The following is a conversation with Michael Minna.

He's a professor at Harvard doing research on infectious disease and immunology.

The most defining characteristic of his approach to science and biology

is that of a first principles thinker and engineer focused

not just on defining the problem but finding the solution.

In that spirit we talk about cheap rapid at home testing,

which is a solution to COVID 19 that to me has become one of the most obvious,

powerful and doable solutions that frankly should have been done months ago and still

should be done now. As we talk about its accuracy is high for detecting actual contagiousness

and hundreds of millions can be manufactured quickly and relatively cheaply.

In general I love engineering solutions like these even if government bureaucracies often don't.

It respects science and data, it respects our freedom, it respects our intelligence

and basic common sense. Quick mention of his sponsor,

followed by some thoughts related to the episode. Thank you to Brave,

a fast browser that feels like Chrome but has more privacy preserving features,

athletic greens, the all new one drink that I start every day with to cover all my nutritional

bases, ExpressVPN, the VPN I've used for many years to protect my privacy on the internet,

and Cash App, the app I use to send money to friends. Please check out these sponsors in

the description to get a discount and to support this podcast. As a side note, let me say that

I've always been solution oriented, not problem oriented. It saddens me to see that public discourse

disproportionately focuses on the mistakes of those who dare to build solutions rather than

applaud their attempt to do so. Teddy Roosevelt said it well in his The Man in the Arena speech

over 100 years ago. I should say that both the critic and the creator are important.

But in my humble estimation, there are too many now of the former and not enough of the latter.

So while we spread the derisive words of the critic on social media making it viral,

let's not forget that this world is built on the blood, sweat, and tears of those who dare to create.

If you enjoy this thing, subscribe on YouTube, review it with five stars on our podcast,

follow on Spotify, support on Patreon, or connect with me on Twitter at Lex Freedman.

And now here's my conversation with Michael Mina. What is the most beautiful, mysterious,

or surprising idea in the biology of humans or viruses that you ever come across in your work?

Sorry for the overly philosophical question.

Wow. Well, that's a great question. You know, I love the pathogenesis of viruses and

one of the things that I've worked on a lot is trying to understand how viruses interact with

each other. And so pre all this COVID stuff, I was really, really dedicated to understanding

how viruses impact other pathogens. So how if somebody gets an infection with one thing or a

vaccine, does it either benefit or harm you from other things that appear to be unrelated to most

people? And so one system which is highly detrimental to humans, but what I think is just

immensely fascinating is measles. And measles gets into a kid's body. The immune system picks it up

and essentially grabs the virus and does exactly what it's supposed to do, which is to take this

virus and bring it into the immune system so that the immune system can learn from it,

can develop an immune response to it. But instead, measles plays a trick. It gets into the immune

system, serves almost as a Trojan horse. And instead of getting eaten by these cells, it just

takes them over and it ends up proliferating in the very cells that were supposed to kill it.

And it just distributes throughout the entire body, gets into the bone marrow, kills off children's

immune memories. And so it essentially, what I've found and what my research has found is that

this one virus was responsible for as much as half of all of the infectious disease deaths in kids

before we started vaccinating against it because it was just wiping out

children's immune memories to all different pathogens, which is, I think, just astounding.

It's just amazing to watch it spread throughout bodies. We've done the studies in monkeys and

you can watch it just destroy and obliterate people's immune memories in the same way that

some parasite might destroy somebody's brain. Is that an evolutionary coincidence or is there

some kind of advantage to this kind of interactivity between pathogens? I think in that sense it's

just coincidence. It's a good way for measles to essentially be able to survive long enough to

replicate in the body. It just replicates in the cells that are meant to destroy it.

So it's utilizing our immune cells for its own replication, but in so doing, it's destroying

the memories of all the other immunological memories. But there are other viruses, so a

different system is influenza and flu predisposes to severe bacterial infections. And that, I think,

is another coincidence. But I also think that there are some evolutionary benefits that bacteria

may hijack and piggyback on viral infections. Viruses, they just grow so much quicker than

bacteria. They replicate faster. And so there's the system with viruses, with flu and bacteria,

where the influenza has these proteins that cleave certain receptors. And the bacteria

want to cleave those same receptors. They want to cleave the same molecules that give entrance to

those receptors. So instead, the bacteria found out like, hey, you know, we could just piggyback

on these viruses. They'll do it a hundred or a thousand times faster than we can. And so then

they just piggyback on and they let flu cleave all these sialic acids. And then the bacteria just

glom on in the wake of it. So there's all different interactions between pathogens that are just

remarkable. So does this whole system of viruses that interact with each other and so damn good at

getting inside our bodies, does that fascinate you or terrify you? I'm very much a scientist. And so

it fascinates me much more than terrifies me. But knowing enough, I know just how well, you know,

we get the wrong virus in our population, whether it's through some random mutation or

whether it's this same COVID 19 virus. And these things are tricky. They're able to

mutate quickly. They're able to find new hosts and rearrange in the case of influenza.

So what terrifies me is just how easily this particular pandemic could have been so much

worse. This could have been a virus that is much worse than it is. You know, same thing with H1N1

back in 2009. That terrifies me. If a virus like that was much more detrimental, you know, that

would be, it could be much more devastating. Although it's hard to say, you know, the human

species were worth, well, I hesitate to say that we're good at responding to things because there

are some aspects that were, this particular virus, SARS COVID 2 and COVID 19 has found a sweet spot

where it's not quite serious enough on an individual level that humans just don't,

we haven't seen much of a useful response by many humans. A lot of people even think it's a hoax.

And so it's led us down this path of, it's not quite serious enough to get everyone to respond

immediately and with the most urgency, but it's enough, it's bad enough that, you know, it's

caused our economies to shut down and collapse. And so I think I know enough about virus biology to

be terrified for humans that, you know, it can, it just takes one virus, just takes the wrong one

to just obliterate us or not obliterate us, but really do much more damage than we've seen.

It's fascinating to think that COVID 19 is a result of a virus evolving together with like

Twitter, like figuring out how we can sneak past the defenses of the humans. So it's not

bad enough. And then the misinformation, all that kind of stuff together is operating in such a

way that the virus can spread effectively. I wonder, I mean, obviously a virus is not intelligent,

but there's a, there's a rhyme and a rhythm to the way this whole evolutionary process works

and creates these fascinating things that spread throughout the entire civilization.

Absolutely. It's, yeah, I'm completely fascinated by this idea of social media in particular,

how it replicates, how it grows, you know, I've been, how it, how it actually starts interacting

with the biology of the virus, masks, who's going to get vaccinated, politics, like these seem so

external to virus biology, but it's become so intertwined. And, and it's, it's interesting.

And I actually think we could find out that, you know, the virus actually becomes obviously not

intentionally, but, you know, we could find that choosing people choosing not to wear masks,

choosing not to counter this virus in a regimented and sort of organized way effectively gives the

virus more opportunity to escape. We can look at vaccines, you know, we're about to, we're about

to have one of the most aggressive vaccination programs the world has ever seen. But we are

unfortunately doing it right at the peak of viral transmission when millions and millions of people

are still getting infected. And when we do that, that just gives this virus so many more opportunities.

I mean, orders of magnitude, more opportunity to mutate around our immune system. Now, if we were

to vaccinate everyone when there's not a lot of virus, then there's just not a lot of virus. And so

there's not going to be as many, you know, I don't even know how many zeros are at the end of however

many viral particles there are in the world right now, you know, more than quadrillions, you know,

and so if you assume that at any given time, somebody might have trillions of virus in them

and at any given individual. So then, you know, multiply trillions by millions. And, you know,

you get a lot of viruses out there. And if you start applying pressure, ecological pressure to

this virus that that, you know, when it's not abundant, kind of opportunity for a virus to

sneak around immunity, especially when all the vaccines are identical, essentially.

All it takes is one to mutate and then jumps. Oh, takes one takes one in the whole world, you

know, and we have to, we have to not forget that this particular virus was one, it was one opportunity

and it has spread across the globe and there's no reason that can't happen tomorrow. I knew,

you know, it's scary. I have a million other questions in this direction, but I'd love to

talk about one of the most exciting aspects of your work, which is testing or rapid testing.

You wrote a great article in time on November 17th. This is like a month ago about rapid testing

titled, How we can stop the spread of COVID 19 by Christmas. Let's jot down the fact that this

is a month ago. So maybe your timeline would be different, but let's say in a month. So you've

talked about this powerful idea for quite a while throughout the COVID 19 pandemic. How do we stop

the spread of COVID 19 in a month? Well, we use tests like these. You know, so the only reason

the virus continues spreading is because people spread it to each other. This isn't magic. Yes.

And so there's a few ways to stop the virus from spreading to each other. And that is you either

can vaccinate everyone and vaccinating everyone is a way to immunologically prevent the virus from

growing inside of somebody and therefore spreading. We don't know yet actually if this vaccine, if any

of these vaccines are going to prevent onward transmission. So that may or may not serve to

be one opportunity. Certainly, I think it will decrease transmission. But the other idea that

we have at our disposal now, we had it in May, we had it in June, July, August, September, October,

November. And now it's December. We still have it. We still choose not to use it in this country and

in much of the world. And that's rapid testing that is giving it's empowering people to know

that they are infected and giving them the opportunity to not spread it to their loved ones

and their friends and neighbors and whoever else. We could have done this. We still can.

Today we could start. We have millions of these tests. These tests are simple paper strip tests.

They are inside of this thing is just a little piece of paper. Now, and I can actually open it

up here. There we go. So this, this is how we do it right here. We have this little paper strip test.

This is enough to let you know if you're infectious with somewhere around the order of 99%

sensitivity, 99% specificity, you can know if you have infectious virus in you. If we can get these

out to everyone's homes, build these, make 10 million, 20 million, 30 million of them a day.

You know, we make more bottles of Desani water every day. We can make these little paper strip

tests. And if we do that and we get these into people's homes so that they can use them twice a

week, then we can know if we're infectious, you know, is it perfect? Absolutely not. But is it

near perfect? Absolutely. You know, and so if we can say, hey, the, the, the transmission of this is,

you know, for every 100 people that get infected right now, they go on to infect maybe 130 additional

people. And that's exponential growth. So 100 becomes 130. A couple of days later, that 130

becomes another 165 people have now been infected and, you know, go over three weeks and 100 people

become 500 people infected. Now, it doesn't take much to have those 100 people not infect 130,

but infect 90. All we have to do is remove, say, 30, 40% of new infections from continuing their

spread. And then instead of exponential growth, you have exponential decay. So this doesn't need

to be perfect. We don't have to go from 100 to zero. We just have to go and have those 100 people

infect 90 and those 90 people infect, you know, 82, whatever it might be. And you do that for a few

weeks and boom, you have now gone instead of 100 to 500, you've gone from 100 to 20. Yes. It's not

very hard. And so the way to do that is to let people know that they're infectious. I mean,

I, we're a perfect example right now. I this morning, I use these tests to make sure that I

wasn't infectious. Is it perfect? No, but it reduced my odds 99%. I already was at extremely low odds

because I spent my life quarantining these days. Well, the interesting thing with this test,

with testing in general, which is why I love what you've been espousing. And it's really

confusing to me that this has not been taken on as it's one, an actual solution that's those

available for a long time. There's, there doesn't seem to have been solutions proposed at a large

scale and a solution that it seems like a lot of people would be able to get behind. There's some

politicization or fear of other solutions that people have proposed, which is like lockdown.

