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The following is a conversation with Michael Mina, his second time on the podcast.
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He s a professor at Harvard doing research on infectious disease and immunology.
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In my view, the most powerful, doable, and obvious solution to COVID-19 from the very beginning is rapid at-home testing.
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This is what Michael has been talking about and writing about since the beginning of the pandemic.
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The accuracy of these tests is high for the task of detecting contagiousness, which is what matters.
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Hundreds of millions can be manufactured quickly and relatively cheaply.
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Privacy and individual freedoms are preserved.
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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.
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at scale, all while respecting their freedom and minimizing the destructive effects of the pandemic on our health and our economy.
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This solution was obvious in May of 2020.
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It was obvious when Michael and I spoke the first time a year ago, and it is obvious today.
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We talk about why it has not yet been done and how we can still do it.
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And now, a quick few second summary of the sponsors.
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Check them out in the description.
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It s the best way to support this podcast.
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First is Notion, a note-taking and team collaboration tool.
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Second is Quip, an electric toothbrush.
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Third is Theragun, the device I use for post-workout muscle recovery.
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Fourth is Athletic Greens, the all-in-one nutrition drink I drink twice a day.
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And fifth is Four Sigmatic, maker of delicious mushroom coffee and plant-based protein.
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So the choice is good notes, clean teeth, muscle recovery, nutrition, or delicious coffee.
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Choose wisely, my friends.
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And now onto the full ad reads.
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As always, no ads in the middle.
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I try to make these interesting, but if you skip them, please still check out the sponsors.
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I enjoy their stuff, maybe you will too.
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This show is brought to you by a new sponsor called Notion.
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It s a popular note-taking app and team collaboration tool.
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It combines note-taking, document sharing, wikis, project management, and much more into one space that s simple, powerful, and beautifully designed.
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I can t tell you how many people recently have told me to start using Notion.
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I m a big fan of strategic sort of organized note-taking in all kinds of aspects.
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So when I do note-taking during paper reading, like technical content, when I do note-taking for brainstorming sessions, when I do note-taking for summarizing meetings,
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all kinds of note-taking, and I think there s a lot of tools that have strengths and weaknesses, and people have been telling me that Notion is amazing.
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The thing that I really want you to know about is that Notion is great for team collaboration.
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To give you a sense, that s almost a year of free Notion for a team of 10.
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go to Notion.com slash startups.
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That s Notion.com slash startups.
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This show is also brought to you by Quip, an electric toothbrush that has timed sonic vibrations with 30-second pulses to guide a dentist s recommended two-minute clean.
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I m a big believer that routine, that daily habits are essential to a productive life, to a successful life, to a happy life.
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It s, as Jaco says, discipline equals freedom.
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I think the discipline of routine is essential for productivity, because motivation is the fickle mistress.
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Routine means you don t have to worry about it.
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Now, brushing your teeth is one of the most common habits that people form and kind of stick with for most of their life.
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So building on this idea of routine and habits, it s not enough to just do it every day, honestly.
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Like, the second step is to use the best tool for the job, and in general, always be challenging.
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Like, can I do this better?
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Can I do this better?
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Like I said, use the best tool for the job.
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So, you should go to getquip.comslashlex right now.
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That s getquip.comslashlex.
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Get, Q-U-I-P, quip.comslashlex.
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This show is also brought to you by Theragun, a handheld percussive therapy device that I use after workouts for muscle recovery.
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It s surprisingly quiet, easy to use, comes with a great app that guides you through everything you need to know.
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I ve been recently getting a lot of hard training sessions, both running, lifting, but also on the mat with jiu-jitsu and training with some killers, training with some really tough people.
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And one of the things is,
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When people are better than you and the training is hard, you really put your body to the test.
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And so I often find myself being sore in a good way, but you have to make sure that you re recovering properly.
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And Theragun works really well for me for the muscle recovery part of the recovery.
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Anyway, try Theragun for 30 days at therabody.com slash lex.
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Theragun Gen 4 has an OLED screen, personalized Theragun app, and is both quiet and powerful, starting at $199.
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Go to therabody.com slash lex.
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This show is also brought to you by Athletic Greens and its new renamed AG1 drink, which is an all-in-one daily drink to support better health and peak performance.
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It replaced the multivitamins for me and went far beyond that with 75 vitamins and minerals.
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It s the first thing I drink every day.
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I drink them twice a day.
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In fact, I am traveling a bit right now.
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It s definitely something I missed because I forgot to pack Athletic Greens.
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So it s become such an integral part of my day that it just, when it s there, I feel great.
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So I have to make sure there s travel packs, so there s no excuse not to travel with Athletic Greens.
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Given the carnivore, given the keto diets I m doing, it s really important that I have a strong nutritional basis, and that s what Athletic Greens does.
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Anyway, they ll give you one month supply of fish oil when you sign up at athleticgreens.com slash lex.
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That s athleticgreens.com slash lex.
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This show is also brought to you by Four Sigmatic, the maker of delicious mushroom coffee and plant-based protein.
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Does the coffee taste like mushrooms, you ask?
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No, it does not, it tastes delicious.
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But beyond taste, it s just part, an integral part of my ritual in the morning.
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Something about the warmth, the kinda steam coming off of it.
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I put it in front of the computer, next to my Kinesis keyboard, listening to brown noise, and that s what I know, it serves as a catalyst.
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and I know this is the time to get some stuff done, to go deep, to think clearly and have a focused mind.
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And coffee somehow, the deliciousness, the warmth, the aroma, all of it contributes to that deep morning focus and I really value that.
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morning ritual.
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Get up to 40% off and free shipping on mushroom coffee bundles if you go to foursigmatic.com slash Lex.
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That s foursigmatic.com slash Lex.
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If you get it, I toast to you my coffee and maybe you can toast back yours.
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This is the Lex Friedman podcast and here is my conversation with Michael Mina.
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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.
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So let s recap.
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Where do things stand today in terms of rapid at-home testing?
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Well, it s certainly something that, you re right, I do think we should have them today.
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We ve now had almost 20 months of
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living in anxiety, uncertainty, being afraid for our health, for our family s health, for our friends, you know, shutdowns, economic instability.
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Everything has been uncertain because of this virus.
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And then there s this little test.
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And it s the first time for many people that they re using it and they re feeling empowered.
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They re feeling like they can control their little slice of this pandemic.
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As these tests have come out and more and more and more Americans have had an opportunity to go and buy them from, you know, CVS or Walgreens or wherever they re at.
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I think that it s really shifting the tenor of the discussion.
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For a long time, all of 2020, I often felt like it was me and a few other people against the world.
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These tests should be public health tools.
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These tests are infectiousness indicators.
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They shouldn t be compared to PCR.
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You know, all of these different things, and we could, of course, go through and recap what the benefits and the metrics are that we should be looking at.
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But the point is, last year and most of this year was about educating scientists, educating public health leaders, educating physicians.
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to get them to understand that there is a different reason to test in a pandemic than purely diagnostics and transmission blockade and severing transmission chains is a big one.
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So now I think we re at a point where people are now understanding.
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And they re understanding because they are feeling it.
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They re holding it and they re doing it.
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And they re feeling the delight of seeing a negative and saying, I feel more comfortable.
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It s not perfect, but it s pretty darn close to perfect.
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to allowing me to go and see my mom without mistakenly infecting her, or whatever the story might be.
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And now that that s happening, I think all of a sudden we re seeing a massive change politically for these tests.
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Biden just came out the COVID-19 action plan the other day, and one of the main pillars of it was testing, and in particular, bringing rapid tests, scaling them up.
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So on that front, I think finally there is success.
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People are actually understanding and I haven t stopped beating this drum for far too long and I hate rapid tests now.
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So maybe it s good to step back.
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Would you say most Americans have not taken a rapid at-home test?
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Absolutely, most have definitely not taken a rapid test.
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So like, many of them probably don t know.
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They kinda 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,
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That s the experience.
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And maybe if you have to travel, like Canada or something like that, you have to get tested, that kind of stuff.
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So what are rapid at-home tests?
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Yeah, so the rapid at-home tests are, I like to call them paper strip tests, simple.
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They re simple tests that, I wish I brought some today, but I didn t.
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They re simple tests that you swab.
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At the moment, most of them use a swab that you just swab the front of your nose.
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So it s not one of the deep swabs that goes into your brain.
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And so it s not very uncomfortable.
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It s just like picking your nose, if you will.
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And you put that swab into a little tube.
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And the tube has some liquid in it.
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And then you put a few drops of that liquid onto a paper strip, or you drop the paper strip into the tube, just like one of those indicators for the pool.
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And if you, just like a pregnancy test, then if you get two lines, you re positive, one line, you re negative.
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It s super simple.
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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.
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They are extraordinarily effective to answer one question, am I infectious?
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And that is the public health question that we need to answer and consistently ask
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during this pandemic?
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Are you infectious?
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Am I infectious?
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Because it s only when we know that we re infectious that we can be empowered to not mistakenly infect others.
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The PCR test is a little different.
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And we can go into the pros and cons, but one of the major differences is that a PCR test gets a lot of
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A lot of people talking about the PCR test say it s much more sensitive.
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And at an analytical level, it is.
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It can detect one molecule instead of 100,000.
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For public health, we don t want a test that can detect one molecule.
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In fact, that has created a net negative for public health.
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We just want to know, am I infectious?
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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.
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And the virus grows so fast, it will grow from zero to a billion in a day.
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So, you don t really need, even on the front end of an infection, you don t need better sensitivity if the tradeoff is that you don t get the result for one, two, or three days.
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You absolutely want a rapid result that can tell you, yes, you re infectious, you re transmitting to others right now.
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And I m going to give you the results right now.
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So it is a much more effective tool because it s fast, because it s accessible.
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We can use them in the home.
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And there s some issues with using them at home.
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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.
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But they can be accessible.
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PCR has to go into a lab.
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It takes a lot of time for somebody to get a PCR test.
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They either have to go online and order it.
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It takes the next day for it to come back.
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They swab themselves.
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They ship it out the next day.
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And then they get a result two days later.
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that s four days minimum for the most part.
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And at that point you re not even infectious even if you did happen to be infectious when you first ordered the test.
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So it s really the speed of these tests and the accessibility and distribution of them that makes them so immensely powerful.
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So you have this amazing graphic you tweeted.
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It s exactly what you re saying, which is a rapid antigen test answers the question, am I currently infectious?
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And you have, I think, a comparison of seven different tests based on the viral load.
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And based on the viral load across these different tests, you look at the likelihood of infectiousness.
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So what does this graphic show?
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We can overlay that for people.
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I think it s just really nice and really clear.
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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.
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That s what the FDA does currently.
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And that question doesn t mean anything.
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We have to say, what is the sensitivity of the test to detect what?
