Speaker 1: Pushkin from Pushkin Industries. This is Deep Background the show
Speaker 1: where we explore the stories behind the stories in the news.
Speaker 1: I'm Noah Feldman. A few weeks ago on the show,
Speaker 1: I spoke to Nobel Prize me economist Paul Romer, and
Speaker 1: Paul had what he considered a simple plan to reopen
Speaker 1: the economy without risking people's health. All we need to
Speaker 1: do is switch to a strategy where we're testing everybody
Speaker 1: with regularity. As soon as we find somebody who's positive,
Speaker 1: we need to isolate them without isolating lots of people
Speaker 1: who could otherwise just go back to daily life and work.
Speaker 1: Paul is not alone. Public health experts have been almost
Speaker 1: unanimous in saying that we need a lot of tests
Speaker 1: very soon in order to protect health and eventually reopen
Speaker 1: the economy. And yet we are behind Germany, Canada, and
Speaker 1: even Italy when it comes to per capita testing. And
Speaker 1: as of now, less than one percent of the US
Speaker 1: population has been tested for coronavirus. So what is the
Speaker 1: hold up? What are the bottlenecks that stand between us
Speaker 1: an effective testing? To learn more about coronavirus testing both
Speaker 1: for diagnosis and then for antibody testing to see if
Speaker 1: people have already had the disease. I'm joined by doctor
Speaker 1: Ohmi Garner. He's the director of Clinical Microbiology Testing for
Speaker 1: UCLA Health. His lab does more than one point five
Speaker 1: million tests a year of all kinds, and so he
Speaker 1: finds himself right in the thick of the question of
Speaker 1: how we test for COVID. Oh my, I'm so grateful
Speaker 1: to you for agreeing to talk to me. I want
Speaker 1: to ask you to help guide us through the process
Speaker 1: of just why testing takes so long to generate and
Speaker 1: to cause to function. So start wherever you want. Maybe
Speaker 1: start with the diagnostic tests first. What are the challenges
Speaker 1: to having millions of diagnostic tests up and running on
Speaker 1: a daily basis? You know, that's the million dollar question.
Speaker 1: I think that there are lots of challenges for many ends,
Speaker 1: and so just I think it's used to a little
Speaker 1: bit walk through the process of getting a diagnostic test
Speaker 1: for COVID nineteen by PRECR because it starts to then
Speaker 1: outlay where the challenges are in the system. And so
Speaker 1: the first part of the diagnostic test is the collection
Speaker 1: of the sample. This is the part I think people
Speaker 1: are most familiar with. You either go to your doctor's office,
Speaker 1: or a hospital or a drive through location, and a
Speaker 1: swab is inserted deep into nasal cavity and then that
Speaker 1: sample is sent to a centralized testing lab. I think
Speaker 1: there's a bit a little bit of confusion around this
Speaker 1: because they call those locations testing locations, but no actual
Speaker 1: testing happens there, and so I think people think, why
Speaker 1: would it takes so long if the test happens right
Speaker 1: where you collected it. So the sample needs to be
Speaker 1: sent to a centralized laboratory like my laboratory where we
Speaker 1: perform the PCR test, and the PCR test, depending on
Speaker 1: which platform is used, can take anywhere from two to
Speaker 1: six hours. And I think this is also something that's
Speaker 1: not well known because if the test only takes two
Speaker 1: to six hours, why are people waiting seven to fourteen
Speaker 1: days to be able to get a test result right?
Speaker 1: And I think one of the infrastructure challenges around this
Speaker 1: particular outbreak and testing itself, is that there are just
Speaker 1: not enough centralized laboratories that are able to do this
Speaker 1: testing right now. And this starts to key in on
Speaker 1: why we don't have testing across the country and a
Speaker 1: lot of and we have labs, so it's not to
Speaker 1: say that there aren't centralized clinical laboratories. There are centralized
Speaker 1: clinical laboratories in almost every single city across this country.
