Michael Mina: Rapid COVID Testing | Lex Fridman Podcast #235
the following is a conversation with michael minna his second time on the podcast he's a professor at harvard doing research on infectious disease and immunology in my view the most powerful doable and obvious solution to covet 19 from the very beginning is rapid at-home testing this is what michael has been talking about and writing about since the beginning of the pandemic the accuracy of these tests is high for the task of detecting contagiousness which is what matters hundreds of millions can be manufactured quickly and relatively cheaply privacy and individual freedoms are preserved i believe that if you give people the power of information information about whether they are contagious or not they will do the right thing at scale all while respecting their freedom and minimizing the destructive effects of the pandemic on our health and our economy the solution was obvious in may of 2020 it was obvious when michael and i spoke the first time a year ago and it is obvious today we talk about why it has not yet been done and how we can still do it this is the lex friedman podcast to support it please check out our sponsors in the description and now here's my conversation with michael minna we spoke a year ago about rapid at-home testing and i think you think it should have been still should be a big part of the solution to covid so let's recap where do things stand today in terms of rapid at home testing well it's a it's certainly something that uh you're right i do think we should have them today we've now had almost 20 months of living in anxiety uncertainty uh being afraid for our health for our family's health for our friends you know shutdowns economic instability everything has been uncertain because this virus and then there's this little test and it's the first time for many people that they are they're using it and they're feeling empowered they're feeling like they can control their little slice of this pandemic so as these tests have come out and more and more more americans have had an opportunity to go and buy them from you know cvs or walgreens or wherever they're at i think that it's really shifting the tenor of the discussion for a long time all of 2020 it was like i often felt like it was me and a few other people against the world you know these tests should be public health tools these tests are infectiousness indicators they shouldn't be compared to pcr you know all of the these different things and we could of course go through and recap what those what the benefits and the metrics are that we should be looking at but the point is last year and most of this year was about educating scientists educating public health leaders educating physicians to get them to understand that there is a different reason to test in a pandemic than purely diagnostics and transmission blockade and severing transmission chains the big one so now i think we're at a point where people are now understanding and they're understanding because they are feeling it they're holding it and they're doing it they're seeing they're feeling the delight of seeing a negative and saying i feel more comfortable it's not perfect but it's pretty darn close to perfect to allowing me to go and see my mom without mistakenly infecting her you know or whatever the story might be and now that that's happening i think all of a sudden we're seeing a massive change politically for these tests uh biden just came out the kova 19 action plan the other day and one of the main pillars of it was testing and in particular bringing rapid tests uh scaling them up so on that front i think finally there is success people are actually understanding and you know i haven't stopped beating this drum for far too long and i like hate rapid tests now so maybe it's good to step back uh would you say most americans have not taken a rapid home test absolutely most have definitely not taken a rapid test so like many of them probably don't know they kind of probably say testing they have like memories of testing like pcr testing they have to go into somewhere and they have to like a swab deep in their nose and that's the experience so maybe when if you have to travel like canada or something like that you have to get tested that kind of stuff so what are rapid at home tests yeah so so the rapid at-home tests are i like to call them paper strip tests simple they're simple tests that i wish i brought some today but i didn't um they're simple tests that uh you swab at the moment most of them use a swab that you just swab the front of your nose so it's not one of the deep the deep swabs that you know goes into your brain and uh and so it's not very uncomfortable it's just like picking your nose if you'll you know and and you you put that swab and you put that swab into a little tube and the tube has some liquid in it and then you pour put a few drops of that liquid onto a paper strip or you drop the paper strip into the tube just like one of those indicators for the pool and if you dress like a pregnancy test then if you get two lines you're positive one line you're negative it's super simple it takes 30 seconds once you know how to do it of hands-on time and you wait around 10 minutes and then you read the result they are extraordinarily effective to answer one question am i infectious and that is the public health question that we need to answer and consistently ask during this pandemic are you infectious am i infectious because it's only when we know that we're infectious that we can be empowered to not mistakenly infect others the pcr test is a little different and we can go into the pros and cons but uh you know one of the the major differences is that a pcr test gets a lot of a lot of people talking about the pcr test say it's much more sensitive and at an analytical level it is it can detect one molecule instead of a hundred thousand but for public health we don't want a test that can detect one molecule in fact that has created a net negative for public health we just want to know am i infectious and to know that question to know if i'm infectious i only need a test that is going to be positive if i have a high viral load like a million and when you're and the virus grows so fast it will grow from zero to a billion in a day so you don't really need even on the front end of an infection you don't need better sensitivity if the trade-off is that you don't get the result for one two or three days you absolutely want a rapid result that can tell you yes you're infectious you're transmitting to others right now and i'm going to give you the results right now so it is a much more effective tool because it's fast because it's accessible we can use them in the home and there's some issues with using them a home we can talk a little bit about what those issues are like reporting and how do you is everything on the honor system if you have a test that you're taking at home and you use it to go to work but they can be they can be accessible pcr has to go into a lab it takes a lot of time for somebody to get a pcr test they either have to go online and order it it takes the next day for it to come back they swab themselves they ship it out the next day and then they get a result two days later that's four days minimum for the most part and you know at that point you're not even infectious even if you did happen to be infectious when you first ordered the test right so it's really of the speed of these tests and the accessibility and distribution of them that makes them so immensely powerful so this like amazing graphic you tweeted it's exactly what you're saying which is a rapid antigen test answers the question am i currently infectious and you have i think a comparison of three different uh sorry seven different tests based on the viral load and based on the viral load across these different tests you look at the likelihood of infectiousness so what is this graphic show we can overlay that for people just i think it's just really nice and really clear yeah so what that's showing is that we can never ask what's the sensitivity of a test and just let that be the answer that's what the fda does currently and that question doesn't mean anything we have to say what is the sensitivity of the test to detect what right and so we can have different viral loads for example we can have you can have a viral load of one or you can have a viral load of a trillion and a pcr test will tell tell you that you are positive regardless of whether it's one or a trillion now so we can't ask the question how sensitive is a rapid test compared to pcr because that covers the whole gamut what we really want to say is how sensitive is the rapid test to detect me if i am infectious and that gets to about 97 or so sensitive if the question is how likely is it to detect me if i'm a super spreader that's a really important one to be able to detect they're all about 100 sensitive so if you have extraordinarily high viral loads to the point where you might be a super spreader these simple rapid tests will essentially always catch you and tell you you're positive and then as you go down the line if you're no longer infectious at all then these rapid tests might have a zero percent sensitivity compared to pcr but that's actually a good thing the fda and others look at it as though it's a bad thing because they average it all together and say oh this is only a 40 sensitive test compared to pcr but that's not the right way to look at it you want to say well out of all of the samples how many of them were not transmissible how many were mid moderate high extremely high super spreader and you should at the very least create a weighted average based on transmissibility potential we don't do that you know and that's why nobody in america has these tests because that's why they're very rare because we have slowed down their authorization because of that misunderstanding that they don't have to be 80 or 90 sensitive compared to any time pcr positivity they need to be 80 or 90 or more if you're infectious and for that question they're like 95 up to 100 sensitive when you're most infectious so you have a lot of iron particles in you so i mean that's what it means when you say viral load that means you're going to be very infectious the more you have the more infectious you are and this test is basically very good at detecting when you're very infectious why don't we have a rapid home test so you said there's a bit of confusion fda is involved you've talked about you continue to talk about that these at-home tests are classified as i guess medical devices that's right and so because of that fda is looking at them differently then they probably should be looked at so what what's the problem here can you can you sort of explain what does it mean to be a medical device why is that an issue where is the fda messing up when we declare something as a medical device and we evaluate it as a medical device then it makes sense that the comparison if you're trying to get a new one onto the market that the comparison would be against a gold standard medical device for that purpose so pcr is currently the gold standard or at least in the in the eyes of the fda the pcr test is the gold standard uh medical device and as a physician that's because it's so sensitive as a physician i have one patient in front of me at a time and that patient comes to me and i don't have to care about the 99.9999 of people in the world who are not in front of me i only care about that one patient and so when i get a sample from that patient and that patient's saying doc you know i don't feel well i haven't been feeling well for the last few weeks do you think this is covid well for that question i want to have the absolute best sensitivity test regardless of what it means for transmissibility because my patient isn't sitting in my office saying doc do you think i'm infectious they're saying doc do you