And there's a worry, you know, especially in the American spirit of freedom,

like you can't tell me what to do. The thing about tests is it like empowers you with

information essentially. So like you, it's, it gives you more information about your,

like your role in this pandemic. And then you can do whatever the hell you want. Like it's all

up to your ethics and so on. So like, and it's obvious that with that information, people would

be able to protect their loved ones and also do, do their sort of quote unquote duty for their

country, right? It's protect the rest of the country. That's exactly right. I mean, it's just,

it's empowerment. But you know, this is a problem. We have not put these into action

in large part because we have a medical industry that doesn't want to see them be used. We have a

political and a regulatory industry that doesn't want to see them be used. That sounds crazy.

Why wouldn't they want them to be used? We have a very paternalistic approach to everything in

this country. You know, despite this country kind of being founded on this individualistic ideal,

pull yourself up from your bootstraps, all that stuff. When it comes to public health,

we have a bunch of ivory tower academics who want data. They, you know, they want to see

perfection. And we have this issue of letting perfection get in the way of actually doing

something at all, you know, doing something effective. And so we keep comparing these tests,

for example, to the laboratory based PCR test. And sure, this isn't a PCR test, but this doesn't

cost $100 and it doesn't take five days to get back, which means in every single scenario,

this is the more effective test. And we have, unfortunately, a system that's not about public

health. We have entirely eroded any ideals of public health in our country for the biomedical

complex, you know, this medical industrial complex, which overrides everything. And that's why, you

know, I'm just, can I swear on this pot? Yes. I'm just so fucking pissed that these tests don't

exist. Meanwhile, and everyone says, you know, oh, we couldn't make these, you know, that we could

never do it. That would be such a hard, a difficult problem. Meanwhile, the vaccine gets, we have,

at the same time that we could have gotten these stupid little paper strip tests out to every

household. We have developed a brand new vaccine. We've gone through phase one, phase two, phase

three trials. We've scaled up its production. And now we have UPS and FedEx and all the logistics in

the world getting freezers out to where they need to be. We have this immense, we see what,

when it comes to sort of medicine, you know, something you're injecting into somebody,

then all of a sudden people say, oh, yes, we can. But you say, oh, no, that's, that's too

simple a solution, too cheap a solution. No way could we possibly do that. It's this faulty

thinking in our country, which, you know, frankly is driven by big money, big, you know,

the only time when we actually think that we can do something that's maybe aggressive and

complicated is when there's billions and billions of billions of dollars in it, you know. And,

I mean, in a difficult note, because this is part of your work from before the COVID,

but it does seem that I saw statistic currently is that 40% would not be taken of Americans would

not be taken a vaccine. Some number like this. So you also have to acknowledge that all the money

that's been invested, like there doesn't appear to be a solution to deal with like the fear and

distrust that people have. I bet, I don't know if you know this number, but for taking a strip,

like a rapid test like this, I bet you people would say like the percentage of people that

wouldn't take it is in the single digits probably. I completely think so. And, you know, there's a

lot of people who don't want to get a test today. And that's because it gets sent to a lab,

it gets reported, it has all the stuff and we're a country which teaches people from the time

they're babies, you know, to keep their medical data close to them. We have HIPAA, we have all

these, we have immense rules and regulations to ensure the privacy of people's medical data.

And then a pandemic comes around and we just assume that all that the average person is going

to wipe all of that away and say, oh, no, I'm happy giving out not just my own medical data,

but also to tell the authority is everyone who I've spent my time with so that they all get a call

and are pissed at me for giving up their names. You know, so people aren't getting tested and

they're definitely not giving up their contacts when it comes to contact tracing. And so for

so many reasons that approach is failing, not to even mention the delays in testing and things

like that. And so this is a whole different approach, but it's an approach that empowers people

and takes the power a bit away from the people in charge, you know, and that's what's really

grating on, I think, public health officials who say, no, we need the data. So they're effectively

saying, if I can't have the data, I don't want the individuals, I don't want the public to have

their own data either, which is a terrible approach to a pandemic where we can't solve

a public health crisis without actively engaging the public. It just doesn't work. And, you know,

and that's what we're trying to do right now, which is a terrible approach.

So first of all, there's, you have a really nice informed website rapidtest.org

with information on this. I still can't believe this is not more popular. It's ridiculous. Okay,

but our one of the FAQs you have is a rapid test too expensive. So can cost be brought down? Like,

I pay, I take a weekly PCR test and I think I pay 160, 170 bucks a week.

No, I mean, it's criminal. Absolutely, we can get costs. This thing right here costs less than a

dollar to make with everything combined plus the swabs, you know, maybe a cost $1.50 could be sold

for, frankly, it could be sold for $3 and still make a profit if they want to sell it for five,

this one here. This is a slightly more complicated one, but you can see it's just got the exact

same paper strip inside. And this is really, it doesn't look like much, but it's kind of the

cream of the crop in terms of these rapid tests. This is the one that the US government bought

and it is doing an amazing job. It has a 99.9% sensitivity and specificity. So it's really,

it's really good. And so essentially the way it works is you just, you use a swab, you put the,

once you, you kind of use a swab in yourself, you put the swab into these little holes here,

you put some buffer on it and you close it and a line will show up if it's positive and a line

won't show up, but it's negative and it takes five, 10 minutes. This whole thing, this can be made

so cheap that the US government was able to buy them, buy 150 million of them from Abbott for

$5 a piece. You know, so anyone who says that these are expensive, we have the proof is right here.

This one at its, you know, was, Abbott did not lose money on this deal. You know, they got $750

million for buying, for selling 150 million of these at five bucks a piece. All of these tests

can do the same. So anyone who says that these should be, you know, unfortunately what's happening

though is the FDA is only authorizing all of these tests as medical devices. So what happens when you,

if I'm a medical company, if I'm, if I'm a test production company and I want to make this test

and I go through and the FDA at the end of my authorization, the FDA says, okay, you know,

you now have a medical device, not a public health tool, but a medical device and that

affords you the ability to charge insurance companies for it. Why would I ever as a, you know,

in our capitalistic economy and sort of infrastructure, why would I ever not sell this

for $30 when insurance will pay for it or $100? You know, it might only cost me 50 cents to make,

but, but by pushing all of these tests through a medical pathway at the FDA, they, what, what

extrudes out the other side is an expensive medical device that's erroneously expensive. It doesn't

need to be inflated in cost, but the companies say, well, I'd rather make fewer of them and just

sell them all for $30 a piece than make tens of millions of them, which I could do and sell them

at a, at a dollar marginal profit. You know, and so it's a problem with our, with our whole

medical industry that we see tests only as medical devices and you know, what I would like to see

is for the government in the same way that they bought 150 million of these from Abbott,

they should be buying, you know, all of these tests that they should be buying 20 million a day

and getting them out to people's homes. This virus has cost trillions of dollars to the American

people. It's closed down restaurants and stores and, you know, obviously the main streets across

America have shut, have shuttered. It's killing people. It's killing our economy. It's killing

lifestyles and, and this is an obvious solution. To me, this is exciting. This is like, this is

a solution. I wish, uh, like in April or something like that, uh, to launch like the larger scale

manufacturing deployment of, uh, tests. It doesn't matter what tests they are. It's obviously the

capitalist system would create cheaper and cheaper tests that, that would be hopefully driving down

to $1. So what, what are we talking about? In America, there's, I don't know, 300 plus

a million people. So that means you want to be testing regularly, right? So how many do you think

it's possible to manufacture? What would be the ultimate goal to manufacture per month?

Yep. So if we want to slow this virus and actually stop it from transmitting, achieve what I call

herd effects like vaccine herd immunity, herd effects are when you get that R value below one

through preventing onward transmission. If we want to do that with these tests, we need about

20 million to 40 million of them every day, uh, which is not a lot in the United States. In the

United States. So we could do it. There's other ways you can have two people in a household,

swab each other, you know, swab themselves rather, and then mix, you know, put the swabs into the

same tube and onto one test so you can pool. So you can get a two or three X gain in efficiency

through pooling in the household. You could do that in schools or offices too, where everyone

just uses a swab. You have a, there's two people, like, I mean, even if it's just standing in line

at a public testing site or something, you know, you could just say, okay,

these two are the last people to test or swab themselves. They go into one thing and if it

comes back positive, then you just do each person and, you know, it's rapid. So you can just say

to the people, one of you is positive, let's test you again. So there's ways to get the

efficiency gains much better. But let's say, I think that the, that the optimal number right

now that matches sort of what we can produce more or less today, if we wanted is 20 million a day.

Right now, one company that I don't have their test here, but one company is already producing

5 million tests themselves and shipping them overseas. It's an American company based in

California called the Nova and they are giving 5 million tests to the UK every day.

Not to the, you know, and this is just because there's no, the federal government hasn't

authorized these tests. So without the support of the government. So yeah. So essentially,

if the government just put some support behind it, then, then yeah, you can get 20 million,

probably easy. Oh yeah. This, I mean, just here, I have three different companies. These,

they all look similar. Well, this one's closed, but these are three different companies right here.

This is a fourth Abbott, you know, this is a fifth. This is a sixth. These two are a little bit

different. Do you mind if, you know, a little bit, would you take some of these or? Yeah, let's,

let's do it. We can, we can, we can absolutely do them. Do you have a lot of tests in front of you?

Could you maybe explain some of them? Absolutely. So there's a few different classes of tests

that I just have here. And there's more tests. There's many more different tests out in the world

too. These are, these are one class of tests. These are rapid antigen tests that are just

the most bare bones, paper strip tests. These are, this is the type that I want to see produced in

the tens of millions every day. It's so simple. You know, you don't even need the plastic cartridge.

You can just, you can just make, make the paper strip and you could have a little,

a little tube like this that, you know, you just dunk the paper strip into. You don't actually need

the plastic, which I'd actually prefer because if we start making tens of millions of these,

this becomes a lot of waste. So I'd rather not see this kind of waste be out there. And there's

a few companies, Quidel is making a test called the quick view, which is just, just this. It's a,

they've gotten rid of all the, all the plastic. And for people who are just listening to this,

we're looking at some very small tests that fit in the palm of your hand and they're basically

paper strips fit into different containers. And that's hence, hence the comment about the

plastic containers. These are just injection molded, I think. And they're, you know,

they can build them at high numbers, but then they have to like place them in there appropriately

and all this stuff. So it is a, it is a bottleneck or some somewhat of a bottleneck in manufacturing.

The actual bottleneck, which the government I think should use the defense productions act

to build up is the, there's a nitrocellulose membrane, laminated membrane on this that allows

the, the material, the, the, the buffer with the swab mixture to flow across it. So the way these

work, they're called lateral flow tests. And you take a swab, you swab the front of your nose,

you dunk that swab into some buffer, and then you put a couple of drops of that buffer onto

the lateral flow. And just like paper, if you dip a piece of paper into a cup of water,

though the paper will pull the water up through capillary action. This actually works very similarly

at flows through, through somewhat of capillary action through this nitrocellulose membrane.

And there's little antibodies on there, these little proteins that are very specific in this

case for antigens or proteins of the virus. So these are antibodies similar to how, to the antibodies

that our body makes from our immune system, but they're just printed on these lateral flow tests

and they're printed just like a little, a line. So then you, you slice these all up into individual

ones. And if there's any virus on that buffer as it flows across, the antibodies grab that virus,

and it creates a little reaction with some colloids in here that cause it to turn dark.