Speaker 1: The challenges that each one of those laboratories does not
Speaker 1: have the equipment to be able to test for COVID nineteen,
Speaker 1: and the labs that do have the equipment there is
Speaker 1: such a shortage on they test themselves that many labs
Speaker 1: that have the equipment still can't run the capacity of
Speaker 1: tests they could run within a day. One of the
Speaker 1: fascinating questions to me is is there some alternative technology
Speaker 1: potentially in the pipeline they would make it easier to
Speaker 1: collect samples by means other than the long swab that
Speaker 1: goes deep into the nasal cavity. You know, Donald Trump
Speaker 1: himself said it was a miserable experience for him to
Speaker 1: have that done, And though I'm not super worried about
Speaker 1: his own experience, it does mark the fact that we
Speaker 1: need not only the swabs, that we need medical professionals
Speaker 1: to do the swabbing, Whereas it might be a lot
Speaker 1: faster and more efficient if people could do it at
Speaker 1: home or there was just alive a test right now,
Speaker 1: why is it the case that we can't do that?
Speaker 1: I think that a lot of this is about clinical
Speaker 1: sensitivity of what you're collecting. And when I say that,
Speaker 1: I mean how likely is it for a false negative
Speaker 1: to be given to a patient. So in the vironment
Speaker 1: of COVID nineteen, we want to try our best to
Speaker 1: avoid a false negative, and in order to do that,
Speaker 1: you want to take the best possible specimen to increase
Speaker 1: your likelihood of actually collecting virus. Now this is really
Speaker 1: then the question is where is the virus? Right, Is
Speaker 1: the virus out at the end of the nasal cavity,
Speaker 1: Is the virus very very deep in the nasal cavity.
Speaker 1: Is the virus in the throat? Is the virus in
Speaker 1: different various oral fluid compartments. And the reason why nasal
Speaker 1: pharyngeal collection was the first thing that was used is
Speaker 1: because that's where we know other respiratory viruses live. And
Speaker 1: so whether you're doing a PCR test for influenza or
Speaker 1: a PCR test for something like respiratory sinciitio virus, the
Speaker 1: best possible specimen, meaning the specimen that gives you the
Speaker 1: highest likelihood for recovery of virus, is actually that really
Speaker 1: deep nasal pharyngeal specimen. So then I think ultimately the
Speaker 1: question is do you need to take the best possible
Speaker 1: specimen or in this particular case, with this particular virus,
Speaker 1: can you find an equal amount of virus in some
Speaker 1: of these other specimens? And those studies are ongoing. I
Speaker 1: agree with you if we could just use oral fluid,
Speaker 1: I would change all of my test to oral fluid tomorrow.
Speaker 1: But I won't do it if it's going to mean
Speaker 1: we produce more false negatives. Now let's turn to the lab.
Speaker 1: So you were saying the sample comes to you, it
Speaker 1: reaches you in the lab, and you're going to perform
Speaker 1: a PCR test. What is a PCR test. The test
Speaker 1: is actually in two components, with PCR being the second component.
Speaker 1: So the first component is really it's called RNA extraction.
Speaker 1: And what happens is that when the sample comes in,
Speaker 1: this first step actually takes out all the nucleic acid
Speaker 1: from that sample. And so now what you have is
Speaker 1: instead of the full sample from the patient, you just
Speaker 1: have a pool of RNA and then you run the
Speaker 1: PCR test. And so the PCR test is called an
Speaker 1: rtPCR test. It's a reversed trend description polymerase chain reaction
Speaker 1: that's that rt PCR, and what it does is because
Speaker 1: we're looking for RNA, PCR is a technology that examines DNA.
Speaker 1: So the first step is you have to turn the
Speaker 1: RNA into DNA, and that's that reverse transcription. The second
Speaker 1: test then is the polymerase chain reaction, and the polymerase
Speaker 1: chain reaction is really a way to amplify a specific
Speaker 1: target on DNA to see whether or not that target
Speaker 1: is there. And of course the target we're looking for
Speaker 1: is COVID nineteen, and so if some of that viral
Speaker 1: RNA is there, it's been converted to DNA, and then
Speaker 1: PCR can target to tell you whether or not that
Speaker 1: viral RNA was originally in that specimen. And it's exquisitely sensitive.