think i have recently been or am infected and these are totally different things one is medicine and if the patient's infected you know i the time isn't of the essence because they're sitting there in my office i can say look i'm sorry you're not feeling well let's get a pcr test on you we'll be able to tell you if you have any evidence that there has been recently an infection inside of you and you'll get the result in a couple days and it might be expensive and so insurance is going to pay for it and you're just one person and so i don't really care how many resources it takes to get you this answer on the other hand there's rapid there's public health testing and public health testing is it has to account for all of the people you're not seeing as well as the person you're testing at the moment so accessibility becomes a central theme frequency of tests it has to account for all the days that you're not sitting there in front of your doctor's office getting a test as well as the one you are so it has to say how frequently what if you're infected tomorrow but you're at the doctor's office today getting a negative covet test that pcr test at the doctor's office today is going to do nothing to let you know that you get exposed and infected tomorrow the only way to know that is to be testing yourself frequently so and the the reason it matters is that these tests can be accessible if we are okay with saying the real purpose of a of a public health test is to answer the question am i infectious the reason we want to answer that is if you're infectious that's when you isolate we actually don't want to isolate positive pcr pcr-positive individuals who are no longer infectious that's bad public health practice like if i haven't been infectious for three weeks i don't want to have somebody tell me that i need to go and isolate for 10 days just because i happen to use a pcr test today three weeks after i was infectious and furthermore i definitely don't want the public health agency to come and you know round up all the people i was with last night and so you guys have to quarantine for 14 days because you were with michael who wasn't infectious yesterday it's nonsensical to do that it's a huge disincentive to actually get tested that's exactly right huge disincentive to get tested people you know if it's too sensitive especially with flights things like that like we shouldn't be stopping people from taking a flight if they haven't been infectious for 60 days and to be clear people are only infectious for i don't know somewhere between three and seven days but can be positive on a pcr test for 30 to 70 days so i mean it's it's potentially a tenfold difference in terms of how long your pc are positive versus how long you're infectious so we don't want to be taking people during those 30 to 70 days and saying you need to isolate just because you go and get a swab or you can't go on your trip just because you had covered last month that's not good use of a test so the reason we don't have these tools right now is because when we evaluate an ant a rapid test as a medical device the fda says well this has to achieve the properties that we expect from a medical device which again doesn't have to take time into account doesn't really have to take cost or resources or scalability or access into account it only takes sensitivity and specificity to catch molecules and so just by definition i mean it is a mathematical fact you know that that if you have a perfect public health test for covid which means that it would be 100 sensitive and 100 specific for contagious people or for the infectious stage of an infection then it literally can't it is an impossibility for that test to achieve an 80 sensitivity at a population level against a medical device which is what the fda asks for and that's because you're only infectious for maybe 20 so theoretically it should only have a 20 sensitivity against the pcr while still being a perfect medical a perfect public health test and the test is answering the question am i infectious that's what you're testing for not for the exact counting of the viron particles in your system that's that's exactly right okay so what why are we still here so have you had conversations with folks you said that there's a bunch of um leaders that are kind of starting to wake up to this idea but why is this taking this so long why don't we still have hundreds of millions of at home tests the reason it's taking long i think is because every agency and government is generally deferential to the fda and in this context i would argue that government hasn't been particularly creative so for example last year trump was still president i would or or in the transition and i i recall talking to the white house a number of times and saying here's a plan to give us our lives back i think that was actually the title of the atlantic article you know and this plan can stop shutdowns it can it can stop outbreaks it can allow society to keep running and could have prevented the outbreaks of last winter and fall and saved hundreds of thousands of lives so when i bring that to the white house or to the government of federal government whoever it might be and i say here's a plan like this this would work they say you know what i get back is this sounds really interesting michael uh it looks like it checks out but there's one problem we don't have the test there's no scale and that's kind of where it all dropped it's like this defeatist attitude of like oh don't have the test so so we can't act on it but now it's really changing well and so that's really where things have been and so nobody's paid attention it's always been this like esoteric thing that yeah maybe one day we'll get around to it but really it's not that important and the pandemic's going away but this was like 100 predictable everything that's happening today we predicted it last year you know it's not this isn't like rocket science or the variance and all those kinds of things so the fda we can start to understand why but also like one question i want to ask is it possible to go around the fda yeah so why has the fda not changed and why has nobody tried to push the fda to change like the i think what the real reason is the fda has one job around these tests and it is to authorize them as medical devices they haven't been charged with doing anything else so in their eyes they're doing exactly what they're supposed to do they're evaluating these tests as medical devices and they're telling company after company after company sorry you don't make the cut and the only way to make the cut is really to kind of skew your clinical trials to favor the rapid test being positive which isn't really good practice we shouldn't be trying to skew clinical trials but that's kind of what's happened that's been it's been forced upon the companies to do that and so i think the fda truly believes from the bottom of their heart that they are doing the right thing here and i would argue that to an extent they are i've been pretty hard on the fda but maybe the issue is a higher level issue like the the in vitro diagnostics division is they get applications and they evaluate them and the applications are for medical claims that's however because there's been a misunderstanding of these tests and the companies only know to apply for these as medical claims because there is no there's nothing else in this country to apply for except the medical claim so we we don't have a public health pathway to evaluate a test and authorize a test it doesn't exist we have defunded and devalued public health for so long that we literally don't have a language for it we don't have laws a language words is it called a public health test is it called something else i call it a public health test because i'm trying to create a new definition here but that's why that's why nobody's acted because no because everyone says well there's no other pathway so the fda in vitro medical diagnostics division is the only pathway so what i am trying to do is to say look the fda very clearly states that they do not authorize or review public health tools and not and they don't authorize or review public health tests for for covid so what i want the president of the united states to do is to utilize executive powers and take an executive action that can simply state like one line one line could potentially change all of this and it's a pretty obvious and simple line and it is that any tools used for public health testing during this public health emergency will be designated as public health tools like it's obvious like it's public health emergency it's a tool used for public health it should be designated as a public health tool if we can do that if we can get that language out there so that that's the president's decision then all of a sudden the fda is off the hook they're not trying to to cram a square peg through a round hole they can say look the antigen tests are not on us anymore at least if they're going to be used for public health like when you test a thousand people at a time or test a school a school classroom if they've been exposed this is public health and so then the cdc could take it over the cdc could say okay what are the metrics we are interested in and they could say we're interested in a test that can catch you if you're infectious so you want high viral load detection that's fast that's scalable and hey you know if your test has been used in europe for months and has performed extremely well then then we'll give you a certificate by right you know immediately and that could actually get hundreds of millions of additional tests into the united states tomorrow so you need some kind of classification from an fda from somebody to call it a public health tool in order for it to be manufactured is it possible to just go around all of this and just for somebody to manufacture at scale tests well you if you did that and you just called them you put a claim on them that called them public health tools the fda has a very weird view of this and they will tell you that it's illegal that it's a crime is there a way to say like elon musk did with the flamethrower it's not a flamethrower yeah uh believe me i've tried i've tried to think of all the different approaches um you know there's weird there's like there's major inconsistencies here so it's not like we don't have a precedent for a public health test even during this pandemic there is a very strong precedent uh pooled testing we have companies like ginkgo right based out here in cambridge that are uh you know working with 100 different labs around the country so that might mean like not a ton of quality control over those labs doing uh i mean i don't want to say that they don't i'm just saying the reality is if you're working with that many labs it's hard to say they're running pooled testing of millions and millions millions of kids so here you have a company that's testing in each pool five to 25 kids at a time millions of kids in a pretty distributed way across the country and all these different labs and the fda doesn't care at all you don't need any ua it doesn't need a regulatory authority it's collection on site it's getting shipped to a lab there's no oversight of it so why does that have no oversight but a rapid test for pub for the exact same purpose you're just giving people immediate results instead of two-day delayed pooled pcr results so it's a much more effective tool why is the rapid test used for the same purpose not designated as a public health tool but requiring fda authorization it's a ridiculous reason and it's because the fda says that if a test and this is actually cms that says this and then the fda adopts it if a test alters your behavior if you get a single result and it's going to alter your behavior then that is a medical device but the thing that i find ridiculous is like okay but you can give a pooled test that alters 25 people's behavior at once