Just like a pregnancy test, one line means negative, it means the control strip worked,

and two lines mean positive. It means, you know, but if you get two lines, it just means you have

virus there, you're very, very likely to have virus there. And so, so they're super simple. This is,

it is the exact same technology as pregnancy tests. It's the technology, this particular one

from Abbott, this has been used for other infectious diseases like malaria and, and actually a number

of these companies have made malaria tests that do the exact same thing. So they just coopted their,

the same form factor and, and just changed the antibody. So it picks up SARS CoV2 instead of

other infections. Is it also the Abbott one? Is it also a strip? Yep. Yeah. This Abbott one here is,

there's the, in this case, instead of being put in a plastic sheath, it's just put in a cardboard

thing and literally glued on. I mean, it's, it looks like nothing, you know, it's just, it looks

like a, like, I mean, it's just the simplest thing you could, you could imagine. The exterior

packaging looks very Apple like this. Nice. It does. Yeah. Yeah. Yeah. So it's nice. This is the,

this is how they're packaged, you know, so and they don't have to, you know, this, these are

coming in individual packages against, again, because they're really considered individual

medical devices, but you could package them in, you know, bigger packets and stuff. You,

you want to be careful with humidity. So they all have a little, one of those humidity removing

things and oxygen removing things. So that's the, this is one class, these antigen tests.

If we could just pause for a second if it's okay. And could you just briefly say what is an antigen

test and what other tests there are out there, like categories of tests? Sure. Just really quick.

So the testing landscape is a little bit complicated, but it's, but I'll break it down. There's really

just three major classes of tests. We'll start with the first two. The first two tests are just

looking for the virus or looking for antibodies against the virus. So we've heard about serology

tests, or maybe some people have heard about it. Those are a different kind of tests. They're looking

to see, has somebody in the past, does somebody have an immune response against the virus, which

would indicate that they were infected or exposed to it. So we're not talking about the antibody

tests. I'll just leave it at that. Those, they, they actually can look very similar to this or

they can be done in a laboratory. They, those are usually done from blood and they're, they're

looking for an immune response to the virus. So that's one. Everything I'm talking about here is

looking for the virus itself, not the immune response to the virus. And so you, there's two

ways to look for the virus. You can either look for the genetic code of the virus, like the RNA,

just like the DNA of somebody's human cells, or you can look for the proteins themselves, the

proteins themselves, the antigens of the pro of the virus. So I like to differentiate them. If you

were a PCR test that looks for RNA in, let's say, let's say if we made it against humans,

it would be looking for the DNA inside of our cells that would be actually looking for our genetic

code. The equivalent to an antigen test is sort of a test that like actually is looking for our

eyes or our nose or physical features of our body that would delineate. Okay, this is,

this is Michael, for example. And so, so you're either looking for this a sequence or you're

looking for a structure. The PCR tests that a lot of people have gotten now and they're done in labs

usually are looking for the sequence of the virus, which is RNA. This test here by a company called

Detect. This is one of Jonathan Rothberg's companies. He's the guy who helped create modern day

sequencing and all kinds of other things. So this Detect device, that's the name of the company,

this is actually a rapid RNA detection device. So it's almost, it's like a PCR like test,

and we could even do it here. It's really, it's a beautiful test, in my opinion, works exceedingly

well. It's going to be a little bit more expensive. So I think it could confirm, could be used as a

confirmatory test for these. Is there a greater accuracy to it? Yes, I would say that there is a

greater accuracy. There's also a downfall though of PCR and tests that look for RNA. They can

sometimes detect somebody who is no longer infectious. So you have the RNA test and then you

have these antigen tests. The antigen tests look for structures, but they're generally only going

to turn positive if people have actively replicating virus in them. And so what happens after an

infection dissipates, you have, you've just gone from having sort of a spike. So if you get infected,

maybe three days later, the virus gets into exponential growth and it can replicate to

trillions of viruses inside the body. Your immune system then kind of tackles it and beats it down

to nothing. But what ends up in the wake of that, you just had a battle. You had this massive battle

that just took place inside your upper respiratory tract. And because of that, you've had trillions

and trillions of viruses go to zero, essentially. But the RNA is still there. It's just these remnants

in the same way that if you go to a crime scene and blood was sort of spread all over the crime

scene, you're going to find a lot of DNA. There's tons of DNA. There's no people anymore,

but there's a lot of DNA there. Same thing happens here. And so what's happening with PCR testing

is when people go and use these exceedingly high sensitivity PCR tests, people will stay positive

for weeks or months after their infection has subsided, which has caused a lot of problems in

my opinion. It's problems that the CDC and the FDA and doctors don't want to deal with. But I've

tried to publish on it. I've tried to suggest that this is an issue both in New York Times

and others. And now it's unfortunately kind of taken on a life of its own of conspiracy theorists

thinking that they call it a case demig. They say, oh, PCR is detecting people who are false

positive. They're not false positives. They're late positives, no longer transmissible.

I think the way you, like what I saw in rapidest.org, I really like the distinction between

diagnostic sensitivity and contagiousness sensitivity. That's so, that website is so obvious

that it's painful because it's like, yeah, that's what we should be talking about is

how accurately is a test able to detect your contagiousness? And you have different plots

that show that actually there's, you know, that antigen tests, the tests we're looking at today

like rapid tests are actually really good at detecting contagiousness. Absolutely. It all

mixes back with this whole idea that of the medical industrial complex, you know, in this country

and in most countries, we have almost entirely defunded and devalued public health period. You

know, we just have. And what that means is that we don't even, we don't have a language for it.

We don't have a lexicon for it. We don't have a regulatory landscape for it. And so the only

window we have to look at a test today is as a medical diagnostic test. And that becomes very

problematic when we're trying to tackle a public health threat and a public health emergency by

definition. This is a public health emergency that we're in. And yet we keep evaluating tests

as though the diagnostic benchmark is the gold standard where if I'm a physician, I am a physician,

so I'll put on that physician hat for a moment. And if I have a patient who comes to me and wants to

know if their symptoms are a result of them having COVID, then I want every shred of evidence that

I can get to see, does this person currently or did they recently have this infection inside of them?

And so in that sense, the PCR test is the perfect test. It's really sensitive. It will find the RNA

if it's there at all so that I could say, you know, yeah, you have a low amount of RNA left. You

might have been, you said your symptoms started two weeks ago. You probably were infectious two

weeks ago and you have lingering symptoms from it. But that's a medical diagnosis. It's kind of

like a detective recreating a crime scene. They want to go back there and recreate the pieces

so that they can assign blame or whatever it might be. But that's not public health. And public

health, we need to only look forward. We don't want to go back and say, well, was this person,

are there symptoms because they had an infection two weeks ago? In public health, we just want to

stop the virus from spreading to the next person. And so that's where we don't care if somebody was

infected two weeks ago. We only care about finding the people who are infectious today. And unfortunately,

our regulatory landscape fails to apply that knowledge to evaluate these tests as public health

tools. They're only evaluating the tests as medical tools. And therefore, we get all kinds of

complaints that say this test, which detects 99 plus, 99.8% of current infectious people.

By the FDA's rubric, they'll say, no, no, it's only 50% sensitive. And that's because when you go out

into the world and you just compare this against PCR positivity, most people who are PCR positive

in the world right now at any given time, are post infectious. They're no longer infectious

because you might only be infectious for five days, but then you'll remain PCR positive for

three or four or five weeks. And so when you go and just evaluate these tests and you say, okay,

this person's PCR positive, does the rapid antigen test detect that? More often than not,

it's no. But that's because those people don't need isolation. They're post infectious. And this is

a, it's become much more of a problem than I think even the FDA themselves is recognizing

because they are unwilling at this point to look at this as a public health problem requiring

public health tools. We'll definitely talk about this a little bit more because the concern I have

is that like a bigger pandemic comes along, what are the lessons we draw from this and how we move

forward? Let's talk about that in a bit. But sort of, can we discuss further the lay of the land

here of the different tests before us? Absolutely. So I talked about PCR tests and those are done in

the lab or they're done essentially with a rapid test like this, the detect. And we can even try

this in a moment. It goes into a little heater. So you might have one of these in a household or

one of these in a nursing home or something like that, or in an airport,

or you could have one that has 100 different outlets. This is just to heat the tube up.

These are the rapid tests. They are super simple. No frills. You just swab your nose and you put the

swab into a buffer and you put the buffer on the test. So we can use these right now if you want.

Yeah. We can try it out. And all the tests we're talking about, they're usually swabbing the nose.

Like that's the... That's still the main, yeah. There are some saliva tests coming about and these

can all work potentially with saliva. They just have to be recalibrated. But these swabs are really

not bad. This isn't the deep swab that goes like way back into your nose or anything. This is just

a swab that you do yourself like right in the front of your nose. So if you want to do it...

Yeah. Do you mind if I...

Sure. Yeah. Yeah. Why don't we start with this one? Because this is the Abbots Bynex Now test

and it's really... It's pretty simple. This is the swab from the Abbott test.

That's correct. That's the swab from the Abbott test. So what I'm going to do to start

is I'm going to take this buffer here, which is... This is just the buffer that goes onto this test.

So this is a brand new one. I just opened this test out. I'm going to just take six drops of this

buffer and put it right onto this test here. Two, three, four, five, six.

Okay. And now you're going to take that swab, open it up.

Yep. And now just wipe it around inside the... Into the front of your nose.

Do a few circles on each nostril.

Yeah. That looks good.

This always makes me want to sneeze.

Yeah. Okay. Now I'm going to have you do it yourself.

I'm getting emotional.

Hold it parallel to the test. So put the test down on the table. Yep. And then go into that

bottom hole. Yep. And push forward so that you can start to see it in the other hole.

There you go. Now turn. If it's... Once it hits up against the top, just turn it three times.

One, two, three, and sort of... Yep. And now you just close. So pull off that adhesive sticker there.

And now you just close the whole thing.

And... And that's it. That's it. Now what we will see is we will see a line form.

What's happening now is the buffer that you put in there is now

moving up onto the paper strip test. And it has the material from the swab in there.

And so what we'll see is a line will form. And that's going to be the control line.

And then we'll also see the... Ideally, we'll see no line for the actual test line.

And that's because you should be negative. So one line will be positive and two lines will be negative.

That's very cool. There's this purple thing creeping up onto the control line.

That's perfect. That's what you want to be seeing. So you want to see that...

So right now, you essentially want to see that that blue line turns pink or purpley color.

There's a blue line that's already there printed. It should turn sort of a purple pink color.

And ideally, there will be no additional line for the sample.

And if there is, that's the 99. whatever percent accuracy on... That means I have... I'm contagious.

That would mean that you're likely contagious or you likely have infectious virus in you.

What we can do, because one of the things that my plan calls for,

is because sometimes these tests can get false positive results. It's rare.

Maybe 1% or in the case of this by next now, this Abbott test, 0.1%. So 1 in 1,000, 1 in 500,

something like that can be falsely positive. What I recommend is that when somebody is

positive on one of these, you turn around and you immediately test on a different test.

You could either do it on the same, but for a good measure, you want to use a separate test

that is somewhat orthogonal, meaning that it shouldn't turn falsely positive for the same reason.

This particular test here, this detect test, because it is looking for the RNA and not the

antigen, this is an amazingly accurate test. And it's sort of a perfect gold standard or

confirmatory test for any of these antigen tests. So one of the recommendations that I've had,

especially if people start using antigen tests before you get onto a plane or as what I call

entrance screening, if somebody's positive, you don't immediately tell them you're positive,

go isolate for 10 days. You tell them, let's confirm on one of these on a detect test.