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And so we can have different viral loads.
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For example, you can have a viral load of one or you can have a viral load of a trillion.
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And a PCR test will tell you that you are positive regardless of whether it s one or a trillion.
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Now, so we can t ask the question, how sensitive is a rapid test compared to PCR, because that covers the whole gamut.
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What we really want to say is, how sensitive is the rapid test to detect me if I am infectious?
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And that gets to about 97% or so sensitive.
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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.
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They re all about 100% sensitive.
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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.
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And then as you go down the line, if you re no longer infectious at all, then these rapid tests might have a 0% sensitivity compared to PCR, but that s actually a good thing.
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The FDA and others look at it as though it s a bad thing because they average it all together and say, oh,
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This is only a 40% sensitive test compared to PCR.
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But that s not the right way to look at it.
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You want to say, well, out of all of the
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How many of them were not transmissible?
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How many were mid, moderate, high, extremely high, super spreader?
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And you should at the very least create a weighted average based on transmissibility potential.
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We don t do that.
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You know, and that s why nobody in America has these tests because, or 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
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80 or 90% sensitive compared to any time PCR positivity.
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They need to be 80 or 90% or more if you re infectious.
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And for that question, they re like 95 up to 100% sensitive when you re most infectious.
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So you have a lot of viron particles in you.
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So that s what it means when you say viral load.
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That means you re going to be very infectious.
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The more you have, the more infectious you are.
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And this test is basically
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very good at detecting when you re very infectious.
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Why don t we have a rapid at-home test?
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You said there s a bit of confusion, FDA is involved, you ve talked about, you continue to talk about
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that these at-home tests are classified as, I guess, medical devices.
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And so because of that, FDA is looking at them differently than they probably should be looked at.
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So what s the problem here?
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Can you sort of explain what does it mean to be a medical device?
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Why is that an issue?
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Where is the FDA messing up?
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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.
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So, PCR is currently the gold standard, or at least in the eyes of the FDA, the PCR test is the gold standard medical device.
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And as a physician, that s because it s so sensitive.
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As a physician, I have one patient in front of me at a time.
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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.
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I only care about that one patient.
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And so when I get a sample from that patient and that patient s saying, Doc, you know, I don t feel well.
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I haven t been feeling well for the last few weeks.
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Do you think this is COVID?
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Well, for that question, I want to have the absolute best sensitivity test.
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regardless of what it means for transmissibility, because my patient isn t sitting in my office saying, Doc, do you think I m infectious?
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They re saying, Doc, do you think I have recently been or am infected?
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And these are totally different things.
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One is medicine.
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And if the patient s infected, you know, time isn t of the essence because they re sitting there in my office.
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I can say, look,
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I m sorry you re not feeling well.
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Let s get a PCR test on you.
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We ll be able to tell you if you have any evidence that there has been recently an infection inside of you.
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And you ll get the result in a couple days.
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And it might be expensive, and so insurance is going to pay for it.
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And you re just one person, and so I don t really care how many resources it takes to get you this answer.
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On the other hand, there s rapid and there s public health testing.
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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.
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So accessibility becomes a central theme.
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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.
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So it has to say how frequently, what if you re infected tomorrow, but you re at the doctor s office today getting a negative COVID test?
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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.
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The only way to know that is to be testing yourself frequently.
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So, and the reason it matters is that these tests can be accessible if we are okay with saying the real purpose of a public health test is to answer the question, am I infectious?
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The reason we want to answer that is if you re infectious, that s when you isolate.
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We actually don t want to isolate PCR-positive individuals who are no longer infectious.
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That s bad public health practice.
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If I haven t been infectious for three weeks, I don t want to have somebody tell me that I need to go and isolate for 10 days just because I happened to use a PCR test today, three weeks after I was infectious.
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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 say, you guys have to quarantine for 14 days because you were with Michael, who wasn t infectious yesterday.
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It s nonsensical to do that.
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It s a huge disincentive to actually get tested voluntarily.
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That s exactly right.
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Huge disincentive to get tested.
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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.
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And to be clear,
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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.
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So, I mean, it s potentially a tenfold difference in terms of how long you re PCR positive versus how long you re infectious.
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So we don t want to be taking people during those 30 to 70 days and saying you need to isolate just because you go and get a swab, or you can t go on your trip just because you had COVID last month.
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That s not good use of a test.
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So the reason we don t have these tools right now is because
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When we evaluate 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.
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It only takes sensitivity and specificity to catch molecules.
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And so just by definition, I mean, it is a mathematical fact that if you have a perfect public health test for COVID, which means that it would be 100% sensitive and 100% specific for contagious people or for the infectious stage of an infection,
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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.
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And that s because you re only infectious for maybe 20%.
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Theoretically, it should only have a 20% sensitivity against the PCR while still being a perfect medical, a perfect public health test.
1
SPEAKER_01
And the test is answering the question, am I infectious?
1
SPEAKER_01
That s what you re testing for, not for the exact counting of the viron particles in your system.
1
SPEAKER_00
That s exactly right.
1
SPEAKER_01
Okay, so why are we still here?
1
SPEAKER_01
So have you had conversations with folks?
1
SPEAKER_01
You said that there s a bunch of,
1
SPEAKER_01
leaders that are kind of starting to wake up to this idea.
1
SPEAKER_01
But why is this taking so long?
1
SPEAKER_01
Why don t we still have hundreds of millions of at-home tests?
1
SPEAKER_00
The reason it s taking long, I think, is because every agency in government is generally deferential to the FDA.
1
SPEAKER_00
And in this context, I would argue that government hasn t been particularly creative.
1
SPEAKER_00
So, for example, last year, when Trump was still president, I would, or in the transition, I recall talking to the White House a number of times and saying, here s a plan to give us our lives back.
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SPEAKER_00
I think that was actually the title of the Atlantic article.
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SPEAKER_00
And this plan can stop shutdowns, it can stop outbreaks, it can allow society to keep running and could have prevented the outbreaks of last winter and fall and saved hundreds of thousands of lives.
1
SPEAKER_00
So when I bring that to the White House or to the government, the federal government, whoever it might be, and I say, here s a plan like this, this would work.
1
SPEAKER_00
They say, you know, what I get back is this sounds really interesting, Michael.
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SPEAKER_00
It looks like it checks out, but there s one problem.
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SPEAKER_00
We don t have the test.
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SPEAKER_00
There s no scale.
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SPEAKER_00
And that s kind of where it all dropped.
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SPEAKER_00
It s like this defeatist attitude of like, oh, don t have the test, so we can t act on it.
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SPEAKER_00
But now it s really changing.
1
SPEAKER_00
Well, and so that s really where things have been.
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SPEAKER_00
And so nobody s paid attention.
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SPEAKER_00
It s always been this esoteric thing that, yeah, maybe one day we ll get around to it, but really it s not that important.
1
SPEAKER_00
And the pandemic s going away.
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SPEAKER_00
But this was 100% predictable, everything that s happening today.
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SPEAKER_00
We predicted it last year.
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SPEAKER_00
This isn t rocket science or anything.
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SPEAKER_01
The variants and all those kinds of things.
1
SPEAKER_01
So the FDA, we can start to understand why, but also one question I wanna ask, is it possible to go around the FDA?
1
SPEAKER_00
Yeah.
1
SPEAKER_00
So why has the FDA not changed?
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SPEAKER_00
And why has nobody tried to push the FDA to change?
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SPEAKER_00
I think the real reason is the FDA has one job around these tests, and it is to authorize them as medical devices.
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SPEAKER_00
They haven t been charged with doing anything else.
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SPEAKER_00
So in their eyes, they re doing exactly what they re supposed to do.
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SPEAKER_00
They re evaluating these tests as medical devices, and they re telling company after company after company, sorry, you don t make the cut.
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SPEAKER_00
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.
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SPEAKER_00
We shouldn t be trying to skew clinical trials.
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SPEAKER_00
But that s kind of what s happened.
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SPEAKER_00
It s been forced upon the companies to do that.
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SPEAKER_00
And so I think the FDA truly believes from the bottom of their heart that they are doing the right thing here.
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SPEAKER_00
And I would argue that to an extent they are.
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SPEAKER_00
I ve been pretty hard on the FDA.
1
SPEAKER_00
Maybe the issue is a higher level issue, like the in vitro diagnostics division is they get applications and they evaluate them and the applications are for medical claims.
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SPEAKER_00
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.
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SPEAKER_00
except a medical claim.
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SPEAKER_00
So we don t have a public health pathway to evaluate a test and authorize a test.
1
SPEAKER_00
It doesn t exist.
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SPEAKER_00
We have defunded and devalued public health for so long that we literally don t have a language for it.
1
SPEAKER_00
We don t have laws, a language, words.
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SPEAKER_00
Is it called a public health test?
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SPEAKER_00
Is it called something else?
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SPEAKER_00
I call it a public health test because I m trying to
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SPEAKER_00
create a new definition here.
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SPEAKER_00
But that s why nobody s acted.
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SPEAKER_00
Because everyone says, well, there s no other pathway.
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SPEAKER_00
So the FDA in vitro medical diagnostics division is the only pathway.
1
SPEAKER_00
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.
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SPEAKER_00
And they don t authorize or review public health tests for COVID.
1
SPEAKER_00
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.
1
SPEAKER_00
One line could potentially change all of this.
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SPEAKER_00
And it s a pretty obvious and simple line.
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SPEAKER_00
And it is that any tools used for public health testing during this public health emergency
1
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will be designated as public health tools.
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SPEAKER_00
It s obvious.
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SPEAKER_00
It s a public health emergency.
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SPEAKER_00
It s a tool used for public health.
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SPEAKER_00
It should be designated as a public health tool.
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SPEAKER_00
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.
1
SPEAKER_00
They re not trying to cram a square peg through a round hole.
1
SPEAKER_00
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 1,000 people at a time or test a school classroom if they ve been exposed.
1
SPEAKER_00
This is public health.
1
SPEAKER_00
And so then the CDC could take it over.
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SPEAKER_00
The CDC could say, OK, what are the metrics we are interested in?
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SPEAKER_00
And they could say, we re interested in a test that can catch you if you re infectious.
1
SPEAKER_00
So you want high viral load detection.
1
SPEAKER_00
That s fast.
1
SPEAKER_00
That s scalable.
1
SPEAKER_00
And hey, if your test has been used in Europe for months and has performed extremely well, then we ll give you a certificate by right immediately.
1
SPEAKER_00
And that could actually get hundreds of millions of additional tests into the United States tomorrow.
1
SPEAKER_01
So you need some kind of classification from an FDA or from somebody to call it a public health tool in order for it to be manufactured?
1
SPEAKER_01
Is it possible to just go around all of this and just for somebody to manufacture at scale tests?
1
SPEAKER_00
And then?