and that's not falling like that's more risky one person turns positive in the pool and 25 people have to be quarantined and uh how do they evaluate the accuracy so for people who don't know a pooled test is you're testing a small fraction of the people and if one of them is positive then you basically say we have to retest everybody in the pool or like you yeah so you take let's say you have a school and each classroom you might have 20 kids each swab their nose in a classroom and all those swabs go into a single tube and then you rinse that tube out with some saline and you run a pcr test on that tube of 25 samples or 20 samples and so if that tube turns positive in the pcr test then all 20 or 25 of those students are now having to quarantine yeah and if there's no positive then all 20 or 25 students are interpreting that their result is negative you know so it really is ridiculous decision by the fda to say that if the test itself only tests one sample at a time it's medicine because it will tell you one person at a time if you're positive or if you're negative but if you do it as a pool and you and you tell 25 people that your pool was negative then that's somehow different that's public health not medicine it it doesn't make there's no logic there was it just personalities and accidents of history or something like that for example you talk about the public health tools and cdc you look at masks so masks were decided to somehow be an effective tool to help with the pandemic like so i'm sure the evidence that was used there was probably not as strong as the evidence supporting antigen rapid tests i was very much reading a lot of research on masks it's tricky it's really tricky to show how well they stop the transmission of a virus especially when you don't fully understand how the virus is transmitted or the viral load required all that kind of stuff but then the cdc pretty quickly decided masks or whatever there's some oscillations back and forth but then they quickly decided all everybody decided masks is a good tool so masks being decided a good tool and then rapid antigen tests not a good tool is that just like certain personalities who didn't speak up in a meeting or who did speak up in a meeting is this just like a weird role of the dice or is there a better explanation i think it's somewhat of a roll the dice but i also think it's that testing so doctors don't pretend to like really understand much about like fluid dynamics and you know how well masks are working like that's like way out of their realm doctors do believe that they understand all aspects of the tests right and so the greatest barriers to rapid tests being brought to market or sort of being being rolled out heavily and supported as public health tools uh the greatest barriers came from physicians saying hell no we can't use a test that's not as sensitive as a pcr and look at what happens if you use this antigen test and not a pcr test you get people who are showing a positive on a pcr negative on an antigen and they just assume that that was a false negative on the antigen for public health i would call it a false positive on the pcr test but this type of thinking literally does not exist in medicine and i think the biggest problem here is that we placed physicians in decision making power we have won this pandemic hit everyone called up clinical uh laboratory folks and microbiologists and physicians to ask well what kind of tests should we use that kind of thing and there is no training in medical school for this kind of public health work like uh you have to optimize on the right qualities of a test that have nothing to do with medicine and then sometimes if not frequently they're actually at odds and i'll give an example why the physicians you could see why the physicians would have been against it from their perspective and they say uh if a physician is a tsa agent at the airport you know a tsa agent their role at any given time and the role they think that the instruments need to play is i want you to scan the bag as well as possible this is the only bag that i'm interested in at the moment and this is my lane this is my bag i want to make sure that my instrument's doing i don't want the crappy instrument in my lane i want to make sure that i'm doing everything i can but what those tsa agents don't have to worry about is well how many other instruments are there in this airport is anyone getting through the lines here without going through security the average tsa agent doesn't have to worry about that they literally have one job to do and it's pay attention to this lane if there's a big gap in the security line and people are flowing through without going through security that's not on the tsa agent that's not a big systematic problem of that of of the the system and we can't expect that tsa agent to have ever even thought about that like that's not on them they were trained to look at a to look at the bag and that's kind of like physicians and i you know probably some physicians will hear this and feel like i'm insulting it i don't mean to be liking you know the two professions and or anything like that i what but the point is is that a physician has one duty do no harm to this patient time isn't of the essence scale how many tests can my hospital perform in a day how many tests can my county or country perform in a day that's not a physician's training to think like that at all and so what has happened is doctors got on board early and said oh hell no we've seen these antigen tests before they're not particularly sensitive compared to pcr and and early in the pandemic there was like pissing matches between labs who had the most sensitive pcr and it just distracted everything it really i was trying to say pretty early like we don't need sensitivity we just need frequency we just need scale we need to think differently because our only goal if we're doing frequent routine testing of asymptomatic people is not medicine it's to say do you need to isolate now and if you have a pcr test that's taking three days to return and you're like if i was currently spreading virus before i walked in here and you handed me this actually happened to me today when i walked into harvard today was my first day back into harvard since february of 2020. i go in i scan my badge and they they hand me a pcr tube and they says they say like return this you know by noon or something before you before your work day's done and i'm looking at it i'm like what is this going to do like what if i'm super spreader right now yeah you're giving me free reign to walk around and infect everyone in the school and you're gonna give me my result to tell me i did that in two days from now it doesn't doesn't really make sense so who is supposed to be so it's understandable that doctors kind of feel that way just like you said do no harm who's supposed to care about public health is it the fda is there some other organization yet to be created is it like uh just like with the military the reason we have civilian leadership when when you talk about war is it the president that's supposed to do like override fda override doctors override and basically politicians in representing the people in the state of emergency make big public health decisions like who is supposed to do it besides you on twitter it's like most people really thinking about solutions to kovid we'll mention you or will mention this idea of rapid home testing and it's it's you watch that happening this discussion that this is an obvious part of the solution and the solution is not happening so who is supposed to implement this idea i think the cdc that it should start there override the fda well i don't even think it needs to override it and that's why i think these should just be designated as a different tool so that the company is it's not overriding it's just saying look this isn't even this isn't in your jurisdiction to the fda this is just a a public health tool but the problem is the centers for medicaid medicare services designates any tool just like fda they designate these as medical devices purely because they could change somebody's behavior based on the result of one test so to change that at this point unless you get cms buy-in you know we don't have there is no designation as a public health tool but the president can just say these are public health tools these are not to be regulated as medical devices if their goal is not medicine but public health and if he does it he does have the authority to do that as president and to say i'm tasking the cdc to certify these tests or or authorize them for use in the united states and you know he has to say something like that he can't come out and say these are public health tools have free reign just you know any company start start shipping them in the us because that would create pandemonia and we'd have a lot of bad tests but there's a lot of really good tests out there we just are taking like 6 to 12 months to run trials they're failing because they can't keep up with pcr and if the president were to do this then the cdc could take it over and they could say okay it's on us we're going to decide the uk actually did this they early on they said okay they laid out a very clear regimen they said this is how we are going to evaluate rapid antigen tests because they're public health tools they did it in a in a domain that was outside of their normal medical diagnostic regulatory agencies and they they literally just had a very fast screening to say what are the best tests they went through a huge number of different tests they said okay these are the this is the rank order of which tests are good which are bad which are scalable which are not and they were able to start deploying them in weeks not years so i think the cdc really needs to take charge the problem is when it comes to like law if everyone currently perceives this as like fully within the domain of the fda and they've never heard of such an uh public health test idea enable it but but the fda itself has created the idea by saying we don't regulate public health tools so the word is out there the fda has said we don't regulate them so that gives the president an opportunity to say okay these are those you know these are public health tools by definition and and i do think that this is a kind of a crisis and it's a crisis of testing but it's also a crisis of like really we're going to go through this whole pandemic and never figure this thing out that's just really sad you know if we get through this and don't figure out how to evaluate a damn rapid test so how do vaccines play with this so one of the things that when people discuss solutions to covid there's a sense that once you have a vaccine kova dissolved so how does that interplay like why do we still need tests if we have vaccines yeah i am i actually wrote an op-ed in new york times or wall street journal or something that was titled why we still need rapid tests with with vaccines and the real reason is because we have evaluated our vaccines based on their ability to stop disease in fact most of the trials didn't evaluate them based on their ability to stop transmission they didn't even evaluate that at all no less put it as one of the metrics for authorization and with a virus like this it would be a bit naive to think that it's really going to stop transmission well i think a lot of excitement happened right after the first clinical trials and i'm sure we were talking about it when when i was last here i would imagine given the timing but those first clinical trials came out and everyone you know jumped for joy that these things were going to be the the end to this pandemic but we had really short-sighted vision there by not recognizing two main features one is uh that they might not stop transmission another i guess three another is that uh new variants might come around that will break through the vaccine protective immunity and the third is