That is because it's completely orthogonal, it's looking for the RNA instead of the antigen. There's

no reason, no biological reason that both of these should be falsely positive. So if one's

falsely positive and the other one is negative, especially because this one's more sensitive,

then I would trust this as a confirmatory test. If this one's negative, then the antigen test

would be considered falsely positive. It does look like there's only a single line. This is very

exciting news. That's right. Yep. It says wait 15 minutes to see both lines. But in general,

if somebody's really going to be positive, that line starts showing up within a minute or two.

So you want to keep the whole, we'll keep watching it for the whole 15 minutes as it's

sitting there. But I would say you're knowing that you've had PCR tests recently and all that.

The odds are pretty good. The odds are very good. The packaging, very iPhone like,

I'm digging the sexy packaging. I'm a sucker for good packaging. Okay.

So then there's this test here, which is, this is another, it's funny. Let me open this up and

show you. This is a really nice test. It's another antigen test. Works the exact same way as this,

essentially. But what you can see is it's got lights in it and a power button and stuff. This

is called an allume test, which is fine. And it's a really nice test, to be honest. But it has to

pair with an iPhone. And so it's good as a, I think that this is going to become, there's a

lot of use for this from a medical perspective, where you want good reporting. This can, because

it pairs with an iPhone, it can immediately send the report to a Department of Health,

whereas these paper strip tests that they're just paper, they don't report anything unless you

want to report it. Okay. So I'm going to just pick it up and pick it apart. And so you can see,

is there's like fluorescent readers and little lasers and LEDs and stuff in there.

You can actually see the lights going off. And there's a paper strip test right inside there,

but you can see that there's like a whole circuit board and all this stuff. Right. And so

this is the kind of thing that, you know, the FDA is looking for, for like home use and things like

that, because it's kind of foolproof. Like you can't go wrong with it. It pairs with an iPhone,

so you need Bluetooth. So it's going to be more limited. It's a great test. Don't get me wrong.

It's as good as any of these. But, you know, when you compare this thing with a battery and a

circuit board and all this stuff, it's got its purpose, but, you know, it's not a public health

tool. I don't want to see this made in the tens of millions a day and thrown away.

But FDA likes that kind of stuff. FDA loves this stuff, you know, because they can't get

it out of their mind that this is a public health crisis. You know, we need, we need,

I mean, just look at the difference here. Something flashing lights is essential.

Got batteries. It's got a Bluetooth thing. It's a great test, but, you know, it's,

to be honest, it's not any better than this one. And so, you know, I want this one.

It's nice and all. The form factor is nice, but, and it's really nice that it goes to Bluetooth.

But it goes against the principle of just 20 million a day. The easy solution. Everybody has it.

You can manufacture and probably, you could have probably scaled this up in a couple of weeks.

Oh, absolutely. These companies, I mean, the rest of the world has these. They can be scaled up.

They already exist. You know, SD biosensors, one company is making tens of millions a day,

not coming to the United States, but going all over Europe, going all over Southeast Asia and

East Asia. So they exist. The US is just, you know, we can't get out of our own way.

I wonder what, why somebody, I don't know if you were paying attention, but somebody like an Elon

Musk type character. So he was really into doing some like obvious engineering solution, like this

at home rapid test seems like a very Elon Musk thing to do.

Well, I don't know if you saw, but I had a little Twitter conversation with Elon Musk.

Does he not like what was it? Do you know what his thoughts are on rapid testing?

Well, he was using a slightly different one, one of these, but that requires an instrument called

the BD Veritor. And he got a false positive or no, I shouldn't say he didn't necessarily get a

false positive. He got discrepant results. He did this test four times. He got two positives, two

negatives. But then he got a PCR test and it was a very low positive result. So I think

what happened is he just tested himself at the tail end of it. This was actually right before

he was about to send those. It was the day of essentially that he was sending the astronauts

up to the space station the other day. So he was using these rapid tests because he wanted to

make sure that he was good to go in and he got discrepant results. Ultimately, they were correct,

but you know, two were negative, two were positive. But what really happened, once he got his,

he shared his PCR results and they were very low positive. So really what was happening

is my guess is he found himself right at the edge of his positivity, of his infectiousness.

And so, you know, the test worked out, it was supposed to work. It probably had he used it

two days earlier. It would have been screaming positive. You know, he wouldn't have gotten

discrepant results. But he found himself right at the edge by the time he used the test. So the

PCR would always pick it up because it's still, because it will still stay positive then for

weeks, potentially. But the rapid antigen test was starting to falter, not in a bad way, but just

he probably was really no longer particularly infectious. And so it was kind of when it gets

to be a very low viral load, it becomes stochastic.

It's fascinating this duality. So one, you can think from an individual perspective,

it's unclear when you take four and a half are positive, half a negative, like what are you

supposed to do? But from a societal perspective, it seems like if just one of them is positive,

just stay home for a couple days, for a while. So if one year CEO of a company you're launching

astronauts to space, you may not want to rely absolutely on the antigen test as a thing by

which you steer your decisions of like 10,000 plus people companies. But us individuals just

living in the world, if it comes up positive, then you make decisions based on that. And then

that scales really nicely to an entire society of hundreds of millions of people. And that's how

you get that virus to a stop spreading. That's exactly right. You don't have to catch every

single one. And the nice thing is that these will, these will catch the people who are most

infectious. So with Elon Musk, generally that test, we don't have the counterfactual. We don't

have his results from three days earlier when he was probably most infectious. But my guess is the

fact that it was catching two out of the four, even when he was down at a CT value of really,

really very, very low viral load on the PCR test suggests that it was doing its job. And you just

want to, and the nice thing is because these can be produced at such scale, getting one positive

doesn't immediately have to mean 10 days of isolation. That's the CDC's more conservative

stance to say, if you're positive on any test, stay home for 10 days and isolate. But here,

people would just have more tests. So the recommendation should be test daily. If you

turn positive test daily, until you've been negative for 24, 48 hours, and then go back to

work. And the nice thing there is, right now, people just aren't testing because they don't want

to take 10 days off. They're not getting paid for it. So they can't take 10 days off.

Do you know what Elon thinks about this idea of rapid testing for everybody? So I understood,

I need to look at that whole Twitter thread. So I understand his perhaps criticism of,

he had like a conspiratorial tone for my vague look at it of like, what's going on here with

these tests? But what does he actually think about this very practical to me engineering

solution of just deploying rapid tests to everybody? It seems like that's a way to open

up the economy in April. Well, to be honest, I've been trying to get in touch with him again.

I think, take somebody like Elon Musk with the engineering prowess within his ranks to

easily, easily build these at the tens of millions a day. He could build the machines from scratch.

A lot of the companies, they buy the machines from South Korea or Taiwan, I believe. We don't

have to. We can build these machines. They're simple to build. Put somebody like Elon Musk on it.

Take some of his best engineers and say, look, the US needs a solution in two weeks. Build

these machines. Figure it out. He'll do it. He could do it. This is a guy who is literally,

he started multiple entirely new industries. He has the capital to do it without the US government

if he wanted to. The return on investment for him would be huge. But frankly, the return on

investment in the country would be hundreds of billions of dollars because it means we could

get society open. I know that his first experience with these rapid tests was confusing, which is

how I ended up having this Twitter conversation with him very briefly. But I think that if he

understood a little bit more, and I think he does, I really love to talk to him about it,

because I think he could totally change the course of this pandemic in the United States

singlehandedly. He loves grand things. I think out of all the solutions I've seen,

this is the obvious engineering solution to at least a pandemic of this scale.

I love that you say the engineering solution. So this is something I've been really trying to,

I'm an engineer. My previous history was all engineering, and that's really how I think.

I then went into medicine and PhD world. But I think that the world, one of the major

catastrophes or one of the major problems is that we have physicians making the decisions about

public health and a pandemic when really we need engineers. This is an engineering problem.

What I've been trying to do, I actually really want to start a whole new field called public

health engineering. Eventually, I want to try to bring it to MIT and get MIT to want to start a

new department or something. That's a doubly awesome idea. I love this. I love every aspect.

I love everything you're talking about. A lot of people believe because vaccines started being

deployed currently that we are no longer in need of a solution. We're no longer in need of slowing

the spread of the virus. To me, as I understand, it seems like this is the most important time

to have something like a rapid testing solution. Can you break that apart? What's the role of rapid

testing in the next three, four months maybe? Even more. The vaccine rollout isn't going to be as

peachy as everyone is hoping. I hate to be the Debbie Downer here, but there's a lot of unknowns

with this vaccine. You've already mentioned one, which is there's a lot of people who just don't

want to get the vaccine. I hope that that might change as things move forward and people see

their neighbors getting it and their family getting it, and it's safe and all. We don't know how

effective the vaccine is going to be after two or three months. We've only measured it in the first

two or three months, which is a massive problem, which we can go into biologically because there's

reasons, very good reasons to believe that the efficacy could fall way down after two or three

months. We don't know if it's going to stop transmission, and if it doesn't stop transmission,

then herd immunity is much, much more difficult to get because that's all based on transmission

blockade. And frankly, we don't know how easily we're going to be able to roll it out. Some of

the vaccines need really significant cold chains, have very short half lives outside of that cold

chain. We need to organize massive numbers of people to be able to distribute these. Most

hospitals today are saying that they're not equipped to hire the right people to be even

administering enough of these vaccines. And then a lot of the hospitals are frustrated because

they're getting much lower, smaller allocations than they were expecting. So I think right now,

like you say, right now is the best time, besides three or four or five or six months ago,

right now is the best time to get these rapid tests out. The country has the capacity to build

them. We're shipping them overseas right now. We just need to flip a switch, get the FDA to

recognize that there's more important things than diagnostic medicine, which is the effectiveness of

the public health program when we're dealing with a pandemic. They need to authorize these as public

health tools or frankly, the president could. There's a lot of other ways to get these tests to

not have to go through the normal FDA authorization program, but maybe have the NIH and the CDC

give a stamp of approval. And if we could, we could get these out tomorrow. And that's where

that article came from, how we can stop the spread of this virus by Christmas. We could. Now it's

getting late. And so we have to keep updating that timeframe, maybe putting Christmas in the title

wasn't, I should have said how we can stop the spread of this virus in a month. It would be a

little bit more timeless, but we could do it. We really could do it. And that's the most frustrating

part here is that we're just choosing not to as a country. We're choosing to bankrupt our society

because some people at the FDA and other places just can't seem to get their head around the fact

that this is a public health problem, not a bunch of medical problems. Is there a way to change that

policy wise? So this is, this is a much bigger thing that you're speaking to, which I, I love in

terms of the MIT engineering approach to public health. Is there a way to push this? Is this,

is this a political thing like where some Andrew Yang type characters need to like start screaming

about it? Is it more of an Elon Musk thing where people just need to build it and then on Twitter

start talking crap to politicians who are not doing it? What are the ideas here?

I think it's a little both. I think it's political on the one hand, and I've certainly been talking

to Congress a lot, talking to senators. Are they receptive? Oh, yeah. I mean, that's the crazy

thing. Everyone but the FDA is receptive. I mean, it's, it's astounding. I mean, I advise, you know,

informally, I advise the president and the president elects teams. I talk to Congress,

I talk to senators, governors, you know, and then all the way down to mayors of towns and things.

And I held, I mean, months ago, I held a roundtable discussion with Mayor Garcetti,

who's the mayor of LA. And I brought all the, all the companies who make these things. This was in

like July or August or something. I brought all the companies to the table and said, okay, how can

we get these out? And unfortunately, it went nowhere because the FDA won't authorize them as

public health tools. The nice thing is that this is one of the nice and frustrating things. This

is one of the few bipartisan things that I know of. And like you said, it's, it's a real solution.