1
SPEAKER_00
Well, if you did that, and you just called them, you put a claim on them that called them public health tools, the FDA has a very weird view of this.
1
SPEAKER_00
And they will tell you that it s illegal, that it s a crime.
1
SPEAKER_01
Is there a way to say, like Elon Musk did with the flamethrower, it s not a flamethrower?
1
SPEAKER_00
Believe me, I ve tried to think of all the different approaches.
1
SPEAKER_00
There s major inconsistencies here.
1
SPEAKER_00
So it s not like we don t have a precedent for a public health test, even during this pandemic.
1
SPEAKER_00
There is a very strong precedent.
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SPEAKER_00
Pooled testing.
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SPEAKER_00
We have companies like Ginkgo based out here in Cambridge that are working with 100 different labs around the country.
1
SPEAKER_00
So that might mean not a ton of quality control over those labs.
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SPEAKER_00
I don t want to say that they don t.
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SPEAKER_00
I m just saying the reality is if you work with that many labs, it s hard to say.
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SPEAKER_00
They re running pooled testing of millions and millions and millions of kids.
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SPEAKER_00
So here you have a company that s testing in each pool five to 25 kids at a time, millions of kids in a pretty distributed way across the country in all these different labs, and the FDA doesn t care at all.
1
SPEAKER_00
You don t need an EUA.
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SPEAKER_00
It doesn t need a regulatory authority.
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SPEAKER_00
It s collection on site.
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SPEAKER_00
It s getting shipped to a lab.
1
SPEAKER_00
There s no oversight of it.
1
SPEAKER_00
So why does that have no oversight but a rapid test for the exact same purpose?
1
SPEAKER_00
You re just giving people immediate results instead of two-day delayed pooled PCR results, so it s a much more effective tool.
1
SPEAKER_00
Why is the rapid test used for the same purpose, not designated as a public health tool, but requiring FDA authorization?
1
SPEAKER_00
It s a ridiculous reason, and it s because the FDA says that if a test
1
SPEAKER_00
And this is actually CMS that says this and the FDA adopts it.
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SPEAKER_00
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.
1
SPEAKER_00
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.
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SPEAKER_00
And that s not falling, like that s more risky.
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SPEAKER_00
One person turns positive in the pool and 25 people have to be quarantined.
1
SPEAKER_01
And how do they evaluate the accuracy?
1
SPEAKER_01
So for people who don t know, 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.
1
SPEAKER_00
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.
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SPEAKER_00
and all those swabs go into a single tube.
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SPEAKER_00
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.
1
SPEAKER_00
And so if that tube turns positive in the PCR test, then all 20 or 25 of those students are now having to quarantine.
1
SPEAKER_00
And if there s no positive, then all 20 or 25 students are interpreting that their result is negative.
1
SPEAKER_00
So it really is a 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 one person at a time if you re positive or if you re negative.
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SPEAKER_00
But if you do it as a pool and you tell 25 people that you re
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SPEAKER_00
was negative, then that s somehow different.
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SPEAKER_00
That s public health, not medicine.
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SPEAKER_00
It doesn t make, there s no logic there.
2
SPEAKER_01
Was it just personalities and accidents of history or something like that?
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SPEAKER_01
For example, you talk about the public health tools and CDC, you look at masks.
2
SPEAKER_01
So masks were decided to somehow be an effective tool to help with the pandemic.
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SPEAKER_01
So
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SPEAKER_01
I m sure the evidence that was used there was probably not as strong as the evidence supporting antigen rapid tests.
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SPEAKER_01
I was very much reading a lot of research on masks.
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SPEAKER_01
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.
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SPEAKER_01
but then the CDC pretty quickly decided masks, or whatever, there s some oscillations back and forth, but then they quickly decided, everybody decided masks is a good tool.
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SPEAKER_01
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?
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SPEAKER_01
Is this just like a weird roll of the dice or is there a better explanation?
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SPEAKER_00
I think it s somewhat of a roll of the dice, but I also think it s that testing.
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SPEAKER_00
So doctors don t pretend to like really understand much about like
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SPEAKER_00
fluid dynamics and how well masks are working.
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SPEAKER_00
That s way out of their realm.
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SPEAKER_00
Doctors do believe that they understand all aspects of the tests.
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SPEAKER_00
And so the greatest barriers to rapid tests being brought to market or sort of
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SPEAKER_00
being rolled out heavily and supported as public health tools, the greatest barriers came from physicians saying, hell no, we can t use a test that s not as sensitive as a PCR.
2
SPEAKER_00
And look at what happens if you use this antigen test and not a PCR test.
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SPEAKER_00
You get people who are showing a positive on a PCR and negative on an antigen.
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SPEAKER_00
And they just assume that that was a false negative on the antigen.
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SPEAKER_00
For public health, I would call it a false positive on the PCR test.
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SPEAKER_00
But this type of thinking literally does not exist in medicine.
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SPEAKER_00
And I think the biggest problem here is that we placed physicians in decision-making power.
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SPEAKER_00
We have, when this pandemic hit, everyone called up clinical laboratory folks and microbiologists and physicians to ask, well, what kind of test should we use?
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SPEAKER_00
That kind of thing.
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SPEAKER_00
And there is no training in medical school for this kind of public health work.
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SPEAKER_00
You have to optimize on the right qualities of a test that have nothing to do with medicine.
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SPEAKER_00
And then sometimes, if not frequently, they re actually at odds.
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SPEAKER_00
And I ll give an example.
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SPEAKER_00
why the physicians, you could see why the physicians would have been against it from their perspective.
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SPEAKER_00
And they say, if a physician is a TSA agent at the airport, a TSA agent, their role at any given time, and the role they think that the instruments need to play is, I want you to scan the bag as well as possible.
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SPEAKER_00
This is the only bag that I m interested in at the moment.
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SPEAKER_00
And this is my lane, this is my bag.
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SPEAKER_00
I want to make sure that my instrument s doing... I don t want the crappy instrument in my lane.
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SPEAKER_00
I want to make sure that I m doing everything I can.
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SPEAKER_00
What those TSA agents don t have to worry about is, well, how many other instruments are there in this airport?
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SPEAKER_00
Is anyone getting through the lines here without going through security?
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SPEAKER_00
The average TSA agent doesn t have to worry about that.
2
SPEAKER_00
They literally have one job to do, and it s pay attention to this lane.
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SPEAKER_00
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.
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SPEAKER_00
That s not a big systematic problem of the system.
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SPEAKER_00
And we can t expect that TSA agent to have ever even thought about that.
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SPEAKER_00
That s not on them.
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SPEAKER_00
They were trained to look at the bag.
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SPEAKER_00
And that s kind of like physicians.
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SPEAKER_00
And probably some physicians will hear this and feel like I m insulting it.
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SPEAKER_00
I don t mean to be likening the two professions or anything like that.
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SPEAKER_00
But the point is that
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SPEAKER_00
A physician has one duty.
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SPEAKER_00
Do no harm to this patient.
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SPEAKER_00
Time isn t of the essence.
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SPEAKER_00
Scale.
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SPEAKER_00
How many tests can my hospital perform in a day?
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SPEAKER_00
How many tests can my county or country perform in a day?
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SPEAKER_00
That s not a physician s training to think like that at all.
2
SPEAKER_00
And so what has happened is doctors got on board early and said, oh, hell no.
2
SPEAKER_00
We ve seen these antigen tests before.
2
SPEAKER_00
They re not particularly sensitive compared to PCR.
2
SPEAKER_00
And early in the pandemic, there was like pissing matches between labs who had the most sensitive PCR.
2
SPEAKER_00
And it just distracted everything.
2
SPEAKER_00
It really, I was trying to say pretty early, like,
2
SPEAKER_00
We don t need sensitivity.
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SPEAKER_00
We just need frequency.
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SPEAKER_00
We just need scale.
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SPEAKER_00
We need to think differently, because our only goal, if we re doing frequent routine testing of asymptomatic people, is not medicine.
2
SPEAKER_00
It s to say, do you need to isolate now?
2
SPEAKER_00
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,
2
SPEAKER_00
and you handed me, this actually happened to me today when I walked into Harvard.
2
SPEAKER_00
Today was my first day back into Harvard since February of 2020.
2
SPEAKER_00
I go in, I scan my badge, and they hand me a PCR tube, and they say, like, return this by,
2
SPEAKER_00
or something before your workday s done.
2
SPEAKER_00
And I m looking at it, I m like, what is this gonna do?
2
SPEAKER_00
What if I m super spreader right now?
2
SPEAKER_00
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?
2
SPEAKER_00
It doesn t really make sense.
2
SPEAKER_01
So who is supposed to be, so it s understandable that doctors kind of feel that way, just like you said, do no harm.
2
SPEAKER_01
Who s supposed to care about public health?
2
SPEAKER_01
Is it the FDA?
2
SPEAKER_01
Is there some other organization yet to be created?
2
SPEAKER_01
Is it like, just like with the military, the reason we have civilian leadership, when you talk about war, is it the president that s supposed to do like override FDA, override doctors, override,
2
SPEAKER_01
And basically politicians in representing the people in a state of emergency make big public health decisions.
2
SPEAKER_01
Like who is supposed to do it besides you on Twitter?
2
SPEAKER_01
It s like most people really thinking about solutions to COVID will mention you or will mention this idea of rapid at-home testing.
2
SPEAKER_01
And you watch that happening,
2
SPEAKER_01
this discussion that this is an obvious part of the solution, and the solution s not happening.
2
SPEAKER_01
So who is supposed to implement this idea?
2
SPEAKER_00
I think the CDC, that it should start there.
2
SPEAKER_01
Override the FDA?
2
SPEAKER_00
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,
2
SPEAKER_00
This isn t in your jurisdiction to the FDA.
2
SPEAKER_00
This is just a public health tool.
2
SPEAKER_00
But the problem is, the Centers for 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.
2
SPEAKER_00
So to change that at this point, unless you can get CMS buy-in, there is no designation as a public health tool.
2
SPEAKER_00
But the president
2
SPEAKER_00
can just say, these are public health tools.
2
SPEAKER_00
These are not to be regulated as medical devices if their goal is not medicine but public health.
2
SPEAKER_00
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 authorize them for use in the United States.
2
SPEAKER_00
And he has to say something like that.
2
SPEAKER_00
He can t
2
SPEAKER_00
come out and say these are public health tools, have free reign.
2
SPEAKER_00
Just, you know, any company start shipping them in the U.S.
2
SPEAKER_00
because that would create pandemonium and we d have a lot of bad tests.
2
SPEAKER_00
But there s a lot of really good tests out there.
2
SPEAKER_00
We just are taking like six to 12 months to run trials.
2
SPEAKER_00
They re failing because they can t keep up with PCR.