that we were not we were measuring the efficacy of these vaccines during the peak of their performance in the first few months after people got vaccinated and that gives a skewed view of just how effective these are going to be long term so what happened with the vaccines is that everyone got very comfortable this including the cdc saying if you've been vaccinated you know this is the end of the pandemic for you and let's keep it up but then delta comes along and waning immunity comes along and both of these things compound exactly as anticipated to get breakthrough cases and unfortunately what we're seeing now is the cdc and the administration went so all in on saying that breakthrough cases are rare that transmission doesn't really happen if you're vaccinated without great data especially with delta that once people started seeing breakthrough cases they start interpreting that as a failure of the vaccine the vaccines are still working to keep people out of the hospital for the most part but they're not working to stop transmission and if our goal is to stop transmission which until we decide as a society that we have different goals like we're okay with people getting ill and letting transmission go because we don't want to worry about it anymore we're not there yet so until we decide we're not going to stop transmission we need other avenues besides the vaccine because it's it's not doing it it also means that herd immunity isn't going to happen and unfortunately as long as we keep letting spread happen in the context of vaccinated people we're kind of giving this virus a boot camp of exactly what it needs to do and mutate to get around our vaccine-derived antibodies that makes me very nervous so the more we can do to stop spread in the unvaccinated in the elderly vaccinated and in other people the better we we just should be focusing on that so in your eyes the solution would look like this you would have make enough tests where every single person would get tested every single day i think that that would be i don't want to do that actually i want to do a variation on that i think what we should do is have a dynamical testing program it doesn't have to be complicated it's every household has a box of tests in their cupboard and if you haven't seen any cases in your community for a long time stop testing do waste water testing to see if there's any rna coming back if you start to see rna in the waste water that represents the virus and you're still wanting to stop outbreaks you say hey you know those tests that are in your cupboards households in this county why don't what is in each household or each person each household use one test per week and can you uh sorry to just pause on that idea that's really cool the the waste water testing that's the thing so you can you can get a sense of how prevalent the virus is in a particular community by testing the wastewater that's exactly right and so the viral load associated uh the viral load that you can find in the community represents the prevalence of the virus in the community which is really quite nice that's not that's a nice way to paint like a map of the the intensity uh of the virus okay so when it when it goes above a certain level you can start doing much higher frequency testing per house in each household that's right so i don't want people to be in testing purgatory like that's not what i want i just want us to get through this damn pandemic and and so we can monitor the waste water or any other methods we can monitor the hospitals in the clinics and if somebody does come in with coveted like symptoms and then a few other people come in you realize okay we got spread happening in our community send out a text message put it on the news put in the newspaper whatever you need to do tell people tell families use your test and if the cases get worse because you're just doing it once a week that's not going to stop transmission but it's going to enable you to identify where outbreaks are happening if you start to find outbreaks in pockets then the rule is simply okay let's squash the outbreak real fast so everyone in that area uncertain zip code or whatever it might be test every two days you know for seven days or every day for seven days and you'll get rid of the outbreak we can do that and if you've now gone again you know a week or two with no cases uh identified stop the testing again that's the nice thing that everything changes when people have the tests in their home it becomes dynamic it can become easy send a text message take your test today if some people don't do it that's fine the only goal is to get r below one and you stop the outbreak people think it has to be near perfect i always hear people say ah what if somebody doesn't doesn't use it or what if somebody lies like well you you have 98 of people testing or even 50 that's a whole lot better and you know another big difference that people i think often times have their have a problem wrapping their head around especially to the extent physicians who are used to really like who are used to different kinds of metrics is that all we have to do to completely stop an outbreak from spreading in a community is to get for every hundred infected people to get them to go on and infect 95. most people would say oh my god that's a horrible you know that's a horrible program you're still letting a hundred people go and infect 95 people but that's for a virus like this that's a massive public health win if you can get 100 people to infect 90 most people doctors i would say like a lot of people would say that sounds like a failure to be honest but if you do that for multiple days in a row then in a couple of weeks you've gone from a big outbreak to a very very small outbreak and on the other hand if you don't do that if you allow 100 people to just infect 140 people because you're not doing the testing then instead of having 20 people at the end of those four weeks with the testing you literally would have 600 massive differences here and all the only goal then is to get our below one have 100 people in fact less than 100 and you stop the outbreaks and everyone stays safe from everything you've seen how cheap can these things get from like in the past year in in terms of the developments you've seen with the various test manufacturers how cheap can it be to make a test to manufacture a test so there's the manufacturing process that could be 50 cents maybe less it's hard to get it's hard to really have eyeballs inside these companies you know in terms of where they're producing them in china and taiwan a number of other places some of them are produced here in the united states too but 50 cents say it was a very very reasonable generous number for how much it cost per test you look at a place with high market competition that has actually authorized a lot of these tests like germany germany has 60 70 some different companies of high quality rapid tests authorized you can go there and buy it for 80 cents you know that's and they're still making profit and so so it's extremely cheap market competition can drive these tests uh way down in terms of cost i think one of the most important features of a rapid test program is what do you do with the result is it going to be used for you to gain entry to school or work is it going to be reported to the public health agencies you know all of these the primary mode should be just get people test but really if you're going to be using it for a workplace thing like what biden is now saying vaccinate our test which is going to lead to a crisis if we don't fix this soon because we're going to massive demand for testing in the next couple weeks but when he says that that's essentially saying okay companies need to make sure that their people are testing so are you gonna base it on the honor system i would say you probably would not base testing on the honor system if it's like to uh take somebody who would otherwise be quarantined from in school and so you can go to school as long as your test is negative so test to stay program is a big thing that i've been pushing for and others have businesses bringing people into work who need to test they need to have verification but they don't want to like set up nursing stations in their lobbies or in the school parking lot or whatever like everyone's tired of that we need to bring the test into the home but that means we need the technology to enable it and so i was at a conference recently do you know mike milken milken institute he's a very wealthy billionaire but he's done a lot of philanthropy and he hosts a conference to raise money for prostate cancer research i was at this conference recently francis collins a number of other people were there and every morning we all had to test in the morning which i thought was a great idea obviously before we walked into that conference and um but you didn't have to test there and they didn't base it on the honor system every morning i'll i scanned a qr code on the box and emed which is a service that provides test uh verification popped up with a proctor right on my phone or on my computer and said okay let's go through your tests like and they watch you they videotape you using the test so it's all recorded it's all a reportable type of test and at the end of it just from your home you don't actually see the proctor you know they're but they're just verifying that you actually do it they verify the test they verify that test results with you and at the end of it you've then gotten from from your couch or from your car wherever you are an actual verified laboratory report that can be considered proof that you yourself use the test and you yourself got a negative so the tools are out here if we want to use them at scale and in fact the cdc uses emed now to enable people to come back into the united states uh through an antigen test so before you get on your flight you're sitting in the airport in heathrow or wherever you are you can get on your computer use your emed test and you get the negative and that and cdc will accept that tsa will accept you to come back into the us with the rapid antigen test that you did without anyone else watching except for this proctor on your phone super simple how much private information is being collected so like this you know people have in the united states the american way they have a hesitancy on the overreach of government in things like vaccine passports like using any mechanism any mechanism of verification that's controlled by government can lead to overreach by said government so there's a concern of that do you see there a way of achieving testing that's verified but does not violate people's privacy or sense of freedom absolutely i i think so the way that um right now in the united states they're requesting that these tests get that the results get delivered to public health agencies but i've long held that while that's ideal it should never be the thing that holds up somebody being allowed to know their own status but if you are going to work and you have to let your boss or your manager whomever know that you were negative that day or if you're going to school i think it's going to be hard to maintain complete privacy in that situation because they need to know your name but sure i mean could you cut off the public health reporting yes you could but i worry i mean can you opt out maybe you could opt out that should be a feature i want to opt out of the public health reporting because for whatever reason otherwise i'm not going to do the test and but that means that okay then you're not going to go to work so right now there's this serious tension and i am very uncomfortable with the idea that we force anyone to do anything but there is a tension between these two things for sure and how do you balance that during a public health emergency i think first and foremost let people everyone has a right to know their status the fact that we have made it