Lockdowns aren't a solution. They're, they're an emergency bandaid to a catastrophe that's

currently happening. They're not a solution. And they're definitely not a public health solution

if we're taking a more holistic view of public health, which includes people's well being,

includes their psychological well being, their financial well being, you know,

just stopping a virus if it means that all those other things get thrown under the bus

is not a public health solution. It's a, it's a, it's a myopic or very tunnel vision

approach to a viral virus that's spreading. This is a simple solution with essentially

no downfall. You know, there is no, nothing bad about this. It's just giving people

a result. And it's bipartisan, you know, the most conservative and the most liberal people.

Everyone just wants to know their status. You know, nobody wants to have to wait in line for

four hours to find out their status on Monday, a week later on Saturday. You know, it just doesn't

make any sense. It's a useless test at that point. And everyone recognizes that.

So why, why do you think like the mayor of LA, why do you think politicians are going for these,

from my perspective, like kind of half ass lockdowns, which is not, so I have seen good

evidence that like a complete lockdown can work, but that's in theory, it's just like

communism in theory can work. Like theoretically speaking, but it just doesn't, at least in

this country, we don't, I think it's just impossible to have complete lockdown. And still,

politicians are going for these kind of lockdowns that everybody hates,

that's really, really hurting small businesses. Like, why are they going for that?

Yeah, all businesses, but like basically not just hurting, they're destroying small businesses,

right? Which is going to have potentially, I mean, yeah, I've been reading as I don't

shout out about the rise and fall of the third Reich. And, you know, there's economic effects

that take a decade to, you know, there's going to be long lasting effects that may maybe

destructive to the very fabric of this nation. So why are they doing it? And why they're not

using the solution? Is there an intuition? I mean, you've said that FDA has a stranglehold,

I guess, on this whole public health problem. Is that all it is?

That's honestly, it's pretty much all it is. The company, so the somebody like Mayor Garcetti or

Governor Baker, Cuomo Newsom, any of these, DeWine, I've talked to a lot of governors in

this country at this point. And of course, the federal government, including the president's

own teams, you know, and the heads of the NIH, the heads of the CDC about this.

The problem is the tests don't exist in this country at the level that we need them to right now

to make that kind of policy, to make that kind of program. They could, but they don't. And so

what that means is that when Mayor Garcetti says, okay, what are my actual options today,

despite these sounding like a great idea, he looks around and he says, well, they're not

authorized. You know, they don't exist right now for at home use. And from his perspective,

he's not about to pick that fight with the FDA. And it turns out nobody is.

Why are people afraid of it? It seems like an easy struggle to fight. It's like, uh...

Well, it's not a... So they don't see it as a fight. They think that the FDA is the end all

be all. Everyone thinks the FDA is the end all be all. And so they just differ. Everyone is

deferential, including the heads of all the other government agencies, because that is their role.

But what everyone is failing to see is that the FDA doesn't even have a mandate or a remit

to evaluate these tests as public health tools. So they're just falling in this weird gray zone

where the FDA is saying, look, we evaluate medical products. That's the only thing that

I meant, like Tim Stenzel, head of Invitra Diagnostics at the FDA. He's doing what his job is,

which is to evaluate medical tools. Unfortunately, this is where I think the CDC has really

blended. They haven't made the right distinction to say, look, okay, the FDA is evaluating these

for doctors to use and all that. But we're the CDC and we're the public health agency of this

country. And we recognize that these tools require a different authorization pathway and a different

use, not prescription. There's a difference in medical devices and public health. I guess FDA is

not designed for this public health, especially in emergency situations. And they actually

explicitly say that. I mean, when I go and talk to Tim, he's a very reasonable guy.

But when I talk to him, he says, look, we don't, we just do not evaluate a public health tool. If

you're telling me this is a public health tool, great, go and use it. And so I say, okay, great,

we'll go and use it. And then the comment is, but does it give a result back to somebody? I say,

well, yes, of course it gives a result back to somebody. It's being done in their home. So

well, then it's defined as a medical tool. Can't use it. So it's stuck in this gray zone where

unfortunately, there's this weird definition that any tool, any test that gives a result back to

an individual is defined by CMS, Centers for Medicaid Services as a medical device requiring

medical authorization. But then you go and ask, it gets crazier because then you go and ask

Seema Verma, the head of CMS, okay, can these be authorized as public health tools and not

fall under your definition of a medical device? So then the FDA doesn't have to be the ones authorizing

it as a public health tool. And Seema Verma says, oh, well, we don't have any jurisdiction over

point of care and sort of rapid devices like this. We only have jurisdiction over lab devices.

So it's like nobody has ownership over it, which means that they just keep, they stay in this purgatory

of not being approved. And so this is where I think, frankly, it needs a president. It needs a

presidential order to just unlock them to say, this is more important than having a prescription.

And in fact, I mean, really what's happening now because there is this sense that tests are public

health tools, even if they're not being defined as such, the FDA now is pretty much, not only are

they not authorizing these as public health tools, what they're doing by authorizing what are

effectively public health tools as medical devices, they're just diluting down the practice of medicine.

Right. I mean, his answer right now, unfortunately, is, well, I don't know why you want these to be

sort of available to everyone without a prescription. We've already said that a doctor can write

a whole prescription for a whole college campus. It's like, well, if you're going in that direction,

then that's no longer medicine. Having a doctor write a prescription for a college campus for

everyone on the campus to have repeat testing, now we're just in the territory of eroding medicine

and eroding all of the legal rules and reasons that we have prescriptions in the first place.

So it's just everything about it is just destructive instead of just making a simple solution,

which is, these are okay as public health tools as long as they meet X and Y metrics go and CDC can

put their stamp of approval on them. What do you think? Sorry if I'm stuck on this. You mentioned

of MIT and public health engineering, right? I mean, it has a sense of I talked to competition

biology folks. It's always exciting to see computer scientists start entering the space of biology.

And there's actually a lot of exciting things that happen because of that, trying to understand

the fundamentals of biology. So from the engineering approach to public health,

what kind of problems do you think can be tackled? What kind of disciplines are involved?

Like, do you have ideas in this space? Oh, yeah. I mean, I can speak to one of the major

activities that I want to do. So what I normally do in my research lab is develop

technologies that can take a drop of somebody's blood or some saliva and profile for hundreds of

thousands of different antibodies against every single pathogen that somebody could be possibly

exposed to. So this is all new technology that we've been developing more from a bioengineering

perspective. But then I use a lot of the mathematics tools to interpret that. But what I really want

to do, for example, to kind of kick off this new field of what I consider public health

engineering is to create, maybe it's a little ambitious, but create a weather system for viruses.

I want us to be able to open up our iPhones, plug in our zip code, and get a better sense,

get a probability of why my kid has a runny nose today. Is it COVID? Is it a rhinovirus?

An adenovirus or is it flu? And we can do that. We can start building the rules of virus spread

across the globe, both for pandemic preparedness, but also for just everyday use. In the same way

that people used to think that predicting the weather was going to be impossible. Of course,

we know that's not impossible now. Is it always perfect? No. But does it offer, does it completely

change the way that we go about our days? Absolutely. I envision, for example, right now,

we open up our iPhone, we plug in a zip code, and if it tells us it's going to rain today,

we bring an umbrella. So in the future, it tells us, hey, there's a lot of SARS code too in your

community. Instead of grabbing your umbrella, you grab your mask. We don't have to have masks all the

time. But if we know the rules of the game that these viruses play by, we can start preparing

for those. And every year, we go into every flu season blindfolded with our hands tied behind

our back, just saying, I hope this isn't a bad flu season this year. We're in the 21st century.

We have the tools at our disposal now to not have that attitude. This isn't like

1920s. We can just say, hey, this is going to be a bad flu season this year. Let's act accordingly

and with a targeted approach. For example, we don't just use our umbrellas all day long every

single day in case it might rain. We don't board up our homes every single day in case it's a

hurricane. We wait, and if we know that there's one coming, then we act for a small period of

time accordingly. And then we go back and we've prepared ourselves in these little bursts to

not have it ruin our days. I can't tell you how exciting that vision of the future is. I think

that's incredible. And it seems like it should be within our reach. Just these weather maps of

viruses floating about the earth. And it seems obvious. It's one of those things where right now

it seems like maybe impossible. And then looking back like 20 years from now, we'll wonder why

the hell this hasn't been done way earlier. Though one difference between weather, I don't know if

you have interesting ideas in this space. The difference between weather and viruses is it

includes the collection of the data, includes the human body potentially. And that means that

there is some, as with the contact tracing question, there's some concern about privacy.

There seems to be this dance that's really complicated with Facebook getting a lot of

flack for basically misusing people's data or just whether it's perception or reality,

there's certainly a lot of reality to it too, whether they're not good stewards of our private

data. So there's this weird place where it's obvious that if we collect a lot of data about

human beings and maintain privacy and maintain all basic respect for that data, just like

honestly common sense respect for the data, then we can do a lot of amazing things for the world,

like a weather map for viruses. Is there a way forward to gain trust of people

or to do this well? Do you have ideas here? How big is this problem?

I think it's the central problem. There's a couple central problems that need to be solved.

One, how do you get all the samples? That's not actually too difficult. I actually have a pilot

project going right now with getting samples from across all the United States. Tens of thousands

of samples every week are flowing into my lab and we process them. So it's taking like one of the

basically this biology here in chemistry and converting that into numbers. That's exactly

right. So what we're doing, for example, there's a lot of people who go to the hospital every day,

a lot of people who donate blood, people who donate plasma. So one of the projects that I have,

I'll get to the privacy question in a moment, but this, so what I want to do is that the name

that I've given this is a global immunological observatory. There's no reason not to have that.

Good name. I've said, instead of saying, well, how do we possibly get enough people on board to

send in samples all the time? Well, just go to the source. So there's a company in Massachusetts

that makes 80% of all the instruments that are used globally to collect plasma from plasma donors.

So I went to this company, Hemenetics, and said, is there a way you have 80% of the global market

on plasma donations? Can we start getting plasma samples from healthy people that use your machines?

So that hooked me up with this company called Octafarma. And Octafarma has a huge reach

and offices all over the country where they're just collecting people's plasma. They actually pay

people for their plasma, and then that gets distributed to hospitals and all this stuff

is anonymous plasma. So I've just been collecting anonymous samples. And we're processing them,

in this case, for COVID antibodies to watch from January up through December, we're able to

watch how the virus entered into the United States and how it's transmitting every day

across the US. So we're getting those results organized now, and we're going to start

putting them publicly online soon to start making at least a very rough map of COVID.

But that's the type of thinking that I have in terms of like, how do you actually capture huge

numbers of specimens? You can't ask everyone to participate on sort of a, I mean, you maybe

could if you have the right tools, and you can offer individuals something in return like 23 in

me does. That's a great way to get people to give specimens and they get results back. So

with these technologies that I've been building, along with some collaborators at Harvard, we can

come up with tools that people might actually want. So I can offer you your immunological history. I

can say, give me a drop of your blood on a filter paper, mail it in, and I will be able to tell you

every infectious disease you've ever encountered, and maybe even when you encountered it roughly.

I could tell you, do you have COVID antibodies right now? Do you have Lyme disease antibodies

right now? Flu, triple E, and all these different viruses, also peanut allergies, milk allergies,

anything. If your immune system makes a response to it, we can detect that response.