2
SPEAKER_00
And if the president were to do this, then the CDC could take it over, and they could say, OK, it s on us.
2
SPEAKER_00
We re going to decide.
2
SPEAKER_00
The UK actually did this.
2
SPEAKER_00
Early on, they said, OK.
2
SPEAKER_00
They laid out a very clear regimen.
2
SPEAKER_00
They said, this is how we are going to evaluate rapid antigen tests, because they re public health tools.
2
SPEAKER_00
They did it in a domain that was outside of their normal medical diagnostic regulatory agencies.
2
SPEAKER_00
And they literally just had very fast screening to say what are the best tests.
2
SPEAKER_00
They went through a huge number of different tests.
2
SPEAKER_00
They said, okay, this is the rank order of which tests are good, which are bad, which are scalable, which are not.
2
SPEAKER_00
And they were able to start deploying them in weeks, not years.
2
SPEAKER_00
So I think the CDC really needs to take charge.
2
SPEAKER_00
The problem is, when it comes to law, if everyone currently perceives this as fully within the domain of the FDA, and they ve never heard of such a public health test idea,
2
SPEAKER_00
Enabling but the but the FDA itself has created the idea by saying we don t regulate public health tools So the word is out there.
2
SPEAKER_00
The FDA has said we don t regulate them.
2
SPEAKER_00
So that gives the president an opportunity to say okay These are those you know, these are public health tools by definition
2
SPEAKER_00
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?
2
SPEAKER_00
That s just really sad, you know, if we get through this and don t figure out how to evaluate a damn rapid test.
2
SPEAKER_01
So how do vaccines play with this?
2
SPEAKER_01
So one of the things that when people discuss solutions to COVID, there s a sense that once you have a vaccine, COVID is solved.
2
SPEAKER_01
So how does that interplay?
2
SPEAKER_01
Like why do we still need tests if we have vaccines?
2
SPEAKER_00
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 Vaccines.
2
SPEAKER_00
The real reason is because we have evaluated our vaccines based on their ability to stop disease.
2
SPEAKER_00
In fact, most of the trials didn t evaluate them based on their ability to stop transmission.
2
SPEAKER_00
They didn t even evaluate that at all, no less put it as one of the metrics for authorization.
2
SPEAKER_00
And with a virus like this, it would be a bit naive to think that it s really going to stop transmission well.
2
SPEAKER_00
I think a lot of excitement happened right after the first clinical trials.
2
SPEAKER_00
And I m sure we were talking about it when I was last here, I would imagine, given the timing.
2
SPEAKER_00
But those first clinical trials came out and everyone jumped for joy that these things were gonna be the end to this pandemic.
2
SPEAKER_00
But we had really short-sighted vision there by not recognizing two main features.
2
SPEAKER_00
One is that they might not stop transmission.
2
SPEAKER_00
Another, I guess three, another is that new variants might come around that will break through the vaccine protective immunity.
2
SPEAKER_00
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.
2
SPEAKER_00
And that gives a skewed view of just how effective these are going to be long term.
2
SPEAKER_00
So what happened with the vaccines is that everyone got very comfortable, including the CDC, saying, if you ve been vaccinated, you know, this is the end of the pandemic for you.
2
SPEAKER_00
And let s keep it up.
2
SPEAKER_00
But then Delta comes along.
2
SPEAKER_00
and waning immunity comes along.
2
SPEAKER_00
And both of these things compound exactly as anticipated to get breakthrough cases.
2
SPEAKER_00
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,
2
SPEAKER_00
they started interpreting that as a failure of the vaccine.
2
SPEAKER_00
The vaccines are still working to keep people out of the hospital for the most part, but they re not working to stop transmission.
2
SPEAKER_00
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 wanna worry about it anymore,
2
SPEAKER_00
We re not there yet.
2
SPEAKER_00
So until we decide we re not going to stop transmission, we need other avenues besides the vaccine because it s not doing it.
2
SPEAKER_00
It also means that herd immunity isn t going to happen.
2
SPEAKER_00
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.
2
SPEAKER_00
And that makes me very nervous.
2
SPEAKER_00
So the more we can do to stop spread in the unvaccinated, in the elderly vaccinated, and in other people, the better.
2
SPEAKER_00
We just should be focusing on that.
2
SPEAKER_01
So in your eyes, the solution would look like this.
2
SPEAKER_01
You would make enough tests where every single person would get tested every single day?
2
SPEAKER_00
I think that that would be, I don t want to do that actually.
2
SPEAKER_00
I want to do a variation on that.
2
SPEAKER_00
I think what we should do is have a dynamical testing program.
2
SPEAKER_00
It doesn t have to be
2
SPEAKER_00
Complicated.
2
SPEAKER_00
Every household has a box of tests in their cupboard.
2
SPEAKER_00
And if you haven t seen any cases in your community for a long time, stop testing.
2
SPEAKER_00
Do wastewater testing to see if there s any RNA coming back.
2
SPEAKER_00
If you start to see RNA in the wastewater that represents the virus and you re still wanting to stop outbreaks,
2
SPEAKER_00
You say, hey, you know those tests that are in your cupboards, households in this county, why doesn t each household or each person in each household use one test per week?
2
SPEAKER_01
And- Can you, sorry to just pause on that idea, that s really cool, the wastewater testing, that s the thing?
2
SPEAKER_01
So you can get a sense of how prevalent the virus is in a particular community by testing the wastewater?
2
SPEAKER_00
That s exactly right, and so the viral load associated, the viral load that you can find in the community represents the prevalence of the virus in the community, which is really quite nice.
2
SPEAKER_01
That s a nice way to paint like a map of the intensity of the virus.
2
SPEAKER_01
Okay, so when,
2
SPEAKER_01
when it goes above a certain level, you can start doing much higher frequency testing in each household.
2
SPEAKER_00
That s right.
2
SPEAKER_00
So I don t want people to be in testing purgatory.
2
SPEAKER_00
Like that s not what I want.
2
SPEAKER_00
I just want us to get through this damn pandemic.
2
SPEAKER_00
And so we can monitor the wastewater or any other methods.
2
SPEAKER_00
We can monitor the hospitals and the clinics.
2
SPEAKER_00
And if somebody does come in with COVID-like symptoms and then a few other people come in, you realize, okay, we got spread happening in our community.
2
SPEAKER_00
send out a text message, put it on the news, put it in the newspaper, whatever you need to do, tell people, tell families, use your test.
2
SPEAKER_00
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.
2
SPEAKER_00
If you start to find outbreaks in pockets, then the rule is simply, okay, let s squash the outbreak real fast.
2
SPEAKER_00
So everyone in that area, in certain zip code or whatever it might be, test every two days,
2
SPEAKER_00
you know, for seven days, or every day for seven days, and you ll get rid of the outbreak.
2
SPEAKER_00
We can do that.
2
SPEAKER_00
And if you ve now gone, again, a week or two with no cases identified, stop the testing again.
2
SPEAKER_00
That s the nice thing that everything changes when people have the tests in their home.
2
SPEAKER_00
It becomes dynamic.
2
SPEAKER_00
It can become easy.
2
SPEAKER_00
Send a text message, take your test today.
2
SPEAKER_00
If some people don t do it, that s fine.
2
SPEAKER_00
The only goal is to get R below one and you stop the outbreak.
2
SPEAKER_00
People think it has to be near perfect.
2
SPEAKER_00
I always hear people say, oh, what if somebody doesn t use it?
2
SPEAKER_00
Or what if somebody lies?
2
SPEAKER_00
Well, you have 98% of people testing, or even 50%.
2
SPEAKER_00
That s a whole lot better.
2
SPEAKER_00
And another big difference that people, I think, oftentimes have a problem wrapping their head around
2
SPEAKER_00
Especially, to an extent, physicians who are used to different kinds of metrics, is that all we have to do to completely
3
SPEAKER_01
an outbreak from spreading in a community is to get for every hundred infected people to get them to go on and infect 95.
3
SPEAKER_01
Most people would say, oh my god, that s a horrible, you know, that s a horrible program.
3
SPEAKER_01
You re still letting a hundred people go and infect 95 people.
3
SPEAKER_01
But that s, for a virus like this, that s a massive public health win.
3
SPEAKER_01
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.
3
SPEAKER_01
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.
3
SPEAKER_01
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.
3
SPEAKER_01
Massive differences here.
3
SPEAKER_01
And the only goal then is to get R below 1, have 100 people infect less than 100, and you stop the outbreaks and everyone stays safe.
3
SPEAKER_00
From everything you ve seen, how cheap can these things get?
3
SPEAKER_00
From like in the past year, in terms of the developments you ve seen with the various test manufacturers, how cheap can it be to make a test, to manufacture a test?
3
SPEAKER_01
So there s the manufacturing process, that could be $0.50, maybe less.
3
SPEAKER_01
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.
3
SPEAKER_01
Some of them are produced here in the United States too, but $0.50 is a very, very reasonable, generous number for how much it costs per test.
3
SPEAKER_01
You look at a place with high market competition that has actually authorized a lot of these tests, like Germany.
3
SPEAKER_01
Germany has 60, 70 some odd different companies of high quality rapid tests authorized.
3
SPEAKER_01
You can go there and buy it for 80 cents.
3
SPEAKER_01
And they re still making a profit.
3
SPEAKER_01
So it s extremely cheap.
3
SPEAKER_01
Market competition can drive these tests way down in terms of cost.
3
SPEAKER_01
I think one of the most important features of a rapid test program is what do you do with the result?
3
SPEAKER_01
Is it going to be used for you to gain entry to school or work?
3
SPEAKER_01
Is it going to be reported to the public health agencies?
3
SPEAKER_01
You know, all of these, the primary mode should be just get people tests.
3
SPEAKER_01
But really, if you re going to be using it for a workplace thing, like what Biden is now saying, vaccinator test, which is going to lead to a crisis if we don t fix this soon, because we re going to have massive demand for testing in the next couple of weeks.
3
SPEAKER_01
But when he says that, that s essentially saying, okay, companies need to make sure that their people are testing.
3
SPEAKER_01
So are you going to base it on the honor system?
3
SPEAKER_01
I would say you probably would not base testing on the honor system if it s like to take somebody who would otherwise be quarantined in school.
3
SPEAKER_01
And so you can go to school as long as your test is negative.
3
SPEAKER_01
So test to stay program is a big thing that I ve been pushing for and others have.
3
SPEAKER_01
Businesses bringing people into work.
3
SPEAKER_01
Who needs a test?
3
SPEAKER_01
They need to have verification.
3
SPEAKER_01
But they don t want to set up nursing stations in their lobbies or in the school parking lot or whatever.
3
SPEAKER_01
Everyone s tired of that.
3
SPEAKER_01
We need to bring the test into the home, but that means we need the technology to enable it.