hard for people to know their status on their terms i think is a travesty i mean it's just so terrible that we have prioritized us knowing at the expense of you know essentially what like elta's long said during this pandemic is if i'm public health it's if i can't know then you can't know your status like that's not the right way to look at public health we need to engage the public and if some of them don't want to participate in the public health part but want to know their status by default they are participating in public health whether they know it or not because they're not going to go get their mom sick by mistake at least most people wouldn't and then also you can create systems where you can individuals can form relationships based on their status without ever reporting it to a centralized place so you can go to i don't know a local business owner might require that you show that you're negative but that doesn't require reporting it you can like there might be um basically like an id that's only in possession you are the only person in possession of that so you literally show it exactly here's a test i took it's negative and nobody else knows about that test so that could very well be done even through a company like e-med i think and i might be wrong here uh i believe that they take the test result and because they are considered a clia waived laboratory like a digital laboratory they report their results by law out to uh the public health agencies but let's say there was something a little different let's say you were verifying an over-the-counter test and it doesn't have to be a cleo wave because it's over the counter then you're not bound by clio rules and you could create the same service but that just doesn't report out to the public health agencies it gives people the option to opt in or out of public health reporting and you know i know that public health people get a little queasy when i talk about this but as a public health person myself like yes of course i would prefer that the data be available to evaluate to know where the cases are but first and foremost i want to make sure that the people using the test are are going to use the test and if that means that they're not reporting and if that's the only way that they will use it is if it's not reported then that's better than no test and especially given that the central to the vaccine hesitancy is a distrust of authority in the distrust of government so you're asking you're asking people to get tested and report their status to a centralized authority when they're clearly do not trust that authority it doesn't make any sense it seems like a perfect solution to let people who are hesitant on the vaccine to uh get their own status and have full control of that information and opt-in provide that information if they wish to but they have the full control of it and have the freedom to do that information what they want i fully agree with that i really do i think we can have the verified services and we could have the privacy if you want if you want if you need to go into a restaurant and there's a rule that you have to be a negative test have it on your phone and only your phone and it's okay like emed emails you the the lab report you have it you can say look that's my name i use it this morning negative and in that case you'd want something that just is there and is not going anywhere else and i think that those services like i think they can exist and it's a struggle because for those companies they don't want to fall out of favor with the cdc or with the fda and so this is a big problem in our marketplace in general by having by having private companies who want to be the be the public health agents of this pandemic we lose a lot of control because the companies ultimately have to do what's going to make them money so they survive and keep performing the service it's really it's really just such a hard problem and i this is why last time i was here i'm guessing i was probably really pushing for the government to be producing these tests i think i would have still been pushing for that you know at this point i've decided okay the government's clearly not going to do that i've been thinking i really want elon musk to produce the tests like i i really am sort of serious that these tests are simple to make but we've been using like machines to make them that have been around for a long time scale is an issue right now kind of really it's the eua process and getting the companies to be allowed to market in the us that's the issue but let's just say scale is the issue and one company wants to make 20 million tests a day these aren't that hard like we we should be able to do that we just need a faster machine a better machine yeah and a quicker one and a few folks like you mentioned know how to solve that problem yeah i've had a lot of discussion with uh with tesla folks you know with with people that used to work a test like jim keller about how to make stuff much cheaper much better that's basically what tesla is world-class at and it's like okay does this thing have to cost a thousand dollars no it can cost ten dollars right and let's figure out how to manufacture it those those those folks are like the best in the world they're doing that okay but um what about this biden action plan so it sounds like the guy uh agrees with you vaccinate or test so i think given that choice a lot of people go test in america because there's there's like a division it seems like so what is this just uh politics is is this just words or do you think this is actually going to lead to something and maybe can you explain what the action plan sure is so there's there's a number of pillars to the action plan um the two that i've been most focused on i mean some of them are we want to get everyone vaccinated all these things and one pillar is saying any company in the united states that has more than a hundred employees is now required to ensure that any unvaccinated individuals in their workforce test weekly another pillar is that the president's going to reduce the cost of pcr tests by 35 which is pretty moderate reduction um and is going to reduce the cost of antigen tests and scale them up and make 280 million tests and put two billion dollars into it so those are the two that i found most intriguing for the kind of mission that i've been on which is to just educate people around hey we have really really powerful public health tools we have yet to deploy um the issue at hand though is that now that the president has said vaccinate or test there's a problem inherent in that you know it's essentially to coerce people around vaccinated to get vaccinated because vaccinator test doesn't make sense when the vaccinated people can transmit the virus just fine it should be vaccinate and test exactly it's the problem that i have with that vaccinate or test idea is it's great if you want to use it as a coercive uh effort to get people vaccinated like i'm not going to wade into that argument do i agree with it or not i'm just not going to even put my uh i disagree with let me say i disagree as opposed to doing great yes science communication this weird like people talking down to the populace as if they're children trying to trick them here have some candy uh this kind like everyone with common sense somebody told me i was having a conversation like if the government is going to give you money to take the vaccine people that were already hesitant about the vaccine are not going to trust whatever the heck you're doing so don't trick people into taking a vaccine be honest and communicate transparently everything that's known about the vaccine communicate the data inspire people with uh with uh transparency and like real communication of all the uncertainty around it and all the difficult decisions of risk and all those kinds of things and as opposed to trying to trick them like children into taking the vaccine anyway yes but okay well i didn't have to say it so there but you're saying it should not be uh uh like vaccinate or test this that's that tradeoff doesn't mean exactly vaccinate by saying vaccinate or test is absolutely confusing because it implies for anyone who's thinking about it it is implying and and i've seen this because i have business leaders call me fortune 500 business leaders who call me and say what do i do like i have 8 000 employees where am i going to get my tests you know and a lot of people are saying they're calling this a pandemic of the unvaccinated these types of divisive this divisive language doesn't help this isn't a pandemic of the unvaccinated it's a pandemic of a virus you know like don't ever put it on the unvaccinated who frankly are just scared they don't know who to trust and we haven't given them a lot of reason to trust public health to be frank so i agree i mean now that you've opened the door i'll just say my piece like absolutely we need to be the most honest we can with all of this this this is confusing language to say vaccinator tests we need to say we need to be very upfront that says and say look vaccines aren't aren't stopping transmission very well unfortunately this is the world we have we have delta we're going to have new mutants we have a vaccine that's that wanes somewhat over time you know this is biology i'm sorry i'm you know this is just what it is and then we say but the vaccines are really protective for your personal health they're going to keep you out of the hospital this is what you should care about as an individual and as a population we need to figure out okay we have to stop transmission if that's our goal so we should use the tools that are going to stop transmission if that's our goal and saying vaccinate or test if our goal is to actually stop transmission that's confusing because vaccines are not stopping it there may be mildly lowering the risk of transmission so i i'm just not a fan of that language i think we should be being very very clear like you said and up front about what are the limitations of the test of the vaccine and of the test and we should be very clear that like you know it can only help the american public in aggregate is extremely intelligent to you know they will figure out when you say that vaccine breakthrough cases are rare and then they start seeing story after story of like whole parties of people or vaccines have outbreaks and and everyone knows more people now who are having breakthrough cases than they knew who had regular cases before the vaccine people start to wonder hmm well this is weird they say that the vaccines are working breakthrough cases are rare maybe the whole vaccine program is failing entirely and so it ends up shooting ourselves in the foot if we try to create false expectations because we think it's going to be beneficial uh for one thing when it's not for the other and so the other so to get back to the action plan vaccinate or test i think and and the re and the increase in rapid tests i do think it was a bold move i think it i i would say that it was the most prominent sort of display encouraging display of the fact that rapid tests are indeed effective public health tools my real concern now with with is that 280 million tests that's like less than one per person per year in the united states so that's not the way that he said and delivered it and what most people think of when they hear the word 280 million you don't usually put a lot of thought into what does that number mean it sounds a big number most people are now going to be expecting that these tests are actually going to be staying in stock on the on the shelves at cvs and walgreens and amazon or whatever so that's crisis number one it's like now the expectation is set for having rapid tests but they're not going to scale that well we won't have them and then there's vaccinate or test and that's going to bring millions and millions of people who are not currently testing to have to start testing so that's