So all of a sudden, we have this very valuable technology that on the one hand,

gives people maybe information they might want to know about themselves. But on the other hand,

becomes this amazingly rich source of big data to enter into this global immunological observatory

sort of mathematical framework to start building these maps, these epidemiological tools. But

you ask about privacy. And absolutely, that's essential to keep in mind, first and foremost.

So privacy can be, you can keep these samples 100% anonymous. They're just, when I get them,

they show up with nothing. They're literally just tubes. I know a date that they were collected and

a zip code that they're collected from or even just sort of a county level ID. With an IRB and

with ethical approval and with the people's consent, we can maybe collect more data,

but that would require consent. But then there's this other approach, which I'm really excited

about, which is certainly going to gain some scrutiny, I think. But we'll have to figure out

where it comes into play. But I've been recognizing that we can take somebody's

immunological profile, and we can make a biological fingerprint out of it. And it's

actually stable enough so that I could take your blood. Let's say I don't know who you are,

but you sent me a drop of blood a year ago, and then you sent me a drop of blood today.

I don't know that those two blood spots are coming from the same person. They're just showing up

in my lab. But I can run our technology over, and it just gives me your immunological history.

But your immunological history is so unique to you, and the way that your body responds to these

pathogens is so unique to you that I can use that to tether your two samples. I don't know who you

are. I know nothing about you. I only know when those samples came out of a person,

but I can say, oh, these two samples a year apart actually belong to the same person.

Yeah, so there's sufficient information in that immunological history to match the samples.

Or from a privacy perspective, that's really exciting. Does that generally hold for humans?

So you're saying there's enough uniqueness to match? Yeah, because it's very stochastic,

even twins. So this, I believe, we haven't published this yet. We will soon.

You have a twin too, right? I do have a twin. I have an identical twin brother,

which makes me interested in this. He looks very much like me. Oh, is that how that works?

And DNA can't really tell us apart. But this tool is one of the only tools in the world that

could tell twins apart from each other, could still be accurate enough to say this blood,

it's like 99.999% accurate to say that these two blood samples came from the same individual.

And it's because it's a combination both of your immunological history,

but also how your unique body responds to a pathogen, which is random. The way that we

make antibodies is by and large, it's got an element of randomness to it. How the cells,

when they make an antibody, they chop up the genetic code to say, okay, this is the antibody

that I'm going to form for this pathogen. And you might form, if you get a coronavirus, for

example, you might form hundreds of different antibodies, not just one antibody against the

spike protein, but hundreds of different antibodies against all different parts of the virus.

So that gives this really rich resolution of information, that when I then do the same thing

across hundreds of different pathogens, some of which you've seen, some of which you haven't,

it gives you an exceedingly unique fingerprint that is sufficiently stable over years and years

and years to essentially give you a barcode. And I don't have to know who you are,

but I can know that these two specimens came from the same person somewhere out in the world.

It's so fascinating that there's this trace, your life story in the space of viruses,

in the space of pathogen. Because there's this entire universe of these organisms that are trying to

destroy each other. And then your little trajectory through that space leaves a trace. And then you

can look at that trace. That's fascinating. And that data period is just fascinating. And the

vision of making that data universally connected to where you can make, like infer things, and just

like with the weather is really fascinating. And there's probably artificial intelligence

applications there, start making predictions, start finding patterns.

Exactly. We're doing a lot of that already. And that's how we had this going. I've been

trying to get this funded for years now. And I've spoken to governments, everyone says,

cool idea, not going to do it. Why do we need it? Oh, really? The why do you need it?

The why do you need it? And of course now, I've wrote in 2015 about this,

why this would be useful. And of course, now we're seeing why it would be useful.

Had we had this up and running in 2019, had we had it going, we were getting blood samples from

hospitals and clinics and blood donors from New York City, let's just say. We didn't run the

first PCR test for coronavirus until probably a month and a half or two months after the virus

started transmitting in New York City. So it's like with the rain, we didn't start wearing umbrellas

or taking out umbrellas. Exactly, for two months. It's getting wet.

But different than the rain, we couldn't actually see that it was spreading.

And so Andrew Cuomo had no choice but to leave the city open. They were hints that maybe the

virus was spreading in New York City, but he didn't have any data to back it up. No data.

And so it was just week on week on week. And he didn't have any information to really go by to

allow him to have the firepower to say, we're closing down the city. This is an emergency,

we have to stop spread before it starts. And so they waited until the first PCR test

were coming about. And then the moment they started running PCR tests, they find out it's

everywhere. And so that was a disaster because of course New York City, it was just hit so bad

because nobody was, we were blind to it. We didn't have to be blind to it. And the nice thing about

this technology is we wouldn't have, with the exact same technology we had in 2017,

we could have detected this novel coronavirus spreading in New York City in 2020,

not because we changed, not because we are actually actively looking for this novel coronavirus,

but because we would see, we would have seen patterns in people's immune responses using AI

or just frankly using our just the raw data itself. We could have said, hey, it looks like there's

something that looks like known coronavirus is spreading in New York, but there's gaps.

You know, there's, for some reason, people aren't developing an immune response to this

coronavirus that seems to be spreading to these normal things that, you know, and it just looks,

the profile looks different. And we could have seen that and immediately, especially since we

had an idea that there was a novel coronavirus circulating in the world, we could have very

quickly and easily seen, hey, clearly we're seeing a spike of something that looks like a known

coronavirus, but people are responding weirdly to it. Our AI algorithms would have picked it up

and just our basic heck, you could have put it in an Excel spreadsheet, we would have seen it.

Some basic visualization would have shown that. Exactly. We would have seen spikes and they would

have been kind of like off, you know, immune responses that the shape of them just looked

a little bit different, but they would have been growing and we would have seen it and it could

have saved tens of thousands of lives in New York City. So to me, the fascinating question,

everything we've talked about, so both the huge collection of data at scale,

which is super exciting. And then the kind of obvious at scale solution to the current virus

and future ones is the rapid testing. Can we talk about the future of viruses that might be

threatening the, our very existence? So do you think like a future natural virus can

have an order of magnitude greater effect on human civilization than anything we've ever seen?

So something that either kills all humans or kills, I don't know, 60, 70% of humans. So some

like something, something we can't even imagine. Is that, is that something that you think is

possible? Because it seems to have not happened yet. So maybe like the entirety, whoever, whoever

the programmer is of the simulation that sort of launched the evolution for the Big Bang,

seems to not want to destroy us humans. Or maybe that's a natural side effect of the

evolutionary process that humans are useful. But do you think it's possible that the evolutionary

process will produce a virus that will kill all humans? I think it could. I don't think it's likely.

And the reason I don't think it's likely is, well, on the one hand, it hasn't happened yet,

in part because mobility is a recent phenomena. People weren't particularly mobile until

fairly recently. Now, of course, now that we have people flying back and forth across the globe all

the time, the chances of global pandemics has escalated exponentially, of course. And so

on the one hand, that's part of why it hasn't happened yet. We can look at things like Ebola.

Now, Ebola, we don't, we haven't generally had major Ebola epidemics in the past, not because

Ebola wasn't transmitting and infecting humans, but because they were, it was largely affecting

and infecting humans in disconnected communities. So you see in rural parts of Africa, for example,

in Western Africa, you might end up having isolated Ebola outbreaks, but there weren't

connections that were fast enough that would allow people to then spread it

into the cities. Of course, we saw back in 2014, 15 massive Ebola outbreak that wasn't

because it was a new strain of Ebola, but it was because there's new inroads and connections

between the communities and people got it to the city. And so we saw it start to spread.

So that should be a little bit foreshadowing of what's to come. And now we have this pandemic,

we had 2009, we have this. There is a benefit, or there is sort of a natural check. And this is

like kind of Latke Voltaire predator prey dynamic kind of systems, ecological systems and mathematics

that if you have something that's so deadly, people will respond more, maybe with a greater panic,

a greater sense of panic, which alone could destroy humanity. But at the same time,

like we now know that we can lock down. We know that that's possible. And so if this

was a worse virus that was actually killing 60% of people who was infecting, we would lock down

very quickly. My biggest fear though is let's say that was happening. You need serious lockdowns if

you're going to keep things going. So the only reason we were able to keep things going during

our lockdowns is because it wasn't so bad that we were still able to have people work in the

grocery stores. Still people work in the shipping to get the food onto the shelves.

So on the one hand, we could probably figure out how to stop the virus,

but can we stop the virus without starving? And I'm not sure that that if this was

another acute respiratory virus that say it transmitted the same way, but say it actually

did worse damage to your heart. But it was like a month later that people started having heart attacks

in mass. It's like not just one offs, but really severe. Well, that could be a serious problem for

humanity. So in some ways, I think that there are lots of ways that we could end up dying at the

hand of a virus. I mean, we're already seeing it. I mean, my fear is still, I think coronaviruses

have demonstrated a keen ability to destroy or to create outbreaks that can potentially be deadly

to large numbers of people. Flu strains, though, are still by and large my concern.

So you think the bad one might come from the flu, the influenza?

Yeah, their replication cycle, they're able to genetically recombine in a way that coronaviruses

aren't. They have segmented genomes, which means that they can just swap out whole parts of their

genomes, no problem, repackage them, and then boom, you have a whole antigenic shift, not a drift.

What that means is that on any occasion, any day of the year, you can have, boom, a new,

whole new virus that didn't exist yesterday. And now with farming and industrial livestock,

we're seeing animals and humans come into contact much more. Just the opportunities for an

influenza strain that is unique and deadly to humans increases all the while transmission and

mobility has increased. It's just a matter of time, in my opinion.

What about from an immunology perspective of the idea of engineering a virus? So not just

the virus leaking from a lab or something, but actually being able to understand the protein,

like the everything about what makes a virus enough to be able to figure out ways to

maybe targeted or untargeted attack by...

It's the birth immunity.

Yeah. Is that something, obviously that's somewhere on the list of concerns,

but is that anywhere close of the top 10 highlights along with nuclear weapons and so on

that we should be worried about? Or is the natural pandemic really the one that's much

great a concern? I would say that the former, that manmade viruses and genetically engineered

viruses should be right up there with the greatest concerns for humanity right now.

We know that the tools for better or worse, the tools for creating a virus are there.

We can do it. I mean, heck, the human species is no longer vaccinated against smallpox.

I didn't get a smallpox vaccine. You didn't get a smallpox vaccine, at least I don't think.

So if somebody wanted to make smallpox and distribute it to the world in some way,

it could be exceedingly deadly and detrimental to humans and that's not even using your imagination

to create a new virus. That's one that we already have. Unlike the past, when smallpox would

circulate, you had large fractions of the community that was already immune to it.

And so it wouldn't spread or it would spread a little bit slower, but now we have essentially,

in a few years, we'll have a whole global population that is susceptible. Let's look at measles.

We have an entire, I mean, measles. There are some researchers in the world right now which,

for various reasons, are working on creating a measles strain that evades immunity. It's not

for bioterrorism, at least that's not the expectation. It's for using measles as an

oncolytic virus to kill cancer. And the only way you can really do that is if your immune system

doesn't, you know, if you take a measles virus and there's, you know, we don't have to go into

the details of why it would work, but it could work. Measles likes to target potentially cancer

cells. But to get your immune system not to kill off the virus, if you're trying to use the virus

to target it, you maybe want to make it blind to the immune system. But now imagine we took some

virus like measles, which has an R0 of 18, transmits extremely quickly. And now we have

essentially, let's say we had a whole human race that is susceptible to measles. And this is a virus

that spreads orders of magnitude easier than this current virus. Imagine if you were to plug something

toxic or detrimental into that virus and release it to the world.