3
SPEAKER_01
And so I was at a conference recently.
3
SPEAKER_01
Do you know Mike Milken, Milken Institute?
3
SPEAKER_01
He s a very wealthy billionaire, but he s done a lot of philanthropy.
3
SPEAKER_01
And he hosts a conference to raise money for prostate cancer research.
3
SPEAKER_01
I was at this conference recently.
3
SPEAKER_01
Francis Collins and a number of other people were there.
3
SPEAKER_01
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.
3
SPEAKER_01
But you didn t have to test there, and they didn t base it on the honor system.
3
SPEAKER_01
Every morning, I scanned a QR code on the box, and eMed, which is a service that provides test verification, popped up with a proctor right on my phone or on my computer, and said, okay, let s go through your tests.
3
SPEAKER_01
And they watch you, they videotape you using the test, so it s all recorded, it s all a reportable type of test.
3
SPEAKER_01
And at the end of it, just from your home, you don t actually see the proctor.
3
SPEAKER_01
But they re just verifying that you actually do it.
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SPEAKER_01
They verify the test.
3
SPEAKER_01
They verify the test results with you.
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SPEAKER_01
And at the end of it, you ve then gotten from your couch or from your car, wherever you are, an actual verified laboratory report that can be considered proof that you yourself used the test and you yourself got a negative.
3
SPEAKER_01
So the tools are out here if we want to use them at scale.
3
SPEAKER_01
And in fact, the CDC uses eMed now to enable people to come back into the United States through an antigen test.
3
SPEAKER_01
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.
3
SPEAKER_01
And you get the negative, and CDC will accept that.
3
SPEAKER_01
TSA will accept you to come back into the U.S.
3
SPEAKER_01
with a rapid antigen test that you did without anyone else watching, except for this proctor on your phone.
3
SPEAKER_01
Super simple.
3
SPEAKER_00
how much private information is being collected.
3
SPEAKER_00
So people have, in the United States, the American way, they have a hesitancy on the overreach of government in things like vaccine passports.
3
SPEAKER_00
Like using any mechanism, any mechanism of verification that s controlled by government can lead to overreach by said government.
3
SPEAKER_00
So there s a concern of that.
3
SPEAKER_00
see there a way of achieving testing that s verified but does not violate people s privacy or sense of freedom?
3
SPEAKER_01
Absolutely.
3
SPEAKER_01
I think so.
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SPEAKER_01
The way that right now in the United States, they re requesting that these tests get, that the results get delivered to public health agencies.
3
SPEAKER_01
But I ve long held that
3
SPEAKER_01
While that s ideal, it should never be the thing that holds up somebody being allowed to know their own status.
3
SPEAKER_01
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.
3
SPEAKER_01
in that situation because they need to know your name.
3
SPEAKER_01
But sure, I mean, could you cut off the public health reporting?
3
SPEAKER_01
Yes, you could.
3
SPEAKER_01
But I worry, I mean, can you opt out?
3
SPEAKER_01
Maybe you could opt out.
3
SPEAKER_01
That should be a feature.
3
SPEAKER_01
I want to opt out of the public health reporting because
3
SPEAKER_01
for whatever reason, otherwise I m not going to do the test.
3
SPEAKER_01
But that means that, okay, then you re not going to go to work.
3
SPEAKER_01
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.
3
SPEAKER_01
And how do you balance that during a public health emergency?
3
SPEAKER_01
I think first and foremost, let people, everyone has a right to know their status.
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SPEAKER_01
The fact that we have made it hard for people to know their status on their terms, I think is a travesty.
3
SPEAKER_01
I mean, it s just so terrible that we have
3
SPEAKER_01
prioritized us knowing at the expense of you.
3
SPEAKER_01
Essentially, what public health has long said during this pandemic is, if I m public health, if I can t know, then you can t know your status.
3
SPEAKER_01
That s not the right way to look at public health.
3
SPEAKER_01
We need to engage the public
3
SPEAKER_01
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.
3
SPEAKER_01
At least most people wouldn t.
3
SPEAKER_00
And then also you can create systems where individuals can form relationships based on their status without ever reporting it to a centralized place.
3
SPEAKER_00
So you can go to, I don t know, a local business owner might require that you show that you are negative.
3
SPEAKER_00
but that doesn t require reporting it.
3
SPEAKER_00
You can, like there might be basically like an ID that s only in possession, you are the only person in possession of that, so you literally show it.
3
SPEAKER_00
Here s a test I took, it s negative.
3
SPEAKER_00
And nobody else knows about that test.
3
SPEAKER_01
So that could very well be done, even through a company like EMED.
3
SPEAKER_01
I think, and I might be wrong here, 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 the public health agencies.
3
SPEAKER_01
But let s say there was something a little different.
3
SPEAKER_01
Let s say you were verifying an over-the-counter test, and it doesn t have to be a CLIA wave because it s over-the-counter.
3
SPEAKER_01
Then you re not bound by CLIA rules, and you could create the same service, but that just doesn t report out to the public health agencies.
3
SPEAKER_01
It gives people the option to opt in or out of public health reporting.
3
SPEAKER_01
And, you know, I know that public health people get a little queasy when I talk about this,
3
SPEAKER_01
As a public health person myself, I guess, of course, I would prefer that the data be available to evaluate to know where the cases are.
3
SPEAKER_01
But first and foremost, I want to make sure that the people using the test are going to use the test.
3
SPEAKER_01
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.
3
SPEAKER_00
Especially given that the central to the vaccine hesitancy is a distrust of authority and a distrust of government.
3
SPEAKER_00
So you re asking people to get tested and report their status.
3
SPEAKER_00
to a centralized authority when they re clearly do not trust that authority.
3
SPEAKER_00
It doesn t make any sense.
3
SPEAKER_00
It seems like a perfect solution to let people who are hesitant on the vaccine to get their own status and have full control of that information and opt in, provide that information if they wish to, but they have the full control of it and they have the freedom to do that information what they want.
3
SPEAKER_01
I fully agree with that, I really do.
3
SPEAKER_01
I think we can have the verified services, and we could have the privacy if you want it.
3
SPEAKER_01
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.
3
SPEAKER_01
And it s okay, like eMed emails you the lab report, you have it.
3
SPEAKER_01
You can say, look, that s my name, I used it this morning, negative.
3
SPEAKER_01
And in that case, you d want something that just is there and is not going anywhere else.
3
SPEAKER_01
And I think that those services,
3
SPEAKER_01
I think they can exist and it s a struggle because for those companies they don t want to fall out of favor with CDC or with the FDA and so this is a big problem in our marketplace in general by having
3
SPEAKER_01
By having private companies who want to be the public health agents of this pandemic, we lose a lot of control because the companies ultimately have to do what s going to make them money so they survive and keep performing the service.
3
SPEAKER_01
It s really just such a hard problem, and this is why last time I was here, I m guessing I was probably really pushing for the government to be producing these tests.
3
SPEAKER_01
I think I would have still been pushing for that.
3
SPEAKER_01
You know, at this point, I ve decided, okay, the government s clearly not going to do that.
3
SPEAKER_01
I ve been thinking I really want Elon Musk to produce the test.
3
SPEAKER_01
I really am sort of serious that these tests are simple to make, but we ve been using machines to make them that have been around for a long time.
3
SPEAKER_01
Scale is an issue right now, kind of.
3
SPEAKER_01
Really, it s the EUA process and getting the companies to be allowed to market in the US that s the issue.
3
SPEAKER_01
But let s just say scale is the issue, and one company wants to make 20 million tests a day.
3
SPEAKER_01
These aren t that hard.
3
SPEAKER_01
We should be able to do that.
3
SPEAKER_01
We just need a faster machine, a better machine, and a quicker one.
3
SPEAKER_00
And there s a few folks, like you mentioned, know how to solve that problem.
3
SPEAKER_00
I ve had a lot of discussion with Tesla folks and with people that used to work at Tesla, like Jim Keller, about how to make stuff much cheaper, much better.
3
SPEAKER_00
That s basically what Tesla is world class at.
3
SPEAKER_00
It s like, okay, does this thing have to cost $1,000?
3
SPEAKER_00
No, it can cost $10.
3
SPEAKER_00
And let s figure out how to manufacture it.
3
SPEAKER_00
Those folks are like the best in the world at doing that.
3
SPEAKER_00
Okay, but what about this Biden action plan?
3
SPEAKER_00
So it sounds like the guy agrees with you, vaccinate or test.
3
SPEAKER_00
So I think given that choice, a lot of people go test in America because there s like a division it seems like.
3
SPEAKER_00
So what, is this just politics, is this just words or do you think this is actually gonna lead to something?
3
SPEAKER_00
And maybe can you explain what the action plan is?
3
SPEAKER_01
So there s a number of pillars to the action plan.
3
SPEAKER_01
The two that I ve been most focused on, I mean, some of them are we want to get everyone vaccinated, all these things.
3
SPEAKER_01
And one pillar is saying any company in the United States that has more than 100 employees is now required to ensure that any unvaccinated individuals in their workforce test weekly.
3
SPEAKER_01
Another pillar is that the president s going to reduce the cost of PCR tests by 35%, which is pretty moderate reduction, and is going to reduce the cost of antigen tests and scale them up and make 280 million tests and put $2 billion into it.
3
SPEAKER_01
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.
3
SPEAKER_01
The issue at hand, though, is that now that the president has said vaccinate or test, there s a problem inherent in that.
3
SPEAKER_01
It s essentially to coerce people who are unvaccinated to get vaccinated.
3
SPEAKER_01
Because vaccinate or test doesn t make sense when the vaccinated people can transmit the virus just fine.
3
SPEAKER_00
It should be vaccinate and test.
3
SPEAKER_01
Exactly.
3
SPEAKER_01
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 effort to get people vaccinated.
3
SPEAKER_01
Like, I m not going to wade into that argument.
3
SPEAKER_01
Do I agree with it or not?
3
SPEAKER_01
I m just not going to even put my words under it.
3
SPEAKER_00
I disagree with it.
3
SPEAKER_00
Let me say that.
3
SPEAKER_00
I disagree.
3
SPEAKER_00
As opposed to doing great science communication, this weird
3
SPEAKER_00
People talking down to the populace as if they re children trying to trick them.
3
SPEAKER_00
Here, have some candy.
3
SPEAKER_00
Everyone with common sense.
3
SPEAKER_00
Somebody told me, I was having a conversation, if the government is gonna give you money to take the vaccine, people that were already hesitant about the vaccine,
3
SPEAKER_00
are not going to trust whatever the heck you re doing.
3
SPEAKER_00
So don t trick people into taking the vaccine.
3
SPEAKER_00
Be honest and communicate transparently everything that s known about the vaccine.