going to overwhelm our pcr labs and it's going to create five-day delays again with pcr if not longer because we'll have backlogs and so the only real solution to this is to just scale up the tests that are actually scalable and that's these simple rapid tests and it's not even to scale them up through production and manufacturing here it's to open the doors so the companies that already exist here and can scale are allowed to do it and to bring in the international market some of the biggest diagnostic companies in the world are not selling their millions and millions and millions of tests in the billions of tests in the united states because they don't want to play the the the game that the fda is currently requiring of them so we have an opportunity and i i am very encouraged that the president actually did put these into the action plan and i do want to say for the record that i'm supportive of it in principle but i think now now we actually are in a in like a the timer has been set and we have to deal with the crisis before it happens otherwise there could be some real political points taken off you know i do worry that the president if he doesn't pull through with this and really make the test available we end up getting into this other test crisis this fall there could be political consequences to that and the reason is like these rapid tests are so personal they become emotional almost they're so they give people that empowerment that i was talking about earlier and when people can't get that because the shelves are out of stock they actually feel frustrated and then that converts into like anger like in the blame and so i do think that we have to be really smart about making a policy like this and then ensuring that we can carry through with what the average american is actually expecting and speaking of politics one of the great things about testing maybe you can correct me but for my sense it's one of the only solutions to covid that has not yet been politicized so masks and vaccines whether you like it or not have been heavily politicized where there's literally a red blue split on the use of those or like proud use effective use of those tools and it seems like everybody i talked to about testing everybody's on board red or blue they are which is why i am particularly concerned about the vaccinate or test policy right because all of a sudden we just politicized it we just brought it with this thing that was fully bipartisan really by part i mean i've talked to the fully the really right side of congress and the super liberal side of congress the senate the same politicians governors everywhere in this country have asked me for support around these rapid tests because it just you can have it reported or not you can have it in the home in the privacy of your own home or not or you do it at school these these tools are just so powerful to identify infectious people they didn't have to be politicized they still don't i don't think that the action plan went so far that it's going to politicize them but i do think already it's starting to conjure up emotion saying well now i have to get tested i have to part right and that is where we go wrong it's i have to get tested or vaccinated you know screw that i am independent you know whatever and and i do worry that this thing that was purely bipartisan that we could have just scaled up months ago people would have we could have delivered it to every household didn't even have to ask people to request to just deliver packages to every home in america by now easily if we were smart about it you know we could have done it the most unpleasant thing about covet is the uncertainty and that's what leads to fear on both the um uh vaccine hesitant it's the answer into about the vaccine and uh people who are have taken the vaccine the uncertainty around like am i in danger walking around can i go can i walk down the hall like this fear of the world around you and i think testing allows you to uh remove a lot of that uncertainty like you you gain back confidence that you can operate in this world and not get infected and you become like a nicer person i i find myself every time i get tested i become a nicer person to others because i know i'm not putting a danger i'm not putting people in danger it's a it's a heavy burden to carry to worry am i infectious like i was out last night but i do want to go see my mom today you know like am i infectious i don't know and this has created massive anxiety and i can't tell i completely agree that it is it's a relieving feeling and and it's an amazing feeling to be in a room when and i did this in the middle of the pandemic when everyone was supposed to be wearing a mask indoors at every one rapid test you know and i said everyone should wrap a test before you walk into this room and it was a wonderful experiment because everyone was just so relaxed yeah you know the other the alternative is everyone nobody tests and everyone wears a mask you have a mask that maybe gives you 20 maybe protection during if you're all in the same room together if that or you have a rapid test program wherever in rapid test before and that gives you like 95 to 100 protection not 100 but close and all of a sudden that allows everyone to take a big sigh and be like wow this is the first time i've seen people without masks indoors in a long time and i feel pretty good and restaurants like restaurants are scary right now because you just don't know who might be infectious and nobody's masked and like wouldn't it be great to just go into a restaurant where you know that everyone just tested negative that day it just really reduces anxiety it makes individuals feel empowered and i mean at the end of the day covet and our response to covet is a re is a it's truly an information problem you know we why do we quarantine anyone why did we ever close anything down we didn't close things down because everyone is positive we closed things down because we didn't know if anyone was positive we quarantine a whole classroom of kids not because they're all positive but because we don't know if one of them are positive and so we just quarantine everyone when there's a positive in the case in the in the classroom like one day we'll then ask the whole classroom not to come to school for 10 days that's not a biological problem that's an information problem and the crazy thing is we have the tool to solve that information problem it's literally our eyes on the virus it's how we see this virus and if everyone glowed green when they were infectious we would have never had to close down anyone any society and we would have never had the outbreaks because we would have been able to stay away from the green people you know and yeah i like what you said the quarantine is an information problem that's absolutely right what is there something you can say to what people can do like listening to this individuals do you just complain like loudly like why can't we do this can you speak with your money somehow what what can people do to help god it's it's amazing to think you're asking me this question and this video will go out to you know the web and all the people that watch you and uh last year in july maybe something like that june i forget exactly what it was i was on twitter this week in virology um shout out to two of those guys are awesome they are awesome i love i love twiv and they asked me the exact same question towards the end i said this makes so much sense you know why wouldn't we do this what can people do and so i said oh you know just send me an email like write to me i'm sure you could find my email somewhere online and uh and get in touch and i will you know and and we can try to figure out how to uh make something happen yeah bad idea very smart way too many emails i didn't i feel bad because i didn't end up getting back to anyone because i just got inundated but it did lead to the development of rapid test.org where we did automate the process of writing letters to um congressional members and and elected representatives so that helps fast forward to today what can what can people do i honestly don't know like what can the average person at this point do we have tried everything the fda is immutable on this they will not change and we shouldn't ask them to change because they have decided that this is how they regulate medical devices and they're going to stick to it so what we need to do and maybe this is something to do is get if you know people who have sway over politicians lobbyists whatever it might be let people know to request that the president literally the president of the united states uses executive powers to just do a sim something as simple as designating these powerful public health tools as public health tools allow the cdc and the nih or whoever it must be or or academic centers of excellence designated by the cdc to evaluate the tests in a very fast fashion with the appropriate metrics that these tests need to achieve for public health and within two days we can have ten new tests authorized you know this doesn't have to be a six to twelve month endeavor this could be a two day endeavor we actually did it i judged the rapid test x prize and it went great we actually got incredible metrics about how well does each test work and no clinical trials you know just a couple days worth of work in the lab and boom and if we actually systematize it would be an hour so in the lab you know so simple so i don't know i mean i don't know how to really impact change i've thankfully you know i have a platform and i've been able to start talking with people who are very close to the president and the white house and um and i do think that some change is finally happening because the silver bullet of the vaccine has not panned out to be the silver bullet so now we gotta now i think we're moving from a country that was a vaccine only approach to finally recognizing at the highest levels that there's other tools do you think it's possible to reopen fully without solving the testing problem completely like do you think this vaccine approach will get us to reopen fully i do yeah i think over time though i mean if we a lot of people ask me like what's what's like happening like what's the end game here like where does this end and um it's actually not a mystery the end game is we will grow out of this virus and by that i mean you and i and most people who are watching this are adults right adults don't like to get infected with a virus for the very first time as adults babies are okay with it and so what we have to do to understand how we're getting out of this virus is to look at babies look at newborns and say okay how does a baby get out of their high risk time period they get exposed they get like exposed multiple times or vaccinated of course and eventually they get exposed enough that they build up this nice cushion of immunity that's sufficiently diverse that they can battle whatever gets thrown at them because they've seen it all already but one exposure doesn't do it i mean over the course of the first few years of life kids get exposed to chronoviruses tons of times lots of different viruses they get so unfortunately what's happening with us why this is so bad for us is that as we're adults we don't regenerate tissue very well we have like over abundant inflammatory response we have all these problems that when we get an infection for the first time it sucks it harms us it causes us problems but over time just like a baby we're going to start building up our immunity through vaccines and exposures you know i hate to say it but tons of people are getting exposed to delta right now who don't know it tons and uh if you're vaccinated you don't know it as my point there and you know at the end of the day this is actually i do not want this to be misconstrued as like saying go get infected but the fact that people are getting infected you know will add to our level of protection