of me that most.

people never get the privilege to be. aware of and that is a pretty profound. and. it's a it's a profound uh feeling i. think or just awareness to to say oh i. do have the cap if i ever need to go. back to that i have the capacity. to do that and i do use it i mean i. don't use it a lot but i use it when i. really need to um. to try to like settle to settle myself. to. to actually calm.

myself whether it's pain physical or. emotional pain like it is possible to. make those things go away but it just. like anything it takes training. [Music]. have you if you take yourself back to. that place you were. you know sam harris talks about. that through his meditation practice. he's able to. escape the sense of free will. and uh this the sense of agency. you can get away from that hey do you.

ever think about. consciousness and free will. when when you were meditating. like did you get some deep insight about. the nature. of consciousness. that you were somehow able to escape it. through meditation or no. i looked at it in a much more. utilitarian way. i think and. the sensation like minimizing amount of. thoughts in your mind and then uh. beginning to really appreciate the. sensation. yeah you weren't writing a book on the.

on free will right. and uh i mean maybe if i kept at it you. know there's a good chance that if the. tsunami didn't happen i might still be. sitting there on the top of that. mountain. tsunamis you see uh pain you see. especially um. uh if you see cruelty and you're. supposed to meditate through that that. doesn't. there's something in the human spirit. that. pushes us to want to help. if you see somebody who's suffering. to react to that seems like to help them.

as opposed to. care less through meditation. don't become attached to the suffering. of others. exactly i mean that's i i do think that. that's you know and they're two totally. valid ways to live life. um they are. generally i think they're ingrained in. us pretty early in society right and. it's hard to escape yeah what about uh. just in general becoming detached from. possessions. like minimalism. in uh not having many things so the the.

capitalist world. kind of. pushes you towards having possessions. and. deriving joy from more and more and. better possessions. have you um. have you returned back to the joys of. that world. or do you find yourself. enjoying. the minimalist life. uh a little of both i think i. really don't like i find things to be a. burden to be a massive burden.

yeah and. and to me when you have a burden like. that you know even if it's just knowing. that there's like boxes in your basement. of stuff you know whatever it might be. it makes it hard to. focus. um and so. i personally like. i mean my ideal like if i had a. my house for example would be to have. like nothing on anything it just. and and. that to me is like peaceful some people.

find that to be not peaceful. for me it's like i love the night to. have the night the idea that. if needed i could like. pack up and move yeah and not worry. about anything do i actually have that. in reality. no. um we're about to have a baby. you know there's but it's like it's our. i already see it it's like stressful. there's like boxes of stuff showing up. at the house like bottles and. clothes and all these little hats and.

whatnot and. i do i do have to like sometimes go into. my meditation to just. just say like this is okay you know. like it's. it's okay to have all of this stuff. it's not permanent you know and um but i. do think that it's easy to get lost in. it all and it's important to remember. given all that like people who buy. houses. you know buy a home and buy a house and. make a home out of it and you start a.

family it's easy to. forget that even though you have all. these responsibilities you're still free. and like freedom takes work and it takes. remembering it takes meditation on it. but you're you're free. you're you're born free you live free i. mean depends of course which country but. in the united states even with all the. possessions. even with all the burdens. of um. sort of credit and owing money and all. those kinds of things.

you can. scale everything down and you're free. but ultimately the people you love. if you love each other it doesn't take. much money to be happy together. and for me i i personally value that. freedom of having the freedom to always. pursue your happiness as opposed to. being burdened by material possessions. that uh. you know yeah that basically limit your. ability to be happy because you're. always paying off stuff you're always.

catching you know trying to match the. neighbors that are always a little bit. richer that kind of pursuit i think that. pursuit is wonderful for innovation and. for building cooler better things but on. an individual level. i think you have to remember that first. of all life is finite and second of all. like your goal is not to get a bigger. house your goal is to be just content. and happy. right in the moment i completely. completely agree with that. so in looking at our failure.

at scale. to. to engineer to manufacture to deploy. tests. how do you feel about our prospect as a. human civilization. are you optimistic. so this pandemic. it is. what it is. it um hurt a lot of people both. it took lives. but it also hurt a lot of businesses and. a lot of people economically.

but uh they're. very likely to be a much worse pandemic. down the line there might be other. threats to human civilization. are you nevertheless optimistic. oh i don't think i'm optimistic about it. all. i think what are you most worried about. i it's it's one of those things so. existential that i don't worry about it. um. but i do think i mean let's in the. united states for example so you asked. about the human civilization but let's. talk about like a american society for a.

