Speaker 1: Bushkin, this is solvable. I'm Jacob Weisberg COVID transmission. Is
Speaker 1: it is solvable? I truly believe that. That's epidemiologist Michael Minna,
Speaker 1: and his optimism isn't based on all the effort going
Speaker 1: into finding a vaccine. It's based on something that exists now.
Speaker 1: Is are used for malaria, for stress, for all these
Speaker 1: different infections. They've been around for a very long time.
Speaker 1: Minna is excited about small scripts of paper about the
Speaker 1: length of your pinky finger. Those cheap pieces of paper
Speaker 1: would be used in millions of transmission indicating tests. These
Speaker 1: are called antigen tests and can identify when people are contagious.
Speaker 1: They can help to quickly contain community spread of the virus.
Speaker 1: And they're already in product option. So what's the catch?
Speaker 1: They aren't easy to get through the FDA. How long
Speaker 1: is it going to take for me, Malcolm Globbwell to
Speaker 1: be able to go to my drug store and buy
Speaker 1: a hundred of these strips for twenty five dollars and
Speaker 1: take one every morning. It's not just turning out to
Speaker 1: be a very very difficult task, but it's actually I think,
Speaker 1: inadvertently leading to potentially tens or hundreds of thousands of
Speaker 1: additional deaths that we don't need to be having. Michael
Speaker 1: Minna is an epidemiologist and immunologist at the Harvard School
Speaker 1: of Public Health and a physician at Brigham and Women's Hospital.
Speaker 1: My solution to defeating COVID is daily rapid tests that
Speaker 1: people could use in their homes every day to stop
Speaker 1: transmission of the virus everywhere. With people dying every day,
Speaker 1: there's no more time to waste. Doctor Minna spoke with
Speaker 1: my co host Malcolm Gladwell about how to solve the
Speaker 1: spread of COVID. Here's their conversation. I wanted to start
Speaker 1: with a really dumb, obvious question, which is, can you
Speaker 1: describe to me all the ways in which you can
Speaker 1: look for the presence of a virus that a human being. Well,
Speaker 1: that's not an obvious question at all. Within each virus,
Speaker 1: virus is just like any other thing. They have a
Speaker 1: genetic code, and then they have a bunch of proteins.
Speaker 1: And the genetic code of a virus is RNA, which
Speaker 1: is akin to a human's DNA. And so the same
Speaker 1: way that you could do a forensic investigation of a
Speaker 1: crime scene and use DNA to find if there was
Speaker 1: a human, a specific human at the crime scene, you
Speaker 1: can do a forensic investigation to look for RNA to
Speaker 1: know if there was RNA inside of a person. So
Speaker 1: that's one way, and that's this tool that these are
Speaker 1: molecular tools that we call PCR. And then there's a
Speaker 1: different way. Instead of using the genetic makeup and the
Speaker 1: RNA to look for the virus in this case, you
Speaker 1: could actually look for the proteins that make up the virus.
Speaker 1: And that's where these antigen tests really shine. So you
Speaker 1: can either look for the genetic code or you could
Speaker 1: look for the proteins. I like to call these rapid
Speaker 1: antigen tests transmission indicating tests. There's one other major way,
Speaker 1: which I'll just say quickly, and that's to look for
Speaker 1: the immunological response to the virus because humans are good
Speaker 1: at making immune responses to viruses. So it's a different way,
Speaker 1: and that's antibody based detection. But that's I put it
Speaker 1: in a whole different category because it usually comes after infection. Yeah,
Speaker 1: So the first way looking for the RNA is the
Speaker 1: kind of gold standard. That's exactly right. And so if
Speaker 1: I go to the hospital and get a today and
Speaker 1: get a COVID test. They're looking for RNA. They're giving
Speaker 1: me they're using PCR to look to see if I
Speaker 1: have virus in my system. That's right, and what's the
Speaker 1: cheapest that a PCR test could produce a result? The
Speaker 1: actual price of a PCR test can be done for
Speaker 1: six bucks, maybe even less, so it can be really cheap.
Speaker 1: But the difference is the whole infrastructure around PCR tests.
Speaker 1: They have to be done in labs, so you have
Speaker 1: logistics of transport, you have all of the people working
Speaker 1: in the lab, robots, and so generally it really drives
Speaker 1: the cost up. And as we've seen, the average test
Speaker 1: costs anywhere from thirty dollars at the absolute low end
Speaker 1: up to one hundred and fifty dollars for some labs
Speaker 1: that are charging it. No contrast PCR two antigen tests.