later on and so yeah but the question is how long that whole process takes i think you know my guess is probably by the end of next year early 2023 we will probably start looking at this as though it is not a particularly dangerous virus for most people the elderly though it will still be but that's because they're immunity like variants and stuff right now other people say this statement you just said a year ago about this spring right well that probably was not wise well i mean it's because your the intuition is like okay now that there's a vaccine you're either going to take the vaccine or get infected and then it'll be hurt immunity over like it'll be very quick so you know that that's the intuition but it seems like that's not happening it seems like we're in this constant state of uh fear-mongering for different reasons it's almost um it's almost like the virus got deeply integrated not into just our biology but in the game of politics and in the fear mongering around the news because the virus now started being together with the vaccine and the masks and it started getting uh integrated into uh the division that's so effective at uh monetizing social media for example and so it's like all right so how do you get out of that mm-hmm because you can always kind of present certain kinds of numbers about number of cases or how full hospitals are and and start making claims about that we're still this is as bad as it's ever been those kinds of statements and so i'm not sure exactly what the way out is except the same way out as it was originally which is testing this information it's information yeah and and i think we can do that we can keep outbreaks suppressed with testing because it's information like people keep thinking of tests as big medical things they're not they're information it can allow us to control things just like we drive down a road and we look at the cars and we don't hit other cars because we have the information that they're in the lane next to us and they're moving over like that's just information like you said glow green the problem with the virus you don't have you don't see you're walking around and everybody is a potential uh like infectious creature and so if you see the world as a potential potential for infection you're going to be terrified of that exactly right and that is what has happened and i and that's why i've been pushing so hard for for these tests because they can allow people if you use them at a community level you can have enough people know that they're positive enough people are good people that they won't go out and affect others and the other great thing about them is again a 10-day isolation period especially for a vaccinated person but in either case is also an information problem we don't have to isolate for 10 days if we're infected what if we're only infectious for two yeah especially if we're vaccinated why are we telling people the only reason the cdc ever and the wha suggested a 10-day isolation or a 14-day quarantine is because we didn't know when people stopped being infectious there's actually some people stay infectious for 14 days it's rare but there's a lot of people who stay infectious for like four and that's a whole other week that we're asking people to isolate people would probably be much more likely to comply if they only have to isolate as long as they wake up each morning and see two lines because you're actually seeing it for your own two eyes you're being empowered to make your own decision you're not being told you need to isolate for 10 days and you're sitting there thinking oh i feel fine i don't know why you know there's a lot of asymptomatic spread but if you see the two lines every day then you actually get to you're doing a little experiment for yourself to prove to yourself today i'm still infectious let's hope it's tomorrow come on immune system you can do this you know and then you get to day four and boom you start being negative that's a much more tolerable thing because you are you are being able to make that decision based on true data that is empowering you and it really does change changes everything like because it's all fear and and empowerment and these are empowering devices well i wanted to have this conversation with you because obviously it's a great solution let's keep talking about it people who listen to this should uh i guess pressure local politicians federal write articles write articles with the title like dear potus yeah you know please designate these as public health tools or just start talking about in the media talk it talk about social media anywhere testing is a public health good testing is a public health good we all like it should not be considered a medical device i shouldn't have to pay to keep you safe like testing should generally be free for that matter like subsidized by the government these tools exist they we should all and i think the more people that generate noise to just say a public health test is a public health tool you know period like it's you can't even argue with it yeah i think if you talk about it enough then certain people that have even a bigger platform like elon musk sandra perchai though those folks that have power to really do like large-scale manufacturing also influence governments will pay attention and that's that's the hope enough people talk about it i think business leaders like business leaders obviously have so much power here yeah you know they they pay the lobbyists who you know make things happen like let's be honest there's people who pull levers that are not the politicians themselves and i do think business leaders have so much to gain from these tools to keep their businesses safe to not have to quarantine and lock down and i hope that all them hear this message to say let's let's ask the president or the people around the president to designate these as public health tools change the system and if you can't change every aspect of the system then figure out how to change the system enough so that you're doing everything in a safe way that is not endangering anyone but it is only protective yeah you mentioned last time you spent time as a buddhist monk we like didn't spend much time talking about i just would love to talk to you about about it a little bit more maybe as uh by way of advice how do you recommend people can integrate meditation into their lives or how does one meditate i i think for me meditation was um really an active effort um which sounds weird because most people think of meditation as like they la in the absence of activity um but just like anything uh meditation is it requires exercise in this case it requires exercise and quieting your mind and the whole well there's a lot of different reasons people meditate most people watching this podcast or this show what is this called i don't know is this a interview i'm not even recording this just you and i talk um it is you know most people are uh meditating to like bring some balance and bring some sanity to their life and just like be able to control their feelings and emotions a little bit more and for that purpose like i think the best way to to you know what meditation is if you can call it what you will it's just getting some alone time some time to think or not think you know whatever and that looks different for each person for me it was a very active effort to try to quiet my mind with the explicit intent to detach from things from lots of things and it's actually it sounds weird in our culture here to talk about detachment as a goal detachment from loved ones detachment from objects is kind of easy to reconcile like people understand that yeah i don't want to be too attached to my car or whatever but detachment from a loved one is like a very hard thing because we want to do the opposite usually we want to love a loved one but in a lot of buddhist thought it is those attachments that keep people in this cycle of rebirth now i don't personally um believe in rebirth in the way that uh you know in a buddhist sense and that like you actually get born multiple times i think we my personal feeling is we die and we're vanished you know um that's just me um and but i still really found meditation to be extraordinarily powerful to feel control over a whole different part of my body that i never thought that it could be controlled your mind like you close your eyes and most of us immediately start seeing blotches and we start thinking about things and and it's an amazing feeling to start getting to the point where you can actually actually quiet your mind and close your mind down so that you can just have peace like silence of your mind for a long period of time and you know i loved it it was you know but it's a it's kind of a dangerous slope because you can kind of get caught up in it and like really start going from okay i'm trying to quiet my mind to almost being like addicted to quiet in your mind and it was a very active exercise every day 15 hours a day to just practice quieting my mind and eventually i could you know it and and in buddhism there's a whole lot of stages that you go through to once you hit that point where you can quiet your mind then there's like other psychological things that happen and eventually the the end goal for a buddhist monk who's spending their life meditating in the forest is to achieve nirvana is to have an absence of any attachment to the point where you're not even attached to your own foot or your own leg you can cut it off and you say well so you don't even have an attachment to self like to you to ego to cause do you feel like a conscious being or no like the goal you never attained it but you know i know is that the goal just that would be so the goal is you have to first look at it through the eyes of samsara which is the cycle of rebirth which is suffering it's a cycle of suffering it's how it's viewed and the idea is like if i really love this hat and then the hat gets lost i'm sad so that makes me suffer and if i hate this hat and i see it then it makes me sad or mad and that you know it's an emotion but if i have if i'm completely ambivalent about that hat i don't care it's there i don't care if it gets lost if it's shredded then that is invokes no emotional rise out of me good or bad and so the idea is to find the balance there where you are so detached from everything that you're not getting a rise negative or positive and you know this is really it's really such a distinct thing in a relative to our normal lives here in america where we live for rises you know you want happiness and joy and then you also you know nobody wants sadness but like when you come out of sadness you feel happy you understand either way it averages out right and if it doesn't average out then you're you know you're in a bad spot like that would be things like major depressive disorder where you're truly not averaging out but if you're living a pretty happy life that's why there's no right or wrong you can go up and down and you average out or you can just go that straight line this is not necessarily the the buddhist ideal is somehow obviously the ideal you should strive for but the actual access exercise and meditation that they the buddhist monks use seems like um seems like a great tool for becoming aware of your own mind and that seems to be important for appreciating life or some some kind of uh experiencing life on a deeper level i i think so i mean that's my my personal opinion is yes and that i think it i don't meditate anymore um back in the capitalist western world where there's meetings and that's right i mean i stopped i i was a monk and then the tsunami hit and i lived in a refugee camp and i was that was the indian ocean tsunami in 2004 and it just really it was really interesting in sri lanka they wanted me i asked well what can i do to help it was it was a horrible horrible you know hell on earth experience in many ways but when i said what can i do to help the answer