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Speaker 1: Bushkin, this is solvable. I'm Jacob Weisberg COVID transmission. Is

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Speaker 1: it is solvable? I truly believe that. That's epidemiologist Michael Minna,

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Speaker 1: and his optimism isn't based on all the effort going

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Speaker 1: into finding a vaccine. It's based on something that exists now.

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Speaker 1: Is are used for malaria, for stress, for all these

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Speaker 1: different infections. They've been around for a very long time.

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Speaker 1: Minna is excited about small scripts of paper about the

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Speaker 1: length of your pinky finger. Those cheap pieces of paper

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Speaker 1: would be used in millions of transmission indicating tests. These

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Speaker 1: are called antigen tests and can identify when people are contagious.

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Speaker 1: They can help to quickly contain community spread of the virus.

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Speaker 1: And they're already in product option. So what's the catch?

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Speaker 1: They aren't easy to get through the FDA. How long

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Speaker 1: is it going to take for me, Malcolm Globbwell to

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Speaker 1: be able to go to my drug store and buy

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Speaker 1: a hundred of these strips for twenty five dollars and

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Speaker 1: take one every morning. It's not just turning out to

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Speaker 1: be a very very difficult task, but it's actually I think,

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Speaker 1: inadvertently leading to potentially tens or hundreds of thousands of

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Speaker 1: additional deaths that we don't need to be having. Michael

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Speaker 1: Minna is an epidemiologist and immunologist at the Harvard School

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Speaker 1: of Public Health and a physician at Brigham and Women's Hospital.

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Speaker 1: My solution to defeating COVID is daily rapid tests that

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Speaker 1: people could use in their homes every day to stop

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Speaker 1: transmission of the virus everywhere. With people dying every day,

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Speaker 1: there's no more time to waste. Doctor Minna spoke with

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Speaker 1: my co host Malcolm Gladwell about how to solve the

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Speaker 1: spread of COVID. Here's their conversation. I wanted to start

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Speaker 1: with a really dumb, obvious question, which is, can you

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Speaker 1: describe to me all the ways in which you can

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Speaker 1: look for the presence of a virus that a human being. Well,

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Speaker 1: that's not an obvious question at all. Within each virus,

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Speaker 1: virus is just like any other thing. They have a

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Speaker 1: genetic code, and then they have a bunch of proteins.

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Speaker 1: And the genetic code of a virus is RNA, which

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Speaker 1: is akin to a human's DNA. And so the same

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Speaker 1: way that you could do a forensic investigation of a

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Speaker 1: crime scene and use DNA to find if there was

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Speaker 1: a human, a specific human at the crime scene, you

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Speaker 1: can do a forensic investigation to look for RNA to

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Speaker 1: know if there was RNA inside of a person. So

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Speaker 1: that's one way, and that's this tool that these are

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Speaker 1: molecular tools that we call PCR. And then there's a

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Speaker 1: different way. Instead of using the genetic makeup and the

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Speaker 1: RNA to look for the virus in this case, you

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Speaker 1: could actually look for the proteins that make up the virus.

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Speaker 1: And that's where these antigen tests really shine. So you

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Speaker 1: can either look for the genetic code or you could

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Speaker 1: look for the proteins. I like to call these rapid

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Speaker 1: antigen tests transmission indicating tests. There's one other major way,

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Speaker 1: which I'll just say quickly, and that's to look for

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Speaker 1: the immunological response to the virus because humans are good

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Speaker 1: at making immune responses to viruses. So it's a different way,

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Speaker 1: and that's antibody based detection. But that's I put it

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Speaker 1: in a whole different category because it usually comes after infection. Yeah,

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Speaker 1: So the first way looking for the RNA is the

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Speaker 1: kind of gold standard. That's exactly right. And so if

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Speaker 1: I go to the hospital and get a today and

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Speaker 1: get a COVID test. They're looking for RNA. They're giving

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Speaker 1: me they're using PCR to look to see if I

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Speaker 1: have virus in my system. That's right, and what's the

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Speaker 1: cheapest that a PCR test could produce a result? The

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Speaker 1: actual price of a PCR test can be done for

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Speaker 1: six bucks, maybe even less, so it can be really cheap.

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Speaker 1: But the difference is the whole infrastructure around PCR tests.

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Speaker 1: They have to be done in labs, so you have

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Speaker 1: logistics of transport, you have all of the people working

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Speaker 1: in the lab, robots, and so generally it really drives

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Speaker 1: the cost up. And as we've seen, the average test

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Speaker 1: costs anywhere from thirty dollars at the absolute low end

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Speaker 1: up to one hundred and fifty dollars for some labs

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Speaker 1: that are charging it. No contrast PCR two antigen tests.