Speaker 1: How do antigen tests? What do they look like and
Speaker 1: what's their cost in time profile? They look like a
Speaker 1: pregnancy test and they work like a pregnancy test. Actually,
Speaker 1: they can be made. It's a little piece of paper.
Speaker 1: Generally speaking, you put some of the sample, whether that
Speaker 1: be a swab that's been mixed with some sailing solution
Speaker 1: or saliva onto a paper strip and it shows up
Speaker 1: with a line it turns either, for example, red if
Speaker 1: it's positive or blue if it's negative, and those can
Speaker 1: be made in the huge numbers. They don't require instruments.
Speaker 1: They don't usually require instruments. There's a few on the
Speaker 1: market right now that to get the sensitivity at the
Speaker 1: FDA wanted, they have some instrumentation associated. But in reality
Speaker 1: these are used for malaria, for a strap for all
Speaker 1: these different infections. They've been around for a very long time,
Speaker 1: and they can be done just on a piece of
Speaker 1: paper in five minutes, and they could get down to
Speaker 1: you can produce them for fractions of a dollar, and
Speaker 1: they might be sold to the public or built by
Speaker 1: the government for a dollar a piece or something on
Speaker 1: those lines. So you're you've been perhaps the leading public proponent,
Speaker 1: public health proponent of using antigen tests much more broadly
Speaker 1: to fight this pandemic. And I wanted to the first
Speaker 1: time I heard you give this argument. You convinced me
Speaker 1: in about two minutes. And I still don't understand why
Speaker 1: why don't we have this system? Because I can imagine
Speaker 1: in a world where if it's this, if they're cheap
Speaker 1: and that easy, then you know, every kid before they
Speaker 1: went to school in the morning, we'd take one of
Speaker 1: these fifty cents or one dollar tests and if they
Speaker 1: were positive, they would stay home, and if they're negative,
Speaker 1: we would know they could go to school. Like or
Speaker 1: if I want to go to a restaurant, why can't
Speaker 1: I just set stand in the vestiable of the restaurant,
Speaker 1: take the test and wait for my response and if
Speaker 1: i'm if I'm negative, I get to go to the restaurant.
Speaker 1: Like it just strikes me as this is a way
Speaker 1: to get going again. Why are we not doing this?
Speaker 1: Can you explain that I can? And I have a
Speaker 1: few theories. I mean, they're not just theories, they're there.
Speaker 1: I'm in the middle of all of this. And so
Speaker 1: these tests because of this whole sensitivity issue. Early in
Speaker 1: March or a really in January, the world decided that
Speaker 1: PCR was a gold standard for these tests. And I
Speaker 1: don't think and I know that this well, maybe we'll
Speaker 1: come across wrong for some people, but there hasn't been
Speaker 1: enough thought placed into what exactly does the PCR test
Speaker 1: mean and is it the right gold standard? The only
Speaker 1: pathway that we have to evaluate tests like this in
Speaker 1: the United states are medical diagnostic pathways. They are pathways
Speaker 1: designed specifically to ensure that a physician like a detective,
Speaker 1: is getting all of the information they need to diagnose
Speaker 1: a sick person in front of them. So it's really
Speaker 1: been first and foremost a regulatory hurdle. We have so
Speaker 1: devalued and defunded public health across our country and really
Speaker 1: across the world, that we actually didn't we don't have
Speaker 1: a regulatory pathway to approve a test who is primary
Speaker 1: objective is one of stopping an epidemic versus one of
Speaker 1: diagnosing a sick person, and that has really led that's
Speaker 1: held everything up. All of the companies that could be
Speaker 1: producing these these really rapid tests in the millions and millions,
Speaker 1: they have been sitting on these tests, trying to hone them,
Speaker 1: trying to get them just a little bit better, just
Speaker 1: a little bit better so that the so that they
Speaker 1: can pass their FDA standards as a medical diagnostic. It's
Speaker 1: not just slowing down their approval and getting them out
Speaker 1: to the public. It's actually bottlenecking the companies into creating
Speaker 1: tests that are not going to be as scalable because
Speaker 1: they're having to use more expensive reagents they're starting to
Speaker 1: put them with instruments and package them more. You know,
Speaker 1: they have to actually become more expensive, highly manufactured tests,
Speaker 1: when in reality they're just these little pieces of paper
Speaker 1: that if we can do the cheap version of them,
Speaker 1: they could be made very fast. But they just won't
Speaker 1: get through the FDA at the moment, And I don't.