Speaker 1: The test that we're using in my laboratory get down
Speaker 1: to about five hundred copies of virus per mill of fluid,
Speaker 1: and so what I'd like to tell people is that
Speaker 1: if the virus is in the sample, the test will
Speaker 1: find it. That's super clarify and helpful. Now, you said
Speaker 1: that there are enough laboratories in the United States to
Speaker 1: handle even a substantial volume of testing, and that the
Speaker 1: problem is that they don't have the necessary equipment in
Speaker 1: a concrete sense, what is missing in these labs, because
Speaker 1: if we could figure out what that is, maybe we
Speaker 1: could talk about how we provide it. Sure So, there
Speaker 1: are now I don't know somewhere around twelve FDA Emergency
Speaker 1: Used Authorization approved PCR tests for COVID nineteen. The challenge
Speaker 1: is that the manufactures of those tests need to get
Speaker 1: those tests to those laboratories to be able to provide testing. So,
Speaker 1: giving an example from my own laboratory, I actually run
Speaker 1: four different FDA approved tests for COVID nineteen. And the
Speaker 1: reason why I do that is because I can't get
Speaker 1: one manufacturer to give me enough volume of test kits
Speaker 1: to meet the need, so I actually have to bring
Speaker 1: in four different tests to be able to do that.
Speaker 1: You get a couple one hundred a day from one place,
Speaker 1: you get a couple one hundred a day from another place,
Speaker 1: and you combine all of that volume together and I
Speaker 1: can get up around the thousand tests a day or
Speaker 1: so that I can offer in my laboratory. This is
Speaker 1: a significant challenge and the shortage by the manufacturers of
Speaker 1: the diagnostic tests really is contributing to our inability to
Speaker 1: have widespread testing. And I don't want to put the
Speaker 1: blame on the manufacturers for this. What they've been asked
Speaker 1: is very very difficult, which is to basically pivot their
Speaker 1: entire operation. And these are diagnostic manufacturers that make all
Speaker 1: kinds of diagnostic tests, HIV viral load tests, goneria, clamydia
Speaker 1: PCR tests, and they're saying to them, Okay, we need
Speaker 1: you to make a COVID nineteen test and ramp it
Speaker 1: up a hundred times more the volume you would normally
Speaker 1: make for testing. What do you think is slowing them
Speaker 1: down in doing that? I mean, just at the most
Speaker 1: basic level, picturing the factory where they make the tests,
Speaker 1: and I'm picturing them shifting over the functionality they usually
Speaker 1: have to produce other kinds of tests onto producing COVID
Speaker 1: nineteen tests. What's the hold up for them that stops
Speaker 1: them from doubling or tripling, to say nothing of going
Speaker 1: up to one hundred times. So I think one of
Speaker 1: the hold ups is just manufacturing capacity, because you can't
Speaker 1: just stop making the other tests because people still have
Speaker 1: those other diseases, and so it's almost like you need
Speaker 1: to on top of what you were making before. Now
Speaker 1: go ahead and produce one hundredfold times COVID nineteen testing,
Speaker 1: and so you know, I really think it's a manufacturing bottleneck.
Speaker 1: You can only do so many runs at a time
Speaker 1: because you only have so much manufacturing capacity in that setting.
Speaker 1: In speaking with the manufacturers, this is what I've been told.