3
SPEAKER_00
Communicate the data.
3
SPEAKER_00
Inspire people with information.
3
SPEAKER_00
with transparency and real communication of all the uncertainty around it and all the difficult decisions of risk and all those kinds of things, as opposed to trying to trick them like children into taking the vaccine anyway.
3
SPEAKER_00
Yes, but.
3
SPEAKER_01
Okay, well, I didn t have to say it, so there we go.
3
SPEAKER_00
But you re saying it should not be like vaccinate or test, that trade-off does not make sense.
3
SPEAKER_00
Exactly.
3
SPEAKER_01
Vaccinate, by saying vaccinate or test, is absolutely confusing.
3
SPEAKER_01
Because it implies, for anyone who s thinking about it, it is implying, and I ve seen this because I have business leaders call me, Fortune 500 business leaders who call me and say,
3
SPEAKER_01
What do I do?
3
SPEAKER_01
Like, I have 8,000 employees.
3
SPEAKER_01
Where am I going to get my tests?
3
SPEAKER_01
You know, and a lot of people are saying they re calling this a pandemic of the unvaccinated.
3
SPEAKER_01
These types of divisive, this divisive language doesn t help.
3
SPEAKER_01
This isn t a pandemic of the unvaccinated.
3
SPEAKER_01
This is a pandemic of a fucking virus.
3
SPEAKER_01
You know, like, don t ever put it on the unvaccinated who frankly are just scared.
3
SPEAKER_01
They don t know who to trust.
3
SPEAKER_01
And we haven t given them a lot of reason to trust public health, to be frank.
3
SPEAKER_01
So, I agree.
3
SPEAKER_01
I mean, now that you ve opened the door, I ll just say my piece.
3
SPEAKER_01
Like, absolutely, we need to be the most honest we can with all of this.
3
SPEAKER_01
This is confusing language to say vaccine or test.
3
SPEAKER_01
We need to say, we need to be very upfront and say, look, vaccines aren t stopping transmission very well.
4
SPEAKER_01
Well, unfortunately, this is the world we have.
4
SPEAKER_01
We have Delta, we re going to have new mutants.
4
SPEAKER_01
We have a vaccine that wanes somewhat over time.
4
SPEAKER_01
You know, this is biology.
4
SPEAKER_01
I m sorry.
4
SPEAKER_01
I m, you know, this is just what it is.
4
SPEAKER_01
And then we say, but the vaccines are really protective for your personal health.
4
SPEAKER_01
They re going to keep you out of the hospital.
4
SPEAKER_01
This is what you should care about as an individual.
4
SPEAKER_01
And as a population, we need to figure out, okay, we have to stop transmission if that s our goal.
4
SPEAKER_01
So, we should use the tools that are going to stop transmission if that s our goal.
4
SPEAKER_01
And saying vaccinate or test, if our goal is to actually stop transmission, that s confusing because vaccines are not stopping it.
4
SPEAKER_01
They re maybe mildly lowering the risk of transmission.
4
SPEAKER_01
So I m just not a fan of that language.
4
SPEAKER_01
I think we should be being very, very clear, like you said, and upfront about what are the limitations of the test, of the vaccine, and of the test.
4
SPEAKER_01
And we should be very clear that, like, you know, it can only help the American public
4
SPEAKER_01
in aggregate, is extremely intelligent.
4
SPEAKER_01
They will figure out when you say that vaccine breakthrough cases are rare, and then they start seeing story after story of whole parties of people who are vaccinated have outbreaks, and everyone knows more people now who are having breakthrough cases than they knew who had regular cases before the vaccine.
4
SPEAKER_01
People start to wonder, hmm.
4
SPEAKER_01
Well, this is weird.
4
SPEAKER_01
They say that the vaccines are working and breakthrough cases are rare.
4
SPEAKER_01
Maybe the whole vaccine program is failing entirely.
4
SPEAKER_01
And so it ends up shooting ourselves in the foot if we try to create false expectations because we think it s going to be beneficial for one thing when it s not for the other.
4
SPEAKER_01
And so to get back to the action plan, vaccinate or test, I think
4
SPEAKER_01
and the increase in rapid tests, I do think it was a bold move.
4
SPEAKER_01
I think it, 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.
4
SPEAKER_01
My real concern now with, is that 280 million tests, that s like less than one per person per year in the United States.
4
SPEAKER_01
So that s not,
4
SPEAKER_01
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.
4
SPEAKER_01
It sounds like a big number.
4
SPEAKER_01
Most people are now going to be expecting that these tests are actually going to be staying in stock on the shelves at CVS and Walgreens and Amazon or whatever.
4
SPEAKER_01
So, that s crisis number one, is like, now the expectation is set for having rapid tests, but they re not going to scale that well.
4
SPEAKER_01
We won t have them.
4
SPEAKER_01
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.
4
SPEAKER_01
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.
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And so the only real solution to this is to just scale up the tests that are actually scalable.
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And that s the simple rapid tests.
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And it s not even to scale them up through production and manufacturing here.
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It s to open the door so that the companies that already exist here in KenScale are allowed to do it, and to bring in the international market, some of the biggest diagnostic companies in the world.
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are not selling their millions and millions and billions of tests in the United States because they don t want to play the game that the FDA is currently requiring of them.
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So we have an opportunity, and 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
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supportive of it in principle.
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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.
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Otherwise, there could be some real political points taken off.
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You know, I do worry that the president, if he doesn t pull through with this and really make the tests available, we end up getting into this other test crisis this fall.
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there could be political consequences to that.
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And the reason is like these rapid tests are so personal, they become emotional almost.
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They give people that empowerment that I was talking about earlier.
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And when people can t get that, because the shelves are out of stock, they actually feel frustrated, and then that converts into anger and blame.
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And so I do think that we have to be really smart about
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making a policy like this and then ensuring that we can carry through with what the average American is actually expecting.
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SPEAKER_00
And speaking of politics, one of the great things about testing, maybe you can correct me, but from my sense, it s one of the only solutions to COVID that has not yet been politicized.
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SPEAKER_00
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.
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Or like,
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proud use, effective use of those tools.
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And it seems like everybody I talk to about testing, everybody s on board, red or blue.
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They are, which is why I am particularly concerned about the vaccinate or test policy.
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Right.
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Because all of a sudden we just politicized it.
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We just...
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brought it with this thing that was fully bipartisan, really bipartisan.
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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
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You can have it reported or not.
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You can have it in the home in the privacy of your own home or not, or you do it at school.
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These tools are just so powerful to identify infectious people.
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They didn t have to be politicized.
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They still don t.
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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.
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The have to part, right.
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And that is where we go wrong.
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It s, I have to get tested or vaccinated.
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You know, screw that, I am independent, you know, whatever.
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And I do worry that this thing that was purely bipartisan, that we could have just scaled up months ago.
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People would have, we could have delivered it to every household, didn t even have to ask people to request it, just delivered packages to every home in America by now, easily.
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if we were smart about it, you know, we could have done it.
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SPEAKER_00
The most unpleasant thing about COVID is the uncertainty, and that s what leads to fear on both the vaccine hesitant, it s the uncertainty about the vaccine, and people who have taken the vaccine, the uncertainty around, like,
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SPEAKER_00
Am I in danger walking around?
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Can I go, can I walk down the hall?
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Like this fear of the world around you.
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And I think testing allows you to remove a lot of that uncertainty.
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Like you gain back confidence that you can operate in this world and not get infected.
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And you become like a nicer person.
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I find myself every time I get tested, I become a nicer person to others.
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Because I know I m not putting people in danger.
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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?
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I don t know and this has created massive anxiety and I can t tell I completely agree that it is
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It s a relieving feeling.
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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 and everyone rapid tests.
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And I said, everyone should rapid test before you walk into this room.
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And it was a wonderful experiment because everyone was just so relaxed.
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The alternative is everyone, nobody tests and everyone wears a mask.
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You have a mask that maybe gives you 20% maybe protection if you re all in the same room together, if that.
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Or you have a rapid test program where everyone rapid tests before and that gives you like 95% to 100% protection, not 100% but close.
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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.
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And restaurants,
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Restaurants are scary right now because you just don t know who might be infectious and nobody s masked.
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And wouldn t it be great to just go into a restaurant where you know that everyone just tested negative that day?
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It just really reduces anxiety.
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It makes individuals feel empowered.
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And I mean, at the end of the day, COVID and our response to COVID, it s truly an information problem.
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You know, why do we quarantine anyone?
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Why did we ever close anything down?
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SPEAKER_01
We didn t close things down because everyone is positive.
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We closed things down because we didn t know if anyone was positive.
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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.
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And so we just quarantine everyone.
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When there s a positive in the classroom, like one day, we ll then ask the whole classroom not to come to school for 10 days.
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That s not
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a biological problem, that s an information problem.
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And the crazy thing is we have the tool to solve that information problem.
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It s literally our eyes on the virus.
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It s how we see this virus.
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SPEAKER_01
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.
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SPEAKER_00
I like what you said, the quarantine is an information problem.
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SPEAKER_00
That s absolutely right.
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SPEAKER_00
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?
4
SPEAKER_00
Can you speak with your money somehow?
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SPEAKER_00
What can people do to help?
4
SPEAKER_01
God, it s amazing to think you re asking me this question and this video will go out to the web and all the people that watch you.
4
SPEAKER_01
And last year, in July maybe, something like that, June, I forget exactly when it was, I was on Twiv this week in virology.
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SPEAKER_00
Shout out to Twiv.
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SPEAKER_00
Those guys are awesome.
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SPEAKER_01
They are awesome.
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SPEAKER_01
I love Twiv.
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SPEAKER_01
And they asked me the exact same question towards the end.
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They said, this makes so much sense.
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Why wouldn t we do this?
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What could people do?
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And so I said, oh, just send me an email.
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Write to me.
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I m sure you could find my email somewhere online.
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And get in touch, and we can try to figure out how to make something happen.
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SPEAKER_01
Yeah, that was smart.
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Bad idea.
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SPEAKER_00
Very smart.
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Way too many emails.
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I feel bad because I didn t end up getting back to anyone because I just got inundated.
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But it did lead to the development of rapidtest.org, where we did automate the process of writing letters to congressional members and elected representatives.
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So that helps.
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Fast forward to today, what can people do?
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I honestly don t know.
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Like what can the average person at this point do?
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We have tried everything.
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The FDA is immutable on this.
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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.
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SPEAKER_01
So what we need to do, and maybe this is something to do, is get, if you know people
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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,
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SPEAKER_01
uses executive powers to just do something as simple as designating these powerful public health tools as public health tools, allow the CDC and the NIH or whomever it must be or academic centers of excellence designated by the CDC to evaluate the tests in a very fast fashion with the appropriate metrics that these tests need to achieve for public health.