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Speaker 1: How do antigen tests? What do they look like and

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Speaker 1: what's their cost in time profile? They look like a

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Speaker 1: pregnancy test and they work like a pregnancy test. Actually,

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Speaker 1: they can be made. It's a little piece of paper.

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Speaker 1: Generally speaking, you put some of the sample, whether that

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Speaker 1: be a swab that's been mixed with some sailing solution

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Speaker 1: or saliva onto a paper strip and it shows up

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Speaker 1: with a line it turns either, for example, red if

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Speaker 1: it's positive or blue if it's negative, and those can

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Speaker 1: be made in the huge numbers. They don't require instruments.

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Speaker 1: They don't usually require instruments. There's a few on the

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Speaker 1: market right now that to get the sensitivity at the

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Speaker 1: FDA wanted, they have some instrumentation associated. But in reality

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Speaker 1: these are used for malaria, for a strap for all

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Speaker 1: these different infections. They've been around for a very long time,

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Speaker 1: and they can be done just on a piece of

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Speaker 1: paper in five minutes, and they could get down to

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Speaker 1: you can produce them for fractions of a dollar, and

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Speaker 1: they might be sold to the public or built by

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Speaker 1: the government for a dollar a piece or something on

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Speaker 1: those lines. So you're you've been perhaps the leading public proponent,

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Speaker 1: public health proponent of using antigen tests much more broadly

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Speaker 1: to fight this pandemic. And I wanted to the first

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Speaker 1: time I heard you give this argument. You convinced me

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Speaker 1: in about two minutes. And I still don't understand why

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Speaker 1: why don't we have this system? Because I can imagine

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Speaker 1: in a world where if it's this, if they're cheap

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Speaker 1: and that easy, then you know, every kid before they

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Speaker 1: went to school in the morning, we'd take one of

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Speaker 1: these fifty cents or one dollar tests and if they

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Speaker 1: were positive, they would stay home, and if they're negative,

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Speaker 1: we would know they could go to school. Like or

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Speaker 1: if I want to go to a restaurant, why can't

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Speaker 1: I just set stand in the vestiable of the restaurant,

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Speaker 1: take the test and wait for my response and if

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Speaker 1: i'm if I'm negative, I get to go to the restaurant.

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Speaker 1: Like it just strikes me as this is a way

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Speaker 1: to get going again. Why are we not doing this?

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Speaker 1: Can you explain that I can? And I have a

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Speaker 1: few theories. I mean, they're not just theories, they're there.

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Speaker 1: I'm in the middle of all of this. And so

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Speaker 1: these tests because of this whole sensitivity issue. Early in

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Speaker 1: March or a really in January, the world decided that

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Speaker 1: PCR was a gold standard for these tests. And I

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Speaker 1: don't think and I know that this well, maybe we'll

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Speaker 1: come across wrong for some people, but there hasn't been

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Speaker 1: enough thought placed into what exactly does the PCR test

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Speaker 1: mean and is it the right gold standard? The only

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Speaker 1: pathway that we have to evaluate tests like this in

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Speaker 1: the United states are medical diagnostic pathways. They are pathways

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Speaker 1: designed specifically to ensure that a physician like a detective,

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Speaker 1: is getting all of the information they need to diagnose

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Speaker 1: a sick person in front of them. So it's really

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Speaker 1: been first and foremost a regulatory hurdle. We have so

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Speaker 1: devalued and defunded public health across our country and really

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Speaker 1: across the world, that we actually didn't we don't have

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Speaker 1: a regulatory pathway to approve a test who is primary

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Speaker 1: objective is one of stopping an epidemic versus one of

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Speaker 1: diagnosing a sick person, and that has really led that's

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Speaker 1: held everything up. All of the companies that could be

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Speaker 1: producing these these really rapid tests in the millions and millions,

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Speaker 1: they have been sitting on these tests, trying to hone them,

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Speaker 1: trying to get them just a little bit better, just

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Speaker 1: a little bit better so that the so that they

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Speaker 1: can pass their FDA standards as a medical diagnostic. It's

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Speaker 1: not just slowing down their approval and getting them out

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Speaker 1: to the public. It's actually bottlenecking the companies into creating

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Speaker 1: tests that are not going to be as scalable because

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Speaker 1: they're having to use more expensive reagents they're starting to

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Speaker 1: put them with instruments and package them more. You know,

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Speaker 1: they have to actually become more expensive, highly manufactured tests,

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Speaker 1: when in reality they're just these little pieces of paper

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Speaker 1: that if we can do the cheap version of them,

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Speaker 1: they could be made very fast. But they just won't

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Speaker 1: get through the FDA at the moment, And I don't.