So it's possible to be both accidental and intentional? Absolutely. Yeah, an accident. So

Mark Lipsitch is a good colleague of mine at Harvard. We're both in the, he's the director

of the Center for Communicable Disease Dynamics from a faculty member. He's spoken very, very

forcefully and he's very outspoken about the dangers of gain of function testing,

where in the lab we are intentionally creating viruses that are exceedingly deadly under the

auspices of trying to learn about them. So that if the idea is that if we kind of accelerate

evolution and make these really deadly viruses in the lab, we can be prepared for if that virus

ever comes about naturally or through unnatural means. The concern though is, okay, that's one

thing, but what if that virus got out on somebody's shoe? Just what if? If the effects of an accident

are potentially catastrophic, is it worth taking the chances just to be prepared a little bit for

something that may or may not ever actually develop? And so it's a serious ethical quandary

we're in. How to both be prepared, but also not cause a catastrophic mistake.

As a small tangent, there's a recent really exciting breakthrough of Alpha 2,

of Alpha Fold 2 solving protein folding or achieving state of the art performance on

protein folding. And then I thought, proteins have a lot to do with viruses. It seems like

being able to use machine learning to design proteins that achieve certain kinds of functions

will naturally allow you to use, maybe down the line, not yet, but allow you to use machine

learning to design basically viruses, maybe like measles for good, which is like to attack

cancer cells, but also for bad. Is that a crazy thought or is this a natural place where this

technology may go? I suppose all technologies can, which is for good and for bad. Do you think

about the role of machine learning in this? Oh yeah, absolutely. Alpha Fold is amazing.

It's an amazing algorithm, series of algorithms. And it does demonstrate, to me, it demonstrates

just how powerful everything in the world has rules. We just don't know the rules. We often

don't know them, but our brain has rules, how it works. Everything is plus and minus. There's

nothing in the world that's really not at its most basic level, positive, negative. Obviously,

it's all just charge. And that means everything. You can figure it out with enough computational

power and enough. In this case, machine learning and AI is just one way to learn rules. It's an

empirical way to learn rules, but it's a profoundly powerful way. And certainly, now that we are

getting to a point where we can take a protein and know how it folds, given its sequence,

we can reverse engineer that and we can say, okay, we want a protein to fold this way. What

does the sequence need to be? We haven't done that yet so much, but it's just the next iteration of

all of this. So let's say somebody wants to develop a virus. It's going to start with somebody wanting

to develop a virus to defeat cancer, something good. And so it will start with a lot of money

from the federal government for all the positives that will come out of it.

But we have to be really careful because that will come about. There's no doubt in my mind

that we will develop, we're already doing it. We engineer molecules all the time

for specific uses. Oftentimes, we take them from nature and then tweak them.

But now we can supercharge it. We can accelerate the pace of discovery. To not have it just be

discovery, we have it be true ground up engineering. Let's say you're trying to make a new molecule

to stabilize somebody with some retinal disease. So we come up with some molecule that can

improve the stability of somebody with retinal degeneration. Just a small tweak to that to

say make a virus that causes the human race to become blind. It sounds really conspiracy

theoryish, but it's not. We're learning so much about biology and there's always an

affair. Heck, look at how AI and just Google searches, they are every single day being leveraged

by nefarious actors to take advantage of people, to steal money, to do whatever it might be,

eventually probably to create wars or already to create wars. And I don't think there's any

question at this point behind disinformation campaigns. And so it's being leveraged, this

thing that could be wholly good, it's always going to be leveraged for bad. And so how do

you balance that as a species? I'm not quite sure. The hope is, as you mentioned previously,

that there's some that we were able to also develop defense mechanisms. And there's something

about the human species that seems to keep coming up with ways to just like on the deadline,

just at the last moment, figuring out how to avoid destruction. I think I'm like eternally

optimistic about the human race not destroying ourselves, but you could do a lot of things

that would be very painful. Yes. What we're doing it already, just, I mean, we are seeing how our

regulation today. Right. We did this thing, it started as a good thing, regulation of medical

products. But now it is unwillingly and unintentionally harming us. Our regulatory landscape,

which was developed wholly for good in our country, is getting in the way of us deploying a tool

that could stop our economies from having to be sputteringly closed, that could stop deaths

from happening at the rate that they are. I think we will come to a solution. Of course,

now we're going to get the vaccine and it's going to make people lose track of why we even

bother testing, which is a bad idea. But we're already seeing that we have this amazing capacity

to both do damage when we don't intend to do damage and then also to pull up when we need to

pull up and stop complete catastrophe. And so we are an interesting species in that way,

that's for sure. So there's a lot of young folks undergrads. Grads, they're also young.

Listen to this. So you've talked about a lot of fascinating stuff that's like, there's

ways that things are done and there's actual solutions and they're not always intersecting.

Do you have advice for undergraduate students or graduate students or even people in high school

now about life, about career, how they might be able to solve real big problems in the world,

how they should live their life in order to have a chance to solve big problems in the world?

It's hard. I struggle a little bit sometimes to give advice because the advice that I give

from my own personal experience is necessarily distinct from the advice that would make other

people successful. I have unending ambitions to make things better. And I don't see barricades

where other people sometimes see barricades. Now, even just little things, like when this

virus started, I'm a medical director at Brigham and Women's Hospital. And so I oversee or helped

oversee molecular virology diagnostics. So when this virus started, wearing my epidemiology hat

and wearing my viral outbreak hat, I recognized that this is going to be a big virus that was

important at a global level. Even if the CDC and WHO weren't ready to admit that it was a pandemic,

it was obvious in January that it was a pandemic. So I started trying to get a test built at the

Brigham, which is one of Harvard's teaching hospitals. The first encounters I had with

the upper administration of the hospital were pretty much, no, why would we do that? That's

silly. Who are you? And I said, well, okay, don't believe me, sure. But I kept pushing on it.

And then eventually I got them to agree. It was really only a couple of weeks before the

Biogen conference happened. We started building the test. I think they started looking abroad and

saying, okay, this is happening. Sure. Maybe he was right. But then I went a step further and I said,

we're not going to have enough tests at the hospital. And so my ambition was to get a better

testing program started. And so I figured what better place to scale up testing than the Broad

Institute? Broad Institute is amazing, very high throughput, high efficiency research institute

that does a lot of genomic sequencing, things like that. So I went to the Broad and I said,

hey, there's this coronavirus that's obviously going to impact our society greatly. Can we start

modifying your high efficiency instruments and robots for coronavirus testing? Everyone in my

orbit in the hospital world just said, that's ridiculous. How could you possibly plan to do

that? It's impossible. And to me, it was the most dead simple thing to do. But the higher ups and

the people who think about, I think one of the most important things is to recognize that most

people in the world don't see solutions. They just see problems. And it's because it's an easy

thing to do. Thinking of problems and how things will go wrong is really easy because you're not

coming up with a brand new solution. And this to me was just a super simple solution. Hey,

let's get the Broad to help build tests. Every single hospital director told me no,

like it's impossible. My own superiors, the ones I report to in the hospital said, Mike,

you're a new faculty member. Your ideas probably would be right, but you're too naive and young

to know that it's impossible. And obviously, now the Broad is the highest throughput laboratory in

the country. And so I think my recommendation to people is as much as possible, get out of the

mode of thinking about things as problems. Sometimes you piss people off. I could probably

use a better filter sometimes to try to be not so upfront with certain things. But it's just so

crucial to always just see, to just bring it, like think about things in new ways that other

people haven't because usually there's something else out there. And one of the things that has

been most beneficial to me, which is that my education was really broad. It was engineering

and physics. And well, and then I became a Buddhist monk for a while. And so that gave me a different

perspective. But then it was medicine and immunology. And now I've brought all of it together from

mathematics and biology and medicine, perspective, and policy and public health. And I think that

I'm not the best in any one of these things. I recognize that there are going to be geniuses

out there who are just worlds better than me at any one of these things that I try to work on.

But my superpower is bringing them all together and just thinking, and that's,

I think, how you can really change the world. I don't know that I'll ever change the world

in the way that I hope. But that's how you can have a chance.

Yeah, that's how you can have a chance, exactly. And I think it's also what,

this to me, this rapid testing program, this is the most dead simple solution in the world.

And this literally could change the world. It could change the world. And it is. There's

countries that are doing it now. The US isn't, but I've been advising many countries on it.

And I would say that some of the early papers that we put out earlier on, a lot of the things

actually are changing. Unless you really look hard, you don't know where you're actually having

an effect. Sometimes it's more overt than other times. In April, I published a paper that was

saying, hey, with the PCR values from these tests, we need to really focus on the CT values,

the actual quantitative values of these lab based PCR tests. At the time, all the physicians

and laboratory directors told me that was stupid. Why would you do that? They're not

accurate enough. And of course, now it's headline news that Florida, they just mandated

reporting out the CT values of these tests because there's a real utility of them.

You can understand public health from it. You can understand better clinical management.

And that was a simple solution to a pretty difficult problem. And it is changing the way

that we approach all of the lab testing in this country is starting to, it's taken a few months,

but it's starting to change because of that. And that was just me saying, hey, this is something

we should be focusing on. Got some other people involved and other people. And now people recognize,

hey, there's actual value in this number that comes out of these lab based PCR tests. So sometimes

it does grow fairly quickly. But I think the real answer, my only answer, I don't know what,

I recognize that everyone, some people are going to be really focused on and have one small,

but deep skill set. I go the opposite direction. I try to bring things together.

But the biggest thing I think is just don't see barriers. Just see,

like, there's always a solution to a barrier. If there's a barrier that literally means a

solution to it, that's why it's called a barrier. And just like you said, most people will just

present to you, only be thinking about it and present to you with barriers. And so it's easy

to start thinking that's all there is in this world. And just think big. I mean, God, there's

nothing wrong with thinking big. Elon Musk thought big. And, you know, and then thinking big builds

on itself, you know, you get a billion dollars from one big idea and then that allows you to

make three new big ideas. And there's a hunger for it. If you think big and you communicate

that vision with the world, all the most brilliant and like passionate people will just like,

you'll attract them and they'll come to you. And then it makes your life actually really

exciting. The people I've met at like Tesla and Neuralink, I mean, there's just like this fire

in their eyes. They just love life. And it's amazing, I think, to be around those people.

I have to ask you about what was the philosophy, the journey that took you to becoming a Buddhist

monk? And what were, what did you learn about life? What did you take away from that experience?

How did you return back to Harvard and the world that's unlike that experience, I imagine?

Yeah. Well, I was at Dartmouth at the time.

Well, I went to Sri Lanka. I was already pretty interested in developing countries and sort

of under resourced areas. And I was doing a lot of engineering work and I went there,

but I was also starting to think maybe health was something of interest.

And so I went to Sri Lanka because I had a long interest in Buddhism as well,

just kind of interested in it as a thing. Which aspect of the philosophy attracted you?

I would say that the thing that interested me most was really this idea of kind of a butterfly

effect of what you do now has ripple effects that extend out beyond what you can possibly imagine,

both in your own life and in other people's lives. And in some ways, Buddhism has,

not in some ways, in a pretty deep way. Buddhism has that as part of its underlying

philosophy in terms of rebirth and sort of your actions today propagate to others,

but also propagate to sort of what might happen in your circle of what's called samsara and

rebirth. And I don't know that I subscribe fully to this idea that we are reborn,

which always was a little bit of a debate internally, I suppose when I was a monk.