moment. i do think that like we're. probably seeing like. the end of a really interesting. experiment like the american experiment. and we're seeing its limitations. we're probably going to become another. blip like another one another power. that's in the history books that like. rose and collapsed probably that's where. we'll go. in terms of civilization i think. we're demonstrating a pretty significant. inability to. recognize the danger when.

whether that's the pandemic or whether. that's climate change. i think it's extraordinary that we. we are not taking these things seriously. yeah and. we're not acting with the urgency and i. mean in some ways climate change. truly makes like this pandemic look like. child's play in terms of like the. destruction it has the potential to read. i tend to think if you just look at the.

progress of human history. that the people. who do good in the world. out power the people that are the. that do bad in the world so we kind of. there's something about our minds. that likes to focus on the negative like. on the destructive because we're afraid. of it. it's also for some reason more fun to. watch destruction i don't you know. but it seems like the people who build. who create solutions who um.

yeah who innovate and who just put. like. both on the emotional level so love out. there and. like. on the actual engineering level tools. that make for higher quality of life i. think those win out if you look at human. history. um but the question is whether the. negative stuff can sometimes peak to the. level where everybody's just destroyed. but as long as that doesn't happen. i i tend to believe that there would be.

like a gradual with some. noise a gradual improvement of quality. of life in human civilization. i do think so to a certain extent but. it's that what's what you said like. unless there's like some. significant peak of bad you know the. the problem with bad. is that it can happen like that you know. good. you can you can't build a society. overnight but you sure can kill one. like i just think. about.

food crises and instability and just i. don't know but i do hope that i mean i. completely agree i think we can engineer. our way to a healthier. better world like i truly do. my concern is that the people who are. doing that until very recently. don't generally rule the world. now of course we're seeing. non-elected leaders and you know people. who. run massive corporations essentially.

having as much or really more power than. elected leaders or than kings and queens. and such. so how they choose to wield that power. you know is an interesting choice and i. do hope that you're right in that. over time. fear. will drive companies to. produce a better product or whatever you. know something like over time it's just. like predator prey models. you get so bad or so everything like.

it's so revved up that all of a sudden. something cracks and they say okay i do. want an electric car or whatever like. and. and that takes some combination of. innovation. letting people know that these electric. cars exist it's kind of rapid tests too. like you get to finally feel it and see. it. have an electric car and then all of a. sudden things change and everyone says. oh this is so bad and actually i'm doing. good for the world relatively speaking. and. you know i guess it's a paradigm shift. yeah. it becomes uh lack of a better word.

viral. positivity does. and. i mean i believe that ultimately that. that wins out. because i think there's much more power. to be gained so i think most people want. to do good and if you want to wield. power you want to uh. channeled people's desire to do good. and i think over time that's that's. exactly what people uh. will do but yeah this i mean both on the.

natural side the pandemic you know. there's still biology at play there's. still viruses out there trying to help. us there's accidents uh there's nuclear. weapons there's unintended consequences. of tools whether it's on the. nanotechnology side or the artificial. intelligence side then there's the. natural things like meteors and all that. that kind of stuff and yeah climate. change. all of that. but i tend to think. we humans are a clever bunch and when. there's a deadline.

a real deadline or real threat before us. we kind of step up. i don't know but. maybe you have to believe that. um until the very end. yeah. that's. that's right it will oh i mean we'll. have to see i guess you know neither. well. ideally we won't be alive to see that. [Laughter]. well no michael i'm glad we talk again. because um. this has been such a difficult time that.

feels like there's no solutions. and it's so refreshing to hear. that there's a solution to covid and. it's an engineering solution on the. individual level something people can do. on the government level is something. people can do on the global level. something people can do we should be. doing rapid testing at scale it's. obvious. it's amazing that you still. are you know telling that story pushing.

that message bravely boldly i really. really appreciate the work you're doing. man and i'm i i will do in my small way. uh the same. to try to help out and everybody else. should too until we get. hundreds of millions of tests in. people's hands uh it's an obvious. solution we should have had a long time. ago. and um. i like solutions not problems and this. is obviously a solution so thank you for. presenting it to the world and thank you.

for talking about it. it's it's something that i can't not do. if it saves one person's life then it. was worth the two years of. lobbying for this you know and uh so. let's hope we see a change. thanks for talking today. absolutely. thanks for listening to this. conversation with michael minna to. support this podcast please check out. our sponsors in the description. and now let me leave you with some words. from lord byron. always laugh when you can.

it is cheap medicine. thank you for listening and hope to see. you next time. you.