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Speaker 1: I'm still so I find it, So I find your explanation.

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Speaker 1: I'm convincing. How dumb is the FDA, Like, don't they

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Speaker 1: understand that they can't be they can't be a group

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Speaker 1: of people who are wholly wedded to only one way

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Speaker 1: of understanding how to deal with the virus. You can't

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Speaker 1: if you make the exact argument you just made to me,

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Speaker 1: to someone at the FDA, who is everybody is smart

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Speaker 1: or smarter than I am and knows a mountain more

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Speaker 1: about medicine, they're not going to say, I see a logic. Well,

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Speaker 1: you know, it's not that they're not smart, it's that

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Speaker 1: this is a regulatory body. They just don't have a pathway.

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Speaker 1: They literally you can't go and apply for FDA approval

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Speaker 1: for a public health test tool. In fact, they say

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Speaker 1: it strongly in their FA ces and their facts that

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Speaker 1: say we do not evaluate public health tools, and so

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Speaker 1: that might make you say, well, that's great, so why

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Speaker 1: bother getting FDA approval. Unfortunately, these tests are defined by

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Speaker 1: the FDA as clinical diagnostic tests, which has a pretty

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Speaker 1: broad definition of a test that gives somebody information about

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Speaker 1: themselves that could cause them to change their behavior is

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Speaker 1: a clinical diagnostic test. So this is this catch twenty

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Speaker 1: two where they're saying, you know, we don't want to

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Speaker 1: have anything to do with public health the proving public

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Speaker 1: health tools, but we also don't want to change our

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Speaker 1: definition to allow you to say that that's not a

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Speaker 1: clinical diagnostic test. And so they've gotten stuck in this

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Speaker 1: regulatory bureacratic nightmare of just regulation for regulation's sake. And

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Speaker 1: there is precedent at the FDA, for example, to think

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Speaker 1: about public health tools. Vaccines are one of them. They

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Speaker 1: have outright been willing to say we will accept a

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Speaker 1: vaccine that has fifty percent efficacy, and that's because, whether

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Speaker 1: they recognize it or not, they're taking into account the

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Speaker 1: public good part of a vaccine that they understand that

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Speaker 1: it will lead to herd immunity. But they have none

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Speaker 1: of that thinking in diagnostic tests because it's just driven

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Speaker 1: by this very antiquated view of what a diagnostic test means.

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Speaker 1: And in our country everything has been you know, the

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Speaker 1: medical establishment is extremely strong. We can't we can't. You

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Speaker 1: can't go to get a cholesterol test without getting a

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Speaker 1: prescription from your doctor, Like, why is that not? Why

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Speaker 1: can't we know that? You know, it's all through this

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Speaker 1: very very heavy medical lens and changing that moving, getting

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Speaker 1: that that big ship to turn is turning. You know,

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Speaker 1: it's not just turning out to be a very very

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Speaker 1: difficult task, but it's actually, I think inadvertently leading to

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Speaker 1: potentially tens or hundreds of thousands of additional deaths that

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Speaker 1: we don't need to be having. You know what this

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Speaker 1: reminds me of. There's a fascinating book that was written

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Speaker 1: about tanks. Tanks are invented in the First World War

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Speaker 1: and then they just kind of sit on the shelf

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Speaker 1: for twenty years. Everyone realizes they're a breakthrough in a

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Speaker 1: revolution and they've changed war for forever, but no one

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Speaker 1: can figure out who where to put them? Do they

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Speaker 1: belong with the infantry? Not really right? Should they take

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Speaker 1: the place of cavalry? Will kind of but those guys

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Speaker 1: are really into horses, you know, like you can go

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Speaker 1: on and on like and they can't. So literally it

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Speaker 1: just sits around for twenty and then the Germans, who

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Speaker 1: don't have a military, was destroyed by the Allies. They

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Speaker 1: get to start over and they put it. They knew

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Speaker 1: where to put them right because they're starting from scratch.

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Speaker 1: They don't have any legacy systems that are inhibiting them.