But it has always been, it was that and then it was also meditation. At the time I was a fairly

elite rower. I was rowing at the national level and rowing to me was very meditative. It was

just, there's, even if you're in a boat with other people, it's, I mean, on the one hand,

it's like the extreme of like a team sport, but it's also the extreme sort of focus and

concentration that requires, that's required of it. And so I was always really into just

meditative type of things. I was doing a lot of pottery too, which was also very meditative.

And so Buddhism just kind of really, really, there are a lot of things about meditating

that just appealed. And so I moved to Sri Lanka planning to only be there for a couple of months.

But then I was shadowing in this medical clinic and there was this physician who was just really,

I mean, it's just kind of a horrible situation. Frankly, this guy was trained

decades earlier. He was an older physician and he was still just practicing like these

fairly barbaric approaches to medicine because he had, you know, as a rural town

and he just didn't have a lot of, he didn't have any updated training, frankly. And so,

you know, I just remember this like girl came in with like shrapnel in her hand and his solution

was to like air it out. And so he was like, without even numbing her hand, he was like cutting it

open more with this idea that like the more oxygen and stuff, you know, and it just, I think

there was something about all of this. And I was already talking to these monks at the time.

Each, I would be in this clinic in the morning and I'd go and my idea was to teach English to

these monks in the evening. Turned out I'm a really bad English teacher. So they just taught,

they allowed me just to sit with them and meditate and they were teaching me more about

Buddhism than I could have possibly taught them about English or being an American or something.

And so I just slowly, I just couldn't take, I like couldn't handle being in that clinic. So

more and more, I just started moving to, you know, spending more and more time at this monastery.

And then after about two months, I was supposed to come back to the States and I decided I didn't

want to. So I moved to this monastery in the mountains primarily because I didn't have the

money to like just keep living. So I was living in a monastery, it's free. And so I moved there

and just started meditating more and more. And then months went by and it just really gravitated.

I gravitated to the whole notion of it. I mean, it became, it sounds strange, but meditating almost,

just like anything that you put your mind to, became exciting. It became like there weren't

enough hours in the day to meditate. And I would do it for 18 hours a day, 15 hours a day,

just sit there and you, and like, I mean, I hate sleeping anyway, but I wouldn't want to go to

sleep because I felt like I didn't accomplish what I needed to accomplish in meditation that day,

which is so strange because there is no end, you know, but it was always, but there are these,

there are these steps that happen during meditation that are very prescribed in a way.

Buddha talked about them, you know, and these are ancient writings, which exist. I mean,

the writings are real. They're thousands of years old now. And, you know, so whether it was Buddha

writing them or whoever, you know, there are lots of different people who have contributed to the,

to these writings over the years. And, but they're very prescribed. And they, they tell you what

you're going to go through. And I didn't really focus too much on them. I read a little bit about

them, but your mind really does when you actually start meditating at that level, like not an hour

here and there, but like truly just spending your day is meditating. It becomes kind of like this

other world where it becomes exciting. And, and you're actively working, you're actively

meditating, not just kind of trying to quiet things. That's sort of just the first stage

of trying to get your mind to focus. Most people never get past that first stage,

especially in our culture. Could you briefly summarize what's waiting beyond the stage of

just quieting the mind? It's hard for me to imagine that there's something that could be described

as exciting on there. Yeah, it's, it's an interesting question. So I would say,

so the first thing, the first step is truly just to like be able to close your eyes, focus on your

breath and not have other thoughts enter into your mind. That alone is just so hard to do.

Like, I couldn't do it now if I wanted, but I could then. And, but once you get past that stage,

you start entering into like all these other, you go through the kind of, I went through this

like pretty trippy stage, which was a little bit euphoric, where you just kind of start not

hallucinating. I mean, it wasn't like some crazy thing that would happen in a movie where you,

but definitely just weird. You start getting to the stage where you, you're able to quiet your

mind for so long, for hours at a time that like for me, I started getting really excited about

this idea of mindfulness, which is part of, part of Buddhism in general, but it's part of

Taravanan Buddhism in particular for this, in this way, which was, you take, you start focusing

on your daily activities, whether that's sipping a cup of tea or walking or, you know, sweeping

around. I lived in, on this mountain side in this cottage thing is built into the rock and,

you know, so every morning I would wake up early and sweep around it and stuff, because that's

just what we did. And you start to, you meditate on all those activities. And one of the things

that was so exciting, which sounds completely ridiculous now, was just almost learning about

your daily activities in ways that you never would have thought about before. So what is,

what's, what's involved with like picking up this glass of water? You know, if I said,

okay, I'm just going to pick, I'm going to take a drink of water, to me right now, it's a single

activity. But during meditation, it's not a single activity. It's a whole series of

activities of like little engineering feats and feelings. And it's gripping the water.

And it's feeling that the glass is cold and it's lifting and it's moving and dragging and dragging.

And you start to learn a whole new language of life. And that to me was like this really

exhilarating thing that it was an exhilarating component of meditation that there was never

enough time, it's kind of like learning a new computer language, like it gets really exciting

when you start coding and all these new things you can do. You learn how to much, to experience

life in a much richer way. And so you never run out of ways to go deeper and deeper and

deeper in the way you experienced, even just the drinking of the glass of water.

That's exactly right. And what becomes kind of exhilarating is you start to be able to predict

things that you never, or I don't even have predictions or a word, but I always think of

the matrix where I forget who it was, somebody was shooting at Neo and he like leans backwards

and he dodges the bullets. In some ways, when you start breaking every little action that

your hands do or that your feet do or that your body does down into all these little actions

that make up one what we normally think of as an action, all of a sudden you can start to see

things almost in slow motion. I like to think of it very much like language. The first time

somebody hears a foreign language, it sounds really fast usually. You don't hear the spaces

between words. And it just sounds like a stream of consciousness, and it just sounds like a

stream of noises if you've never heard the language before. And as you learn the language,

you hear clear breaks between words and it starts to gain context and all of a sudden

like that, what once sounded very fast slows down and it has meaning. That's our whole life.

There's this whole language happening that we don't speak generally. But if you start to speak it

and if you start to learn it and you start to say, hey, I'm picking up this glass is actually 18

little movements, then all of a sudden it becomes extremely exciting and exhilarating to just

just breathe. Breathing alone in the rise and fall of your abdomen or the way the air pushes in

and out of your nose becomes almost interesting. And what's really neat is the world just starts

slowing down. And I'll never forget that feeling. And if there was one euphoric feeling from meditation

I want to gain back, but I don't think I could without really meditating like that again,

and I don't think I will. Was this like slow motion of the world? It was finding the spaces

between all the movements in the same way that the spaces between all the words happen.

And then it almost gives you this new appreciation for everything. It was really amazing. And so I

think it came to an abrupt end though when the tsunami hit. I was there in the Indian Ocean tsunami

hit in 2004. And it was like this dichotomy of being a monk and just meditating in this extraordinary

place. And then the tsunami hits and kills 40,000 people in a few minutes on the coast of this really

small little country in Sri Lanka. And then I like my whole world of being a monk came crashing down

on when I go to the coast. And I mean, that was just a devastating visual site, an emotional site.

But the strangest thing happened, which was that everyone just wanted me to stay as a monk.

People in that culture, they wanted to, the monks largely fled from the coastlines.

And so then there I was and people wanted me to be a monk. They wanted me to stay on the coast,

but be a monk and not help. Not help in the way that I considered helping. They wanted me just

to keep meditating so that they could bring me offerings and have their karmic responsibilities

attended to as well. And so that was really bizarre to me. It was like, how could I possibly just sit

around while all these people, half of everyone's family just died. And so in any case, I stopped

being a monk and I moved to this refugee camp and lived there for another six months or so and

just stayed there, not as a monk, but tried to raise some money from the U.S. and tried to,

like, I didn't know what I was doing. Frankly, I was 22. And I don't think I appreciated at the

time how much of a role I was having in that community's life. But it's taken me many years

to process all of this since then. But I would say it's what put me into the public health world,

seeing it living in that refugee camp and that difference that happened from being a monk to

being in this devastating environment just really changed my whole view of what sort of why I was

existing, I suppose. Well, so there's this richness of life in a single drink of water

that you experience. And then there's this power of nature that's capable to take lives of thousands

of people. So given all that, the absurdity of that, let me ask you, and the fact that you study

things that could kill the entirety of human civilization, what do you think is the meaning

of this all? What do you think is the meaning of life, this whole orchestra with God going on?

Does it have a meaning? And maybe from another perspective, how does one live a meaningful

life if such as possible? Well, from what I've seen, I don't think there's a single answer to

that by any stretch. One of the most interesting things about Buddhism to me is that the human

existence is part of suffering, which is very different from Judeo Christian existence, which

is that human existence is something very different. There's a richness to it. In Buddhism, it's just

another one of your lives. But it's your opportunity to attain nirvana and become a monk, for example,

and meditate to attain nirvana. Else, you just go back into the samsara, the cycle of suffering.

In some ways, the notion of life and what the purpose of life is, they're completely distinct,

this western view of life, which is that this life is the most precious thing in the world,

versus this is just another opportunity to try to get out of life. The whole notion of nirvana

and in Buddhism, getting out of this sort of cycle of suffering is to vanish. If you could

attain nirvana throughout this life, the idea is that you don't get reborn.

On the one hand, you have Christian faith and other things that want to go to heaven and live

forever in heaven. Then you have this other whole half of humans who want nothing more than to

get out of the cycle of rebirth and just not exist anymore. The cycle of suffering.

Yeah. How do you reconcile those two? Do you have both of them in you? Do you basically

oscillate back and forth? I think we're just a bunch of proteins that we've formed and they work

in this really amazing way. They might work in a bigger scale. There might be some

connections that we're not really clear about, but they're still biological. I believe that

they're biological. How do these proteins become conscious and why do they want to

help civilization by having at home rapid tests a scale? Well, I think I don't have an answer to

that one, but I really do believe that it's just an evolution of consciousness. I don't personally

think my feeling is that we're a bunch of pluses and minuses that have just gotten so complex that

they're able to make rich feelings, rich emotions. I do believe though, on the one hand,

I sometimes wake up some days, my fiance doesn't always love it, but I think we're all just a

bunch of robots with pretty complicated algorithms that we deal with. In that sense,

like, okay, if the world just blew up tomorrow and nothing existed the day after that,

it's just another blip in the universe. But at the same time, I don't know. So that's

kind of probably my most core basic feeling about life. It's like we're just a blip and we may as

well make the most of it while we're here blipping. It's one hell of a fine blip though.

It is. It's an amazing blink of an eye in time. Michael, you're one of the most

interesting people I've met, one of the most interesting conversations, important ones.

Now, I'm going to publish it very soon. I really appreciate taking the time. I know

how busy you are. It was really fun. Thanks for talking to me. Well, thanks so much. This was

a lot of fun. Thanks for listening to this conversation with Michael Mina and thank you to

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support on Patreon, or connect with me on Twitter at Lex Freedman. And now, let me leave you with

some words from Teddy Roosevelt. It is not the critic who counts. Not the man who points out

how the strong man stumbles or where the doer of deeds could have done them better. The credit

belongs to the man who actually is in the arena, whose face is marred by dust and sweat and blood,

who strives valiantly, who errs, who comes short again and again because there is no effort without

error and shortcoming, but who does actually strive to do the deeds, who knows great enthusiasm,

the great devotions, who spends himself in a worthy cause, who at the best knows in the end

that triumph of high achievement and who at the worst, if he fails, at least fails while daring

greatly, so that his place shall never be with those cold and timid souls who neither know victory

nor defeat. Thank you for listening and hope to see you next time.