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SPEAKER_01
And within two days, we can have 10 new tests authorized.
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SPEAKER_01
You know, this doesn t have to be a six to 12 month endeavor.
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This could be a two day endeavor.
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We actually did it.
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I judged the rapid test XPRIZE.
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And it went great.
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We actually got incredible metrics about how well does each test work.
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SPEAKER_01
And no clinical trials, you know, just a couple days worth of work in the lab and boom.
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And if we actually systematize it, it would be an hour or so in the lab.
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SPEAKER_01
You know, so simple.
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So I don t know.
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I mean, I don t know how to really impact change.
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Thankfully, I have a platform and I ve been able to start talking with people who are very close to the president and the White House.
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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.
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So now I think we re moving from a country that was a vaccine-only approach to
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finally recognizing at the highest levels that there s other tools.
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SPEAKER_00
Do you think it s possible to reopen fully without solving the testing problem completely?
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SPEAKER_00
Like, do you think this vaccine approach will get us to reopen fully?
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SPEAKER_01
I do.
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SPEAKER_01
Yeah, I think over time though.
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I mean, a lot of people ask me like, what s happening?
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What s the end game here?
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Where does this end?
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And it s actually not a mystery.
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The end game is we will grow out of this virus.
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And by that I mean,
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You and I, and most people who are watching this, are adults, right?
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Adults don t like to get infected with a virus for the very first time as adults.
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Babies are okay with it.
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And so what we have to do to understand how we re getting out of this virus is to look at babies, like at newborns, and say, okay, how does a baby get out of their high-risk time period?
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They get exposed.
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They get exposed multiple times, or vaccinated, of course.
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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.
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But one exposure doesn t do it.
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I mean, over the course of the first few years of life, kids get exposed to coronaviruses tons of times, lots of different viruses they get.
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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.
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We have like overabundant inflammatory response.
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We have all these problems that when we get an infection for the first time, it sucks.
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It harms us.
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It causes us problems.
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But over time, just like a baby, we re going to start building up our immunity through vaccines and exposures.
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I hate to say it, but tons of people are getting exposed to Delta right now who don t know it, tons.
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And if you re vaccinated, you don t know it, is my point there.
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And at the end of the day, this is actually, I do not want this to be misconstrued as like saying, go get infected.
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But the fact that people are getting infected will add to our level of protection later on.
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SPEAKER_00
And so- Yeah, but the question is how long that whole process takes
4
SPEAKER_01
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.
4
SPEAKER_01
The elderly, though, it will still be, but that s because their immunity like variants and stuff.
4
SPEAKER_00
Well, I ve heard other people say this statement you just said a year ago about this spring, right?
4
SPEAKER_01
Well, that probably was not wise.
4
SPEAKER_00
Well, I mean, it s because the intuition is like, okay, now that there s a vaccine, you re either going to take the vaccine or get infected, and then there ll be herd immunity over, like, it ll be very quick.
4
SPEAKER_00
So, you know, that s the intuition.
4
SPEAKER_00
It seems like that s not happening.
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SPEAKER_00
It seems like we re in this constant state of fear mongering for different reasons.
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SPEAKER_00
It s almost like the virus got deeply integrated, not into just our biology, but
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SPEAKER_00
in the game of politics and in the fear-mongering around the news, because the virus now started being, together with the vaccine and the masks, and it started getting integrated into the division that s so effective at monetizing social media, for example.
4
SPEAKER_00
And so it s like, all right, so how do you get out of that?
4
SPEAKER_00
because you can always kind of present certain kinds of numbers about number of cases or how full hospitals are.
5
SPEAKER_00
and start making claims about that we re still, this is as bad as it s ever been, those kinds of statements.
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SPEAKER_00
And so I m not sure exactly what the way out is, except the same way out as it was originally, which is testing, is information.
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SPEAKER_00
It s information.
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SPEAKER_01
Yeah.
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And I think we can do that.
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We can keep outbreaks suppressed with testing because it s information.
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Like people keep thinking of tests as being medical things.
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They re not.
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They re information.
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It can allow us to control things.
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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 out there in the lane next to us.
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SPEAKER_01
and they re moving over, like that s just information.
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SPEAKER_00
Like you said, glow green.
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SPEAKER_00
The problem with the virus, you don t have, you don t see, you re walking around and everybody s a potential infectious creature.
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SPEAKER_00
And so if you see the world as a potential for infection, you re going to be terrified of that world.
5
SPEAKER_01
That s exactly right.
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And that is what has happened, and that s why I ve been pushing so hard for these tests, because they can allow people, if you use them at a community level, you can have enough people know that they re positive, enough people are good people that they won t go out and affect others.
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SPEAKER_01
And the other great thing about them is, again, a 10-day isolation period, especially for a vaccinated person, but in either case,
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is also an information problem.
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SPEAKER_01
We don t have to isolate for 10 days if we re infected.
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SPEAKER_01
What if we re only infectious for two?
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SPEAKER_01
Especially if we re vaccinated.
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SPEAKER_01
Why are we telling people the only reason the CDC ever and the WHO ever suggested a 10-day isolation or a 14-day quarantine is because we didn t know when people stopped being infectious.
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SPEAKER_01
There s actually some people who stay infectious for 14 days.
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SPEAKER_01
It s rare.
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SPEAKER_01
But there s a lot of people who stay infectious for like four.
5
SPEAKER_01
And that s a whole other week that we re asking people to isolate.
5
SPEAKER_01
People would probably be much more likely to comply if they only had to isolate as long as they wake up each morning and see two lines.
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SPEAKER_01
Because you re actually seeing it for your own two eyes.
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SPEAKER_01
You re being empowered to make your own decision.
5
SPEAKER_01
You re not being told, you need to isolate for 10 days.
5
SPEAKER_01
And you re sitting there thinking, oh, I feel fine.
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SPEAKER_01
I don t know why.
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SPEAKER_01
There s a lot of asymptomatic spread.
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SPEAKER_01
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.
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SPEAKER_01
Let s hope it s tomorrow.
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SPEAKER_01
Come on, immune system, you can do this.
5
SPEAKER_01
And then you get to day four, and boom, you start being negative.
5
SPEAKER_01
That s a much more tolerable thing because you are being able to make that decision based on true data that is empowering you.
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SPEAKER_01
And it really does change, changes everything because it s all fear and empowerment and these are empowering devices.
5
SPEAKER_00
Well, I wanted to have this conversation with you, because obviously it s a great solution.
5
SPEAKER_00
Let s keep talking about it.
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SPEAKER_00
People who listen to this should, I guess, pressure local politicians, federal, national politicians.
5
SPEAKER_01
Write articles with the title like, Dear POTUS,
5
SPEAKER_01
you know, please designate these as public health tools, or just start talking about it in the media, talk about it on social media, anywhere.
5
SPEAKER_01
Testing is a public health good.
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SPEAKER_01
Testing is a public health good.
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SPEAKER_01
We all, like, it should not be considered a medical device.
5
SPEAKER_01
I shouldn t have to pay to keep you safe.
5
SPEAKER_01
Like, testing should generally be free, for that matter, like, subsidized by the government.
5
SPEAKER_01
these tools exist, we should all, and I think the more people that generate noise to just say a public health test is a public health tool, you know, period.
5
SPEAKER_01
You can t even argue with it.
5
SPEAKER_00
If you talk about it enough, then certain people that have even a bigger platform, like Elon Musk, Sundar Pichai, those folks that have power to really do large-scale manufacturing, also influence governments, will pay attention.
5
SPEAKER_00
That s the hope.
5
SPEAKER_00
Enough people talk about it.
5
SPEAKER_01
I think business leaders, like business leaders, obviously have so much power here.
5
SPEAKER_01
They pay the lobbyists who make things happen.
5
SPEAKER_01
Let s be honest, there s people who pull levers that are not the politicians themselves.
5
SPEAKER_01
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.
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SPEAKER_01
And I hope that all of them hear this message to say, let s ask the president or the people around the president
5
SPEAKER_01
designate these as public health tools, change the system.
5
SPEAKER_01
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.
5
SPEAKER_00
You mentioned last time that you spent time as a Buddhist monk.
5
SPEAKER_00
We didn t spend much time talking about it.
5
SPEAKER_00
I just would love to talk to you about it a little bit more.
5
SPEAKER_00
Maybe by way of advice, how do you recommend people can integrate meditation into their lives?
5
SPEAKER_00
Or how does one meditate?
5
SPEAKER_01
I think for me meditation was Really an active effort Which sounds weird because most people think of meditation as like they lack in the absence of activity But just like anything meditation is It requires exercise in this case.
5
SPEAKER_01
It requires exercise and quieting your mind and the whole
5
SPEAKER_01
Well, there s a lot of different reasons people meditate.
5
SPEAKER_01
Most people watching this podcast or this show, what is this called?
5
SPEAKER_01
I don t know.
5
SPEAKER_01
Is this an interview?
5
SPEAKER_01
I m not even recording, this is just you and I talking.
5
SPEAKER_01
It is.
5
SPEAKER_01
Most people are meditating to bring some balance and bring some sanity to their life and just be able to control their feelings and emotions a little bit more.
5
SPEAKER_01
And for that purpose, like, I think the best way 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 it looks different for each person.
5
SPEAKER_01
For me,
5
SPEAKER_01
It was a very active effort to try to quiet my mind with the explicit intent to detach from things, from lots of things.
5
SPEAKER_01
And it s actually, it sounds weird in our culture here to talk about detachment as a goal.
5
SPEAKER_01
Detachment from loved ones, detachment from objects is kind of easy to reconcile.
5
SPEAKER_01
People understand that, yeah, I don t want to be too attached to my car or whatever.
5
SPEAKER_01
But detachment from a loved one is like a very hard thing because we want to do the opposite usually.
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SPEAKER_01
We want to love a loved one.
5
SPEAKER_01
But in a lot of Buddhist thought, it is those attachments that keep people in this cycle of rebirth.
5
SPEAKER_01
Now, I don t personally believe in rebirth in the way that, you know,
5
SPEAKER_01
in a Buddhist sense in that you actually get born multiple times.
5
SPEAKER_01
I think my personal feeling is we die and we re vanished.
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SPEAKER_01
That s just me.
5
SPEAKER_01
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
5
SPEAKER_01
it could be controlled your mind like you close your eyes and most of us immediately start seeing watches and we start thinking about things and and it s an amazing feeling to start getting to the point where you can actually
5
SPEAKER_01
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.
5
SPEAKER_01
And you know, I loved it.
5
SPEAKER_01
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.
5
SPEAKER_01
And it was a very active exercise every day, 15 hours a day, to just practice quieting my mind.
5
SPEAKER_01
And eventually I could.
5
SPEAKER_01
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 other psychological things that happen.