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Speaker 1: How I want to go back to how many different

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Speaker 1: companies are could make one of these things if asked,

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Speaker 1: and how fast would it? I mean, if I want

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Speaker 1: to said, let's say the FDA Commission comes to you,

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Speaker 1: Michael and says, okay, you win, rest go tomorrow. How

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Speaker 1: long is it going to take for me, Malcolm Globbel,

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Speaker 1: to be able to go to my drug store and

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Speaker 1: buy one hundred of these strips for twenty five dollars

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Speaker 1: and take one every morning. Yep. So they're actually becoming

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Speaker 1: available now sort of. Abbot just came out with a

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Speaker 1: new test called the Buynex. Now it's it's literally a

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Speaker 1: piece of cardboard. And these have now been approved but

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Speaker 1: only for medical diagnostic use again because they're being approved

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Speaker 1: through the FDA, and so they're being approved for a

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Speaker 1: physician to order, for example, for patients, they'll be able

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Speaker 1: to make about a million a day, but again that's

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Speaker 1: because they're the slightly more manufactured ones. If you take

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Speaker 1: one of these super simple paper strip tests, the blueprints

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Speaker 1: for how to make these are publicly available, no IP.

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Speaker 1: You can get royalty free, non exclusive rights to just

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Speaker 1: produce these, And I think governments should just be contracting

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Speaker 1: with major manufacturers, manufacturers that have the machines to make them,

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Speaker 1: but it's not particularly sophisticated machines needed to make these things.

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Speaker 1: In our case. The US government should be should just

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Speaker 1: be taking the reins and creating a Manhattan Project like

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Speaker 1: effort to just say, print thirty million of these a

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Speaker 1: day for thirty million Americans to use every day. And

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Speaker 1: if everyone's using it every three days, then you've covering

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Speaker 1: ninety million Americans could be using these tests every third day.

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Speaker 1: That is more than enough to suppress all of the

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Speaker 1: outbreaks where they're occurring today. How can you describe how

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Speaker 1: your experience trying to promote this idea has made you feel? Oh? Well, um,

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Speaker 1: I would say it's um, it's been it's been fraught.

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Speaker 1: I would say, I think it's It's been a reality

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Speaker 1: check that you know, we are in a culture and

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Speaker 1: country and world that is so driven by regulation. We've

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Speaker 1: just overregulated in some ways. And I'm not against regulation

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Speaker 1: by any means, but when we can't recognize that there

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Speaker 1: is a national, a global crisis happening and come up

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Speaker 1: with different, more creative pathways, you know, this is a tool.

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Speaker 1: There is no vaccine coming tomorrow for us. Social distancing

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Speaker 1: clearly isn't working to suppress all the outbreaks masks. People

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Speaker 1: aren't choosing to wear them in much of the country

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Speaker 1: and the world, and here it is. This is a

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Speaker 1: test that can that can be made for pennies essentially

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Speaker 1: charged a dollar that could actually really serve to sit

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Speaker 1: in for vaccines until they come about. I mean, people

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Speaker 1: are dying still, you know, people like we're becoming complacent,

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Speaker 1: and that's just that's the frustration part, and that is

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Speaker 1: generally what is the first gut reaction when you ask

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Speaker 1: me that question. But at the same time, this is

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Speaker 1: an idea that has caught on it and it has

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Speaker 1: gotten a huge number of people. You know, it's kind

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Speaker 1: of created a movement, i would say, and that has

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Speaker 1: been just so inspiring. The number of people across all

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Speaker 1: every single day. Not a day has gone by for

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Speaker 1: months now where I haven't gotten emails from everyone from

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Speaker 1: governors of states and prime ministers of countries down to

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Speaker 1: literally people who say, you know, I'm out of my

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Speaker 1: job right now. I have no no idea you know

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Speaker 1: anything about infectious diseases. I'm usually whatever their job is,

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Speaker 1: and but how can I help? You know? I want

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Speaker 1: to help with this cause. And so it's been amazing

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Speaker 1: to see the pouring by the average person in the

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Speaker 1: public to really try to help get these things moving

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Speaker 1: and to help move the needle in whatever capacity that

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Speaker 1: might be. So that's been pretty it's just been inspiring

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Speaker 1: and amazing to me. Are the things our listeners can

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Speaker 1: do to make this solution more likely. First, get more information,

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Speaker 1: and we've actually set up with well I barely did anything,

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Speaker 1: but there's been this kind of small army of people

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Speaker 1: who are springing up to really help with these issues

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Speaker 1: and pushing the FDA in the government in the right direction.