Speaker 1: I'm still so I find it, So I find your explanation.
Speaker 1: I'm convincing. How dumb is the FDA, Like, don't they
Speaker 1: understand that they can't be they can't be a group
Speaker 1: of people who are wholly wedded to only one way
Speaker 1: of understanding how to deal with the virus. You can't
Speaker 1: if you make the exact argument you just made to me,
Speaker 1: to someone at the FDA, who is everybody is smart
Speaker 1: or smarter than I am and knows a mountain more
Speaker 1: about medicine, they're not going to say, I see a logic. Well,
Speaker 1: you know, it's not that they're not smart, it's that
Speaker 1: this is a regulatory body. They just don't have a pathway.
Speaker 1: They literally you can't go and apply for FDA approval
Speaker 1: for a public health test tool. In fact, they say
Speaker 1: it strongly in their FA ces and their facts that
Speaker 1: say we do not evaluate public health tools, and so
Speaker 1: that might make you say, well, that's great, so why
Speaker 1: bother getting FDA approval. Unfortunately, these tests are defined by
Speaker 1: the FDA as clinical diagnostic tests, which has a pretty
Speaker 1: broad definition of a test that gives somebody information about
Speaker 1: themselves that could cause them to change their behavior is
Speaker 1: a clinical diagnostic test. So this is this catch twenty
Speaker 1: two where they're saying, you know, we don't want to
Speaker 1: have anything to do with public health the proving public
Speaker 1: health tools, but we also don't want to change our
Speaker 1: definition to allow you to say that that's not a
Speaker 1: clinical diagnostic test. And so they've gotten stuck in this
Speaker 1: regulatory bureacratic nightmare of just regulation for regulation's sake. And
Speaker 1: there is precedent at the FDA, for example, to think
Speaker 1: about public health tools. Vaccines are one of them. They
Speaker 1: have outright been willing to say we will accept a
Speaker 1: vaccine that has fifty percent efficacy, and that's because, whether
Speaker 1: they recognize it or not, they're taking into account the
Speaker 1: public good part of a vaccine that they understand that
Speaker 1: it will lead to herd immunity. But they have none
Speaker 1: of that thinking in diagnostic tests because it's just driven
Speaker 1: by this very antiquated view of what a diagnostic test means.
Speaker 1: And in our country everything has been you know, the
Speaker 1: medical establishment is extremely strong. We can't we can't. You
Speaker 1: can't go to get a cholesterol test without getting a
Speaker 1: prescription from your doctor, Like, why is that not? Why
Speaker 1: can't we know that? You know, it's all through this
Speaker 1: very very heavy medical lens and changing that moving, getting
Speaker 1: that that big ship to turn is turning. You know,
Speaker 1: it's not just turning out to be a very very
Speaker 1: difficult task, but it's actually, I think inadvertently leading to
Speaker 1: potentially tens or hundreds of thousands of additional deaths that
Speaker 1: we don't need to be having. You know what this
Speaker 1: reminds me of. There's a fascinating book that was written
Speaker 1: about tanks. Tanks are invented in the First World War
Speaker 1: and then they just kind of sit on the shelf
Speaker 1: for twenty years. Everyone realizes they're a breakthrough in a
Speaker 1: revolution and they've changed war for forever, but no one
Speaker 1: can figure out who where to put them? Do they
Speaker 1: belong with the infantry? Not really right? Should they take
Speaker 1: the place of cavalry? Will kind of but those guys
Speaker 1: are really into horses, you know, like you can go
Speaker 1: on and on like and they can't. So literally it
Speaker 1: just sits around for twenty and then the Germans, who
Speaker 1: don't have a military, was destroyed by the Allies. They
Speaker 1: get to start over and they put it. They knew
Speaker 1: where to put them right because they're starting from scratch.
Speaker 1: They don't have any legacy systems that are inhibiting them.