was well you could meditate like that's how you know be keep keep doing what you're doing like that's how you that's how we can get good karma and to me coming from like western roots i just couldn't deal with that i i just said that that doesn't make sense to me why would i just sit and meditate when there's so much devastation happening here and and so i kind of stopped meditating then and then never really recovered from that time in the refugee camp but i do feel like i understand or like i am aware of of a part of me that most people never get the privilege to be aware of and that is a pretty profound and it's a it's a profound uh feeling i think or just awareness to to say oh i do have the cap if i ever need to go back to that i have the capacity to do that and i do use it i mean i don't use it a lot but i use it when i really need to um to try to like settle to settle myself to to actually calm myself whether it's pain physical or emotional pain like it is possible to make those things go away but it just like anything it takes training [Music] have you if you take yourself back to that place you were you know sam harris talks about that through his meditation practice he's able to escape the sense of free will and uh this the sense of agency you can get away from that hey do you ever think about consciousness and free will when when you were meditating like did you get some deep insight about the nature of consciousness that you were somehow able to escape it through meditation or no i looked at it in a much more utilitarian way i think and the sensation like minimizing amount of thoughts in your mind and then uh beginning to really appreciate the sensation yeah you weren't writing a book on the on free will right and uh i mean maybe if i kept at it you know there's a good chance that if the tsunami didn't happen i might still be sitting there on the top of that mountain tsunamis you see uh pain you see especially um uh if you see cruelty and you're supposed to meditate through that that doesn't there's something in the human spirit that pushes us to want to help if you see somebody who's suffering to react to that seems like to help them as opposed to care less through meditation don't become attached to the suffering of others exactly i mean that's i i do think that that's you know and they're two totally valid ways to live life um they are generally i think they're ingrained in us pretty early in society right and it's hard to escape yeah what about uh just in general becoming detached from possessions like minimalism in uh not having many things so the the capitalist world kind of pushes you towards having possessions and deriving joy from more and more and better possessions have you um have you returned back to the joys of that world or do you find yourself enjoying the minimalist life uh a little of both i think i really don't like i find things to be a burden to be a massive burden yeah and and to me when you have a burden like that you know even if it's just knowing that there's like boxes in your basement of stuff you know whatever it might be it makes it hard to focus um and so i personally like i mean my ideal like if i had a my house for example would be to have like nothing on anything it just and and that to me is like peaceful some people find that to be not peaceful for me it's like i love the night to have the night the idea that if needed i could like pack up and move yeah and not worry about anything do i actually have that in reality no um we're about to have a baby you know there's but it's like it's our i already see it it's like stressful there's like boxes of stuff showing up at the house like bottles and clothes and all these little hats and whatnot and i do i do have to like sometimes go into my meditation to just just say like this is okay you know like it's it's okay to have all of this stuff it's not permanent you know and um but i do think that it's easy to get lost in it all and it's important to remember given all that like people who buy houses you know buy a home and buy a house and make a home out of it and you start a family it's easy to forget that even though you have all these responsibilities you're still free and like freedom takes work and it takes remembering it takes meditation on it but you're you're free you're you're born free you live free i mean depends of course which country but in the united states even with all the possessions even with all the burdens of um sort of credit and owing money and all those kinds of things you can scale everything down and you're free but ultimately the people you love if you love each other it doesn't take much money to be happy together and for me i i personally value that freedom of having the freedom to always pursue your happiness as opposed to being burdened by material possessions that uh you know yeah that basically limit your ability to be happy because you're always paying off stuff you're always catching you know trying to match the neighbors that are always a little bit richer that kind of pursuit i think that pursuit is wonderful for innovation and for building cooler better things but on an individual level i think you have to remember that first of all life is finite and second of all like your goal is not to get a bigger house your goal is to be just content and happy right in the moment i completely completely agree with that so in looking at our failure at scale to to engineer to manufacture to deploy tests how do you feel about our prospect as a human civilization are you optimistic so this pandemic it is what it is it um hurt a lot of people both it took lives but it also hurt a lot of businesses and a lot of people economically but uh they're very likely to be a much worse pandemic down the line there might be other threats to human civilization are you nevertheless optimistic oh i don't think i'm optimistic about it all i think what are you most worried about i it's it's one of those things so existential that i don't worry about it um but i do think i mean let's in the united states for example so you asked about the human civilization but let's talk about like a american society for a moment i do think that like we're probably seeing like the end of a really interesting experiment like the american experiment and we're seeing its limitations we're probably going to become another blip like another one another power that's in the history books that like rose and collapsed probably that's where we'll go in terms of civilization i think we're demonstrating a pretty significant inability to recognize the danger when whether that's the pandemic or whether that's climate change i think it's extraordinary that we we are not taking these things seriously yeah and we're not acting with the urgency and i mean in some ways climate change truly makes like this pandemic look like child's play in terms of like the destruction it has the potential to read i tend to think if you just look at the progress of human history that the people who do good in the world out power the people that are the that do bad in the world so we kind of there's something about our minds that likes to focus on the negative like on the destructive because we're afraid of it it's also for some reason more fun to watch destruction i don't you know but it seems like the people who build who create solutions who um yeah who innovate and who just put like both on the emotional level so love out there and like on the actual engineering level tools that make for higher quality of life i think those win out if you look at human history um but the question is whether the negative stuff can sometimes peak to the level where everybody's just destroyed but as long as that doesn't happen i i tend to believe that there would be like a gradual with some noise a gradual improvement of quality of life in human civilization i do think so to a certain extent but it's that what's what you said like unless there's like some significant peak of bad you know the the problem with bad is that it can happen like that you know good you can you can't build a society overnight but you sure can kill one like i just think about food crises and instability and just i don't know but i do hope that i mean i completely agree i think we can engineer our way to a healthier better world like i truly do my concern is that the people who are doing that until very recently don't generally rule the world now of course we're seeing non-elected leaders and you know people who run massive corporations essentially having as much or really more power than elected leaders or than kings and queens and such so how they choose to wield that power you know is an interesting choice and i do hope that you're right in that over time fear will drive companies to produce a better product or whatever you know something like over time it's just like predator prey models you get so bad or so everything like it's so revved up that all of a sudden something cracks and they say okay i do want an electric car or whatever like and and that takes some combination of innovation letting people know that these electric cars exist it's kind of rapid tests too like you get to finally feel it and see it have an electric car and then all of a sudden things change and everyone says oh this is so bad and actually i'm doing good for the world relatively speaking and you know i guess it's a paradigm shift yeah it becomes uh lack of a better word viral positivity does and i mean i believe that ultimately that that wins out because i think there's much more power to be gained so i think most people want to do good and if you want to wield power you want to uh channeled people's desire to do good and i think over time that's that's exactly what people uh will do but yeah this i mean both on the natural side the pandemic you know there's still biology at play there's still viruses out there trying to help us there's accidents uh there's nuclear weapons there's unintended consequences of tools whether it's on the nanotechnology side or the artificial intelligence side then there's the natural things like meteors and all that that kind of stuff and yeah climate change all of that but i tend to think we humans are a clever bunch and when there's a deadline a real deadline or real threat before us we kind of step up i don't know but maybe you have to believe that um until the very end yeah that's that's right it will oh i mean we'll have to see i guess you know neither well ideally we won't be alive to see that [Laughter] well no michael i'm glad we talk again because um this has been such a difficult time that feels like there's no solutions and it's so refreshing to hear that there's a solution to covid and it's an engineering solution on the individual level something people can do on the government level is something people can do on the global level something people can do we should be doing rapid testing at scale it's obvious it's amazing that you still are you know telling that story pushing that message bravely boldly i really really appreciate the work you're doing man and i'm i i will do in my small way uh the same to try to help out and everybody else should too until we get hundreds of millions of tests in people's hands uh it's an obvious solution we should have had a long time ago and um i like solutions not problems and this is obviously a solution so thank you for presenting it to the world and thank you for talking about it it's it's something that i can't not do if it saves one person's life then it was worth the two years of lobbying for this you know and uh so let's hope we see a change thanks for talking today absolutely thanks for listening to this conversation with michael minna to support this podcast please check out our sponsors in the description and now let me leave you with some words from lord byron always laugh when you can it is cheap medicine thank you for listening and hope to see you next time you