5
SPEAKER_01
And eventually, the end goal for a Buddhist monk who s spending their life meditating in the forest,
5
SPEAKER_01
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.
5
SPEAKER_01
You can cut it off and
5
SPEAKER_00
So you don t even have an attachment to self, like to ego, to, do you feel like a conscious being or no?
5
SPEAKER_00
Like the goal.
5
SPEAKER_01
I never attained it, but you know.
5
SPEAKER_00
Is that the goal, to escape?
5
SPEAKER_01
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, is how it s viewed.
5
SPEAKER_01
And the idea is like, if I really love this hat,
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and then the hat gets lost, I m sad.
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So that makes me suffer.
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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.
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But if I m completely ambivalent about that hat, I don t care if it s there, I don t care if it gets lost, if it s shredded, then that invokes no emotional rise out of me, good or bad.
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And so the idea is to find the balance there where
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you are so detached from everything that you re not getting a rise, negative or positive.
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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.
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And then you also, you know, nobody wants sadness, but like, when you come out of sadness, you feel happy.
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Either way, it averages out, right?
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And if it doesn t average out, then you re in a bad spot.
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That would be things like major depressive disorder where you re truly not averaging out.
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But if you re living a pretty happy life, that s why there s no right or wrong.
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You can go up and down and you average out or you can just go that straight line.
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So this is not necessarily the Buddhist ideal is somehow obviously the ideal you should strive for, but the actual exercise and meditation that the Buddhist monks use seems like a great tool for becoming aware of your own mind.
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And that seems to be important for appreciating life or some kind of experiencing life on a deeper level.
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I think so.
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I mean, that s my personal opinion is yes.
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And that I think it, I don t meditate anymore.
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Back in the capitalist Western world where there s meetings and
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That s right, I mean I stopped, I was a monk and then the tsunami hit and I lived in a refugee camp and that was the Indian Ocean tsunami in 2004 and it just really
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It was really interesting in Sri Lanka.
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They wanted me.
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I asked, well, what can I do to help?
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It was a horrible, horrible hell on earth experience in many ways.
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But when I said, what can I do to help?
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The answer was, well, you could meditate.
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Keep doing what you re doing.
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That s how we can get good karma.
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And to me, coming from like Western roots, I just couldn t deal with that.
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I just said that it doesn t make sense to me.
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Why would I just sit and meditate when there s so much devastation happening here?
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And so I kind of stopped meditating then and then never really recovered from that time in the refugee camp.
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But I do feel like I understand or like I am aware of a part of me that most people never get the privilege to be aware of.
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And that is a pretty profound and
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it s a profound feeling, I think, or just awareness to say, oh, I do have the, if I ever need to go back to that, I have the capacity to do that.
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And I do use it.
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I mean, I don t use it a lot, but I use it when I really need to, to try to like settle, to settle myself, to actually calm myself, whether it s pain, physical or emotional pain, like it is possible to,
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make those things go away, but it just like anything it takes training.
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Have you, if you take yourself back to that place you were
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Sam Harris talks about that through his meditation practice he s able to escape the sense of free will and the sense of agency.
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You can get away from that.
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Do you ever think about consciousness and free will when you were meditating?
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Did you get some deep insight about the nature of consciousness that you were somehow able to escape it through meditation or no?
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I looked at it in a much more utilitarian way, I think.
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And the sensation, like minimizing amount of thoughts in your mind and then beginning to really appreciate the sensation.
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Yeah.
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You weren t writing a book on free will.
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Right.
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And I mean, maybe if I kept at it, you know, there s a good chance that if the tsunami didn t happen, I might still be sitting there on the top of that mountain.
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Just not means you see a pain, you see, especially if you see cruelty and you re supposed to meditate through that, that doesn t, there s something in the human spirit that pushes us to want to help.
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If you see somebody who s suffering, to react to that seems like to help them as opposed to care less through meditation.
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Don t become attached to the suffering of others.
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Exactly, I mean that s, I do think that that s, you know, and they re two totally valid ways to live life.
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They are, generally I think they re ingrained in us pretty early in society.
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Right, and it s hard to escape.
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Yeah.
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What about just in general, becoming detached from possessions, like minimalism, and not having many things, so the capitalist world kind of
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pushes you towards having possessions and deriving joy from more and more and better possessions.
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Have you returned back to the joys of that world or do you find yourself enjoying the minimalist life?
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A little of both.
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I think I really don t like, I find things to be a burden, to be a massive burden.
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And to me when you have a burden like that, even if it s just knowing that there s like boxes in your basement of stuff, whatever it might be.
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it makes it hard to focus.
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And so, I personally like, I mean, my ideal, like if I had my house, for example, would be to have like nothing on anything.
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And that to me is like peaceful.
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Some people find that to be not peaceful.
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For me, it s like, I love to have the idea that
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if needed I could like pack up and move and not worry about anything.
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Do I actually have that in reality?
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No, we re about to have a baby, but 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.
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I do have to like sometimes go into my meditation to just
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just say like, this is okay.
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It s okay to have all of this stuff.
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It s not permanent.
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But I do think that it s easy to get lost in it all.
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And it s important to remember, given all that, people who buy houses, 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.
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And freedom takes work, and it takes remembering, it takes meditation on it, but you re free.
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You re born free, you live free.
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I mean, it depends, of course, which country.
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United States, even with all the possessions, even with all the burdens of sort of credit and owing money and all those kinds of things, you can scale everything down and you re free.
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But ultimately, the people you love
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If you love each other, it doesn t take much money to be happy together.
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And for me, I personally value that freedom of having the freedom to always pursue your happiness as opposed to being burdened by material possessions that, you know,
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that basically limit your ability to be happy.
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Because you re always paying off stuff, you re always trying to match the neighbors that are always a little bit richer, that kind of pursuit.
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I think that pursuit is wonderful for innovation and for building cooler, better things.
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But on an individual level, I think you have to remember that, first of all, life is finite.
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And second of all, your goal is not to get a bigger house.
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Your goal is to be just content and happy.
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in the moment.
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I completely completely agree with that.
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So in looking at our failure at scale
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to engineer, to manufacture, to deploy tests.
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How do you feel about our prospect as a human civilization?
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Are you optimistic?
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So this pandemic, it is what it is.
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It hurt a lot of people, both it took lives, but it also hurt a lot of businesses and a lot of people economically.
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but they re very likely to be a much worse pandemic down the line.
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There might be other threats to human civilization.
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Are you nevertheless optimistic?
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Oh, I don t think I m optimistic about it at all, I think.
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What are you most worried about?
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It s one of those things that s so existential that I don t worry about it.
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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 American society for a moment.
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I do think that like we re
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probably seeing 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 power that s in the history books that rose and collapsed.
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Probably that s where we ll go.
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In terms of civilization, I think we re demonstrating a pretty significant inability to recognize the danger wherein, whether that s the pandemic or whether that s climate change.
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I think it s extraordinary that we are not taking these things seriously.
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And we re not acting with the urgency.
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And I mean, in some ways, climate change
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truly makes this pandemic look like child s play in terms of the destruction it has the potential to wreak.
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I tend to think if you just look at the progress of human history, that the people who do good in the world outpower the people that do bad in the world.
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So we kinda, there s something about our minds that likes to focus on the negative, like on the destructive, because we re afraid of it.
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It s also, for some reason, more fun to watch destruction.
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I don t, you know.
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but it seems like the people who build, who create solutions, who innovate, and who just put both on the emotional level, so love out there, and on the actual engineering level, tools that make for higher quality of life, I think those win out, if you look at human history.
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But the question is whether the negative stuff can sometimes peak to the level where everybody s just destroyed.
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But as long as that doesn t happen, I tend to believe that there would be like a gradual, with some noise, a gradual improvement of quality of life in human civilization.
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I do think so, to a certain extent, but it s what you said, unless there s some significant peak of bad.
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The problem with bad is that it can happen like that.
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Good, you can t build a society overnight, but you sure can kill one.
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I just think about food crises and instability and just, I don t know, but I do hope that, I completely agree, I think we can engineer
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our way to a healthier, better world.
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I truly do.
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My concern is that the people who are doing that, until very recently, don t generally rule the world.
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Now, of course, we re seeing non-elected leaders and people who run massive corporations, essentially,
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having as much or really more power than elected leaders or than kings and queens and such.
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So how they choose to wield that power, you know, is an interesting choice.
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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 and prey models.
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you get so bad or everything gets so revved up that all of a sudden something cracks and they say, okay, I do want an electric car or whatever.
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And that takes some combination of innovation, letting people know that these electric cars exist.
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It s kind of like rapid test too.
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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.
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It s a paradigm shift.
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It becomes, for lack of a better word, viral.
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Positivity does.
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I believe that ultimately that wins out.
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Because I think there s much more power to be gained.
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So I think most people wanna do good, and if you want to wield power, you want to channel people s desire to do good.
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And I think over time, that s exactly what people do.
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But yeah, this, I mean, both on the natural side, the pandemic, you know, there s still biology at play.
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There s still viruses out there trying to kill us.
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There s accidents, there s nuclear weapons, there s unintended consequences of tools, whether it s on the nanotechnology side or the artificial intelligence side.
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Then there s the natural things like meteors and all that kind of stuff.
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And the climate change, all of that.
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But I tend to think,
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we humans are a clever bunch, and when there s a deadline, a real deadline, or a real threat before us, we kind of step up.
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I don t know, but maybe you have to believe that until the very end.
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Otherwise, life s not as fun.
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That s right.
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We ll have to see, I guess.
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Ideally, we won t be alive to see that.
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Well, Michael, I m glad we talked again because...
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This has been such a difficult time that feels like there s no solutions.
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And it s so refreshing to hear that there s a solution to COVID.
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And it s an engineering solution.
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On the individual level, it s something people can do.
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On the government level, it s something people can do.
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On the global level, it s something people can do.
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We should be doing rapid testing at scale.
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It s obvious.
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It s amazing that you still are,
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You know, telling that story, pushing that message bravely, boldly, I really, really appreciate the work you re doing, man.
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And I will do, in my small way, the same, to try to help out, and everybody else should too, until we get hundreds of millions of tests in people s hands.
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It s an obvious solution, we should ve had it a long time ago.
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And...
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I like solutions, not problems, and this is obviously a solution.
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So thank you for presenting it to the world, and thank you for talking about it.
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It s something that I can t not do.
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If it saves one person s life, then it was worth the two years of lobbying for this, you know, and so let s hope we see a change.
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Thanks for talking today.
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Absolutely.
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Thanks for listening to this conversation with Michael Mina.
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To support this podcast, please check out our sponsors in the description.
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And now, let me leave you with some words from Lord Byron.
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Always laugh when you can.
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It is cheap medicine.
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Thank you for listening and hope to see you next time.