Speaker 1: How I want to go back to how many different
Speaker 1: companies are could make one of these things if asked,
Speaker 1: and how fast would it? I mean, if I want
Speaker 1: to said, let's say the FDA Commission comes to you,
Speaker 1: Michael and says, okay, you win, rest go tomorrow. How
Speaker 1: long is it going to take for me, Malcolm Globbel,
Speaker 1: to be able to go to my drug store and
Speaker 1: buy one hundred of these strips for twenty five dollars
Speaker 1: and take one every morning. Yep. So they're actually becoming
Speaker 1: available now sort of. Abbot just came out with a
Speaker 1: new test called the Buynex. Now it's it's literally a
Speaker 1: piece of cardboard. And these have now been approved but
Speaker 1: only for medical diagnostic use again because they're being approved
Speaker 1: through the FDA, and so they're being approved for a
Speaker 1: physician to order, for example, for patients, they'll be able
Speaker 1: to make about a million a day, but again that's
Speaker 1: because they're the slightly more manufactured ones. If you take
Speaker 1: one of these super simple paper strip tests, the blueprints
Speaker 1: for how to make these are publicly available, no IP.
Speaker 1: You can get royalty free, non exclusive rights to just
Speaker 1: produce these, And I think governments should just be contracting
Speaker 1: with major manufacturers, manufacturers that have the machines to make them,
Speaker 1: but it's not particularly sophisticated machines needed to make these things.
Speaker 1: In our case. The US government should be should just
Speaker 1: be taking the reins and creating a Manhattan Project like
Speaker 1: effort to just say, print thirty million of these a
Speaker 1: day for thirty million Americans to use every day. And
Speaker 1: if everyone's using it every three days, then you've covering
Speaker 1: ninety million Americans could be using these tests every third day.
Speaker 1: That is more than enough to suppress all of the
Speaker 1: outbreaks where they're occurring today. How can you describe how
Speaker 1: your experience trying to promote this idea has made you feel? Oh? Well, um,
Speaker 1: I would say it's um, it's been it's been fraught.
Speaker 1: I would say, I think it's It's been a reality
Speaker 1: check that you know, we are in a culture and
Speaker 1: country and world that is so driven by regulation. We've
Speaker 1: just overregulated in some ways. And I'm not against regulation
Speaker 1: by any means, but when we can't recognize that there
Speaker 1: is a national, a global crisis happening and come up
Speaker 1: with different, more creative pathways, you know, this is a tool.
Speaker 1: There is no vaccine coming tomorrow for us. Social distancing
Speaker 1: clearly isn't working to suppress all the outbreaks masks. People
Speaker 1: aren't choosing to wear them in much of the country
Speaker 1: and the world, and here it is. This is a
Speaker 1: test that can that can be made for pennies essentially
Speaker 1: charged a dollar that could actually really serve to sit
Speaker 1: in for vaccines until they come about. I mean, people
Speaker 1: are dying still, you know, people like we're becoming complacent,
Speaker 1: and that's just that's the frustration part, and that is
Speaker 1: generally what is the first gut reaction when you ask
Speaker 1: me that question. But at the same time, this is
Speaker 1: an idea that has caught on it and it has
Speaker 1: gotten a huge number of people. You know, it's kind
Speaker 1: of created a movement, i would say, and that has
Speaker 1: been just so inspiring. The number of people across all
Speaker 1: every single day. Not a day has gone by for
Speaker 1: months now where I haven't gotten emails from everyone from
Speaker 1: governors of states and prime ministers of countries down to
Speaker 1: literally people who say, you know, I'm out of my
Speaker 1: job right now. I have no no idea you know
Speaker 1: anything about infectious diseases. I'm usually whatever their job is,
Speaker 1: and but how can I help? You know? I want
Speaker 1: to help with this cause. And so it's been amazing
Speaker 1: to see the pouring by the average person in the
Speaker 1: public to really try to help get these things moving
Speaker 1: and to help move the needle in whatever capacity that
Speaker 1: might be. So that's been pretty it's just been inspiring
Speaker 1: and amazing to me. Are the things our listeners can
Speaker 1: do to make this solution more likely. First, get more information,
Speaker 1: and we've actually set up with well I barely did anything,
Speaker 1: but there's been this kind of small army of people
Speaker 1: who are springing up to really help with these issues
Speaker 1: and pushing the FDA in the government in the right direction.