Speaker 1: The other part of the problem that we've discovered kind
Speaker 1: of over time is that a lot of these manufacturers
Speaker 1: rely on some of the same chemicals to make their
Speaker 1: own proprietary test kits. And if one chemical, let's say
Speaker 1: that multiple manufacturers use, is in shortage, that then stops
Speaker 1: all of them from making more tests. So there's a
Speaker 1: whole supply chain here of the chemicals that are necessary
Speaker 1: to make this work. And so one has to go
Speaker 1: back a further step and go to the chemical companies
Speaker 1: and make sure the chemical companies are manufacturing more of
Speaker 1: this in terms of stopping though the production of their
Speaker 1: other tests can't. An argument be made that given the tremendous,
Speaker 1: almost unimaginable cost of keeping our economy shut down, and
Speaker 1: given the testing is so crucial to reopening, that they
Speaker 1: actually should stop manufacturing the other tests rely on whatever
Speaker 1: backlog they have and just prioritize COVID nineteen tests ahead
Speaker 1: of everything else. I can agree with you there. You know,
Speaker 1: I don't work for the companies. I can only speak
Speaker 1: as an end user that's in an academic medical and
Speaker 1: running these tests. That yes, I think that the pivot
Speaker 1: needs to be fast. I think part of the challenge
Speaker 1: as well, though, is that these companies aren't made to
Speaker 1: pivot like that, and so you know, getting the either
Speaker 1: federal support or whatever would be necessary to encourage them
Speaker 1: to be able to do this is one of the challenges.
Speaker 1: But yes, I will agree with you. Overall, to meet
Speaker 1: this immediate need, there needs to be a shifting, and
Speaker 1: I know a lot of companies are shifting. It's just
Speaker 1: the scale of the shifting. You know, when we think
Speaker 1: of clinical lab testing. You know, there has never been
Speaker 1: a test in my laboratory where I need to do
Speaker 1: two thousand tests a day. So the scale of this
Speaker 1: is just it's mind boggling from an overall diagnostics perspective,
Speaker 1: because I don't want to represent it as something like, well,
Speaker 1: the manufacturers just should have shifted and this would have
Speaker 1: been relatively easy for them to do, and they're negligent
Speaker 1: to not do that. That's not what's going on. This
Speaker 1: is really an unpress sedented shift that's being asked for,
Speaker 1: Yet at the same time we have to be able
Speaker 1: to do it in your lab. The PCR test, if
Speaker 1: you have the equipment, can be run in two to
Speaker 1: six hours. So what is driving the backlog that causes
Speaker 1: people to have to wait seven to ten days for
Speaker 1: a result. A lot of that is that every single
Speaker 1: state doesn't even have large scale testing that's available. One
Speaker 1: of our reference laboratories in California, Quest Diagnostics was receiving
Speaker 1: samples from New York and New Jersey. Well, if you're
Speaker 1: shipping samples across the country to be able to have
Speaker 1: them tested at a facility, and then once they get
Speaker 1: to that facility, if the queue or line is two
Speaker 1: hundred thousand tests long, you can see that it just
Speaker 1: increases exponentially the turnaround time, which is the expression that
Speaker 1: we use in lab diagnostics for the amount of time
Speaker 1: it takes from the sample to be collected all the
Speaker 1: way to the person getting the result back. Is there
Speaker 1: any in centralized national planning for where tests should go.
Speaker 1: I mean, it seems very crazy that someone could be
Speaker 1: tested in New York and then have their samples sent
Speaker 1: to LA so that a lab there can do the work.
Speaker 1: But I get that you have to send the test
Speaker 1: where there's access. It sounds like the kind of thing
Speaker 1: which would benefit from a centralized model. I agree with you.
Speaker 1: I think a centralized model would be helpful. But you know,
Speaker 1: I think that this is tied into our healthcare system,
Speaker 1: and our healthcare system is not built around a centralized model.