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Speaker 1: And that's rapid tests dot org one word, rapid tests

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Speaker 1: dot org. And there's we're trying to fill that website

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Speaker 1: in with increasing amounts of information. There's even links I

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Speaker 1: believe at this point to help people and create letters

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Speaker 1: to the representatives. There's been some really nice articles. If

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Speaker 1: people want to follow me on Twitter, I tend to

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Speaker 1: write about it a lot on Twitter and I try

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Speaker 1: to be a responsive to people, and so my Twitter

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Speaker 1: handle is Michael Minna Underscore Lab. But all of that aside,

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Speaker 1: I think one of the best things that people can

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Speaker 1: do right now is to actually let their leaders and

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Speaker 1: their representatives that whether it be at the county level,

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Speaker 1: their state leaders, and their federal leaders know that that

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Speaker 1: you know, this has been dragging on too long. Rapid

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Speaker 1: tests still have not become available. They are a solution that,

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Speaker 1: along with all of the other things like social distancing

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Speaker 1: and masks, will really help to combat this virus. And

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Speaker 1: we need to have date and federal leadership getting on

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Speaker 1: board to help get these through approval processes quicker and

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Speaker 1: help get the production of these, ideally from the federal

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Speaker 1: government up to speed and have tens of millions of

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Speaker 1: these produced every day. And yeah, and I think it's

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Speaker 1: already working, which is the good thing to keep the

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Speaker 1: momentum up. One last question, why isn't there or is

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Speaker 1: there a black market in these tests? I mean, there's

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Speaker 1: a you know, I don't use cocaine, but if I

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Speaker 1: wanted to use cocaine, I'm pretty sure I could get it.

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Speaker 1: I don't understand why if these things are cheap and

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Speaker 1: easy to make, and they have such a profound impact

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Speaker 1: on people's lives, why isn't there a thriving underground economy

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Speaker 1: and giving us cheap, cheap manage in tests. Well, i'd

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Speaker 1: be lying if I if I were to say, I

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Speaker 1: haven't thought a lot about just importing them from other countries,

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Speaker 1: you know, But I think it's because we do still

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Speaker 1: have laws, and we still have you know, tests aren't

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Speaker 1: so extreme. You know, I might get there if they're

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Speaker 1: really not get approved. At the end of the day,

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Speaker 1: they can just sell them legally in other countries at

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Speaker 1: the moment. So why bother doing something illegal in the

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Speaker 1: US when you know they can sell them elsewhere? Where?

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Speaker 1: Where can I buy them? What country can I buy

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Speaker 1: them legally in? Well, South Korea is making There's at

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Speaker 1: least two companies. There's more. I'm sure South Korea has

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Speaker 1: a company called SD Biosensor, and they're they're actually exporting

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Speaker 1: them all over the world. Now, Canada in a nano

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Speaker 1: he is starting to produce them, and they're I'm guessing

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Speaker 1: going for FDA clearance. But India is making them. Singapore,

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Speaker 1: I believe, has some that they're making, so we're starting

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Speaker 1: to see them. I think even Senegal is producing them,

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Speaker 1: but South Koreans have the highest volume that they're currently making. Yeah,

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Speaker 1: thank you so much. This is totally fascinating. I am

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Speaker 1: once again filled with righteous anger at the inability of

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Speaker 1: our regulatarized system to handle. I mean, it's just not

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Speaker 1: it's just like it doesn't seem like that big of

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Speaker 1: a jump, Like it doesn't seem that hard given the

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Speaker 1: fact that this whole thing's costing is I agree, I

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Speaker 1: just it's frustrating, but I would I do have to

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Speaker 1: say that, you know, the FDA has been willing to

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Speaker 1: come to the table more frequently, and actually we're having

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Speaker 1: the conversations, so maybe they're starting to to really warm

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Speaker 1: up to it. You know. I feel like, if you

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Speaker 1: can you can convince the FDA on this one, you

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Speaker 1: deserve not just a metal but one of those statutes.

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Speaker 1: I will hold chip in for the statue. Well, well,

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Speaker 1: thank you. I'm going to keep fighting this fight until

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Speaker 1: and see it through until we start defeating COVID one

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Speaker 1: way or the other. Michael Minne is an epidemiologist and

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Speaker 1: immunologist at the Harvard School of Public Health and a

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Speaker 1: physician at Brigham and Women's Hospital. Remember to check out

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Speaker 1: our show notes for links to the suggestions our guests

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Speaker 1: make for ways that you can get involved. Next week, Unsolvable,

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Speaker 1: we'll hear from chemist Eric Apple about a new solution

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Speaker 1: for fighting wildfires before they start. And here's the teaser.

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Speaker 1: It involves laying down something like a real life force field.

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Speaker 1: You won't want to miss that conversation. Solvable is brought

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Speaker 1: to you by Pushkin Industries. Our show is produced by

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Speaker 1: Camille Baptista, Senior producer Jocelyn Frame. Catherine Girardo is our

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Speaker 1: managing producer, and our executive producer is Mia Loebell. I'm

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Speaker 1: Jacob Weisberg.