Speaker 1: And that's rapid tests dot org one word, rapid tests
Speaker 1: dot org. And there's we're trying to fill that website
Speaker 1: in with increasing amounts of information. There's even links I
Speaker 1: believe at this point to help people and create letters
Speaker 1: to the representatives. There's been some really nice articles. If
Speaker 1: people want to follow me on Twitter, I tend to
Speaker 1: write about it a lot on Twitter and I try
Speaker 1: to be a responsive to people, and so my Twitter
Speaker 1: handle is Michael Minna Underscore Lab. But all of that aside,
Speaker 1: I think one of the best things that people can
Speaker 1: do right now is to actually let their leaders and
Speaker 1: their representatives that whether it be at the county level,
Speaker 1: their state leaders, and their federal leaders know that that
Speaker 1: you know, this has been dragging on too long. Rapid
Speaker 1: tests still have not become available. They are a solution that,
Speaker 1: along with all of the other things like social distancing
Speaker 1: and masks, will really help to combat this virus. And
Speaker 1: we need to have date and federal leadership getting on
Speaker 1: board to help get these through approval processes quicker and
Speaker 1: help get the production of these, ideally from the federal
Speaker 1: government up to speed and have tens of millions of
Speaker 1: these produced every day. And yeah, and I think it's
Speaker 1: already working, which is the good thing to keep the
Speaker 1: momentum up. One last question, why isn't there or is
Speaker 1: there a black market in these tests? I mean, there's
Speaker 1: a you know, I don't use cocaine, but if I
Speaker 1: wanted to use cocaine, I'm pretty sure I could get it.
Speaker 1: I don't understand why if these things are cheap and
Speaker 1: easy to make, and they have such a profound impact
Speaker 1: on people's lives, why isn't there a thriving underground economy
Speaker 1: and giving us cheap, cheap manage in tests. Well, i'd
Speaker 1: be lying if I if I were to say, I
Speaker 1: haven't thought a lot about just importing them from other countries,
Speaker 1: you know, But I think it's because we do still
Speaker 1: have laws, and we still have you know, tests aren't
Speaker 1: so extreme. You know, I might get there if they're
Speaker 1: really not get approved. At the end of the day,
Speaker 1: they can just sell them legally in other countries at
Speaker 1: the moment. So why bother doing something illegal in the
Speaker 1: US when you know they can sell them elsewhere? Where?
Speaker 1: Where can I buy them? What country can I buy
Speaker 1: them legally in? Well, South Korea is making There's at
Speaker 1: least two companies. There's more. I'm sure South Korea has
Speaker 1: a company called SD Biosensor, and they're they're actually exporting
Speaker 1: them all over the world. Now, Canada in a nano
Speaker 1: he is starting to produce them, and they're I'm guessing
Speaker 1: going for FDA clearance. But India is making them. Singapore,
Speaker 1: I believe, has some that they're making, so we're starting
Speaker 1: to see them. I think even Senegal is producing them,
Speaker 1: but South Koreans have the highest volume that they're currently making. Yeah,
Speaker 1: thank you so much. This is totally fascinating. I am
Speaker 1: once again filled with righteous anger at the inability of
Speaker 1: our regulatarized system to handle. I mean, it's just not
Speaker 1: it's just like it doesn't seem like that big of
Speaker 1: a jump, Like it doesn't seem that hard given the
Speaker 1: fact that this whole thing's costing is I agree, I
Speaker 1: just it's frustrating, but I would I do have to
Speaker 1: say that, you know, the FDA has been willing to
Speaker 1: come to the table more frequently, and actually we're having
Speaker 1: the conversations, so maybe they're starting to to really warm
Speaker 1: up to it. You know. I feel like, if you
Speaker 1: can you can convince the FDA on this one, you
Speaker 1: deserve not just a metal but one of those statutes.
Speaker 1: I will hold chip in for the statue. Well, well,
Speaker 1: thank you. I'm going to keep fighting this fight until
Speaker 1: and see it through until we start defeating COVID one
Speaker 1: way or the other. Michael Minne is an epidemiologist and
Speaker 1: immunologist at the Harvard School of Public Health and a
Speaker 1: physician at Brigham and Women's Hospital. Remember to check out
Speaker 1: our show notes for links to the suggestions our guests
Speaker 1: make for ways that you can get involved. Next week, Unsolvable,
Speaker 1: we'll hear from chemist Eric Apple about a new solution
Speaker 1: for fighting wildfires before they start. And here's the teaser.
Speaker 1: It involves laying down something like a real life force field.
Speaker 1: You won't want to miss that conversation. Solvable is brought
Speaker 1: to you by Pushkin Industries. Our show is produced by
Speaker 1: Camille Baptista, Senior producer Jocelyn Frame. Catherine Girardo is our
Speaker 1: managing producer, and our executive producer is Mia Loebell. I'm
Speaker 1: Jacob Weisberg.