Speaker 1: And so I think this is why you see some
Speaker 1: of the great disparity across the country is because there
Speaker 1: is no centralized model, and thus individual areas some can
Speaker 1: be very very fast, and some may not have access
Speaker 1: to testing at all. What realistically is going to happen
Speaker 1: in your view, if in the next few weeks, you know,
Speaker 1: sort of like end of April, first few weeks of May,
Speaker 1: we see an effort to get people back to work,
Speaker 1: coupled with big companies trying to get tests done for
Speaker 1: their employee eventually over the course of the summer, campuses
Speaker 1: like university campuses trying to get people tested in a
Speaker 1: systematic way is not at all realistically doable from your perspective,
Speaker 1: Given where we stand, I mean, you're perfectly placed to
Speaker 1: give a credible answer to this question because most people
Speaker 1: are just speaking theoretically. Yeah, I'm optimistic. So within that optimism,
Speaker 1: and again I talk to multiple manufacturers of these tests
Speaker 1: on a daily basis. Everybody is ramping up. And as
Speaker 1: everybody ramps up, I see more and more hospitals, even
Speaker 1: just in the Los Angeles area, being able to provide testing.
Speaker 1: And so I think we're moving in the right direction.
Speaker 1: The question is are we moving in a direction fast
Speaker 1: enough to match what we're going to do with changes
Speaker 1: in social distancing policies? And that's a really difficult thing
Speaker 1: to be able to predict because I think the two
Speaker 1: need to be tethered together. As we increase our testing capacity,
Speaker 1: I think that's one way for us to start in
Speaker 1: a responsible way, opening back up, getting people back to work.
Speaker 1: But you know, I think if you just flip the
Speaker 1: switch on May fifteenth or whatever arbitrary day that said,
Speaker 1: it's going to so outpace our pace of testing that
Speaker 1: we're going to end up right back where we were. So,
Speaker 1: you know, I think that states that are going to
Speaker 1: be able to do this in a scientific and educated
Speaker 1: way to meet the testing needs while you open up,
Speaker 1: I think that we can be successful at it. We'll
Speaker 1: be back in just a moment. So far, we've been
Speaker 1: talking about PCR testing, which is to see if a
Speaker 1: person from whom example has been taken has the virus now,
Speaker 1: but part of opening up will also be extensive antibody testing.
Speaker 1: Do you guys do that in your lab? So not yet.
Speaker 1: I'm going through the validation process now, and so my
Speaker 1: expectation is that we should go live at UCLA with
Speaker 1: antibody testing, hopefully sometime early to mid next week. I
Speaker 1: do want to make kind of a general comment about
Speaker 1: the antibody testing compared to the PCR though, so I
Speaker 1: said they were like nine to twelve manufacturer of the
Speaker 1: PCR test. Ultimately they're using the exact same technology, even
Speaker 1: though there are small differences between the tests, and so
Speaker 1: you can really see those tests as the same tests.
Speaker 1: So whether I offer a PCR test or hospital down
Speaker 1: the street offers a PCR test, they're all going to
Speaker 1: be kind of the equivalent sensitivity and high quality. Unfortunately,
Speaker 1: that is not true for antibody testing at all, and
Speaker 1: so the challenge of antibody testing is that it was
Speaker 1: unregulated by the FDA to begin with, So there were
Speaker 1: a lot of tests that flooded the market that were
Speaker 1: very very low quality, and every single antibody test manufacturer,
Speaker 1: because I'm now talked to five or six of them,
Speaker 1: are using a different target on the virus to be
Speaker 1: able to look for antibodies, and that distinctly affects whether
Speaker 1: or not these tests are cross reactive, and they produce
Speaker 1: false positives. And so unfortunately, what you're going to see
Speaker 1: with antibody testing is that depending on the platform each
Speaker 1: testing area uses, they could have vastly different results. And
Speaker 1: this makes antibody testing then, in determining kind of what
Speaker 1: it means, very very challenging. So how did you go
Speaker 1: about the process of choosing the approach that you're going
Speaker 1: to use in your lab? So I was looking for
Speaker 1: the best test possible, right, I think the challenge with
Speaker 1: antibody testing is that it needs to be of the
Speaker 1: highest quality if we're going to have any chance of
Speaker 1: trying to establish some level of immunity or even affect
Speaker 1: behavior by having something like a positive test result. And
Speaker 1: so in speaking with the companies, what I really wanted
Speaker 1: to look at was the size of their validation data,
Speaker 1: whether or not they proved non cross reactivity with something
Speaker 1: like seasonal coronavirus, influenza, some other viruses that we all
Speaker 1: have IgG four that you would not want to be
Speaker 1: cross reactive in a COVID nineteen antibody test, And so
Speaker 1: we did a long process of evaluation and then now
Speaker 1: once we've chosen our company, we want to move forward
Speaker 1: with I'm going to do an extensive in lab validation
Speaker 1: with serum that I already have from COVID nineteen positive
Speaker 1: patients and from patients with other viruses to prove that
Speaker 1: it works before I go forward with a test for
Speaker 1: my patients. So you're actually doubling up. First, you're choosing
Speaker 1: what you think is the best test, and then you're
Speaker 1: going to test it yourself in the lab to make
Speaker 1: sure that you have confidence in it before you start
Speaker 1: using it. Absolutely, I think it's the only way in
Speaker 1: the current environment with the amount of anibody tests that
Speaker 1: are out there. It's just I have to be sure
Speaker 1: because clinical decisions are going to be made based on
Speaker 1: these results. Personal decisions are going to be made based
Speaker 1: on these results, and so you know, that's really the
Speaker 1: role of a clinical lab director in choosing the best possible.
Speaker 1: One of the things that has fascinated me is to
Speaker 1: hear about scientists around the country trying to come up
Speaker 1: with outside the box solutions to massively increase testing capacity.
Speaker 1: And one of the most intriguing ones that I read
Speaker 1: about was produced by a group at the Broad Institute
Speaker 1: here in Cambridge, Massachusetts, which is where I'm based, not
Speaker 1: at the Broad but in Cambridge, that was proposing, at
Speaker 1: least theoretically, a massive throughput approach where they would bar code,
Speaker 1: using a crisper like DNA technique, bar code samples so
Speaker 1: that they could then run through sequencers hundreds of thousands
Speaker 1: of tests at a single run. That's obviously a very
Speaker 1: different technology, and it's using very different kinds of methods
Speaker 1: than are used in most clinical labs. As someone who
Speaker 1: does it the old fashioned way, as it were, what
Speaker 1: do you think are the odds of success here? I mean,
Speaker 1: it might be worth trying it even if the probability
Speaker 1: of success is very low, because it will be great
Speaker 1: to test so many people so quickly. What are the
Speaker 1: big challenges that that approach faces in your view? Yeah,
Speaker 1: So the scientists that run these approaches are very talented scientists,
Speaker 1: you know, their research based scientists, and I think that
Speaker 1: they will be able to successfully put together a system
Speaker 1: that could theoretically do one hundred thousand samples. Part of
Speaker 1: what differentiates a research test from a clinical test, something
Speaker 1: that's allowed to be used on patients is that you
Speaker 1: have to prove that it works before you can actually
Speaker 1: use it clinically. And part of the challenge of a
Speaker 1: system like this I lives literally having this exact same
Speaker 1: conversation with some researchers at UCLA, is that in order
Speaker 1: to prove that it works on scale, you need to
Speaker 1: test fifty thousand samples one hundred thousand samples. And the
Speaker 1: challenge of doing that is how do you get those
Speaker 1: samples within a research setting under IRB approval and not
Speaker 1: have it take nine months, a year, a year and
Speaker 1: a half, which is typically what these sorts of things
Speaker 1: would take before or you even began to have enough
Speaker 1: data to submit to the FDA to get approval of
Speaker 1: your new technique. And so, while I do think that
Speaker 1: this could work, I don't know if it's going to
Speaker 1: move in a time frame that's going to make it feasible.
Speaker 1: There are other concerns that I have kind of wrapped
Speaker 1: up in this. A lot of the challenges of let's say,
Speaker 1: the paper that you had talked about, it doesn't use
Speaker 1: rtPCR uses LAMP, which is a different nucleic acid amplification
Speaker 1: technology that can have sensitivity issues. This is also part
Speaker 1: of some other challenges when you pool large things together,
Speaker 1: is that on an individual sample basis, sometimes you're just
Speaker 1: not as good as the gold standard. And these would
Speaker 1: be the things that these places would have to prove
Speaker 1: to the FGA before they got approval to do massive testing.
Speaker 1: In addition, you know, while I respect the fact that
Speaker 1: you can run one hundred thousand samples at one time,
Speaker 1: just collecting a hundred thousand samples, getting them sent to
Speaker 1: one area and getting them processed to be able to
Speaker 1: run is a phenomenal challenge that's wrapped up on the
Speaker 1: pre analytical side, or kind of even before the testing begins.
Speaker 1: So I am excited about this because I actually don't
Speaker 1: think this is going to be our last pandemic. There
Speaker 1: isn't anything to suggest it would be. And so if
Speaker 1: we can get things online like this and really start
Speaker 1: thinking about how the country when we need to, could
Speaker 1: pivot to mass scale testing for a virus, that's a
Speaker 1: really good thing to have in our back pocket. Is
Speaker 1: this something that's going to work for COVID nineteen. I
Speaker 1: don't know if the time scale is actually going to
Speaker 1: meet up with the technology. If I could close our
Speaker 1: conversation on a modestly lighter note, but it nevertheless an
Speaker 1: important one. I read that you had said that watching
Speaker 1: Cuba Gooding Junior in the nineteen ninety five film Outbreak
Speaker 1: was one of the things that inspired your career path,
Speaker 1: and of course a lot of us now feel like
Speaker 1: we're living Outbreak the sequel. Yes, what does that feel
Speaker 1: like for you personally to be, you know, on the
Speaker 1: front lines here? It's interesting. So twenty fourteen, we had
Speaker 1: our Ebola crisis in the United States and at UCLA,
Speaker 1: I was part of the ebola treatment team, and so
Speaker 1: in that setting, you know, as an ebola treatment a
Speaker 1: person participating in the treatment of the patient, you have
Speaker 1: to get fully suited up. So if you can imagine
Speaker 1: Cuba getting Junior an outbreak in that yellow suit, that's
Speaker 1: similar to what you wear when you're attempting to discern
Speaker 1: whether or not somebody has ebola. So it was that
Speaker 1: moment I really kind of had my outbreak moment. This
Speaker 1: one I have felt it's a little bit strange because
Speaker 1: until we kind of all moved forward with masking, it
Speaker 1: was a pandemic but everything looked fine, So it was
Speaker 1: kind of different from the outbreak scenario. It was like
Speaker 1: a shift in what I thought a pandemic would look like.
Speaker 1: And that's what I found to be the most surprising
Speaker 1: of this whole thing. Hundreds of thousands to potentially millions
Speaker 1: of people worldwide are going to die of this disease,
Speaker 1: but it's not like running around in the biosafety level
Speaker 1: four suits. All of the movies, TV shows, and so forth,
Speaker 1: none of them has a scene where people say, well,
Speaker 1: we should all suit up. Oh but wait a minute,
Speaker 1: we don't have enough suits. You know, that's not a
Speaker 1: plot detail that they've ever taken advantage of in the past,
Speaker 1: though I suppose we'll see it going forward. Yes, thank you, Ohmi.
Speaker 1: This was extraordinarily clarifying and helpful. I really hugely appreciate
Speaker 1: your step by step patients in explaining what you do
Speaker 1: every day to us. Thank you for doing the work
Speaker 1: that you're doing, and we all appreciate it. Excellent. Thanks
Speaker 1: for having me out. No, I appreciate it. Listening to
Speaker 1: doctor Ohmi Garner. I had moments of optimism because he
Speaker 1: himself said that he thinks we are scaling up our
Speaker 1: capacities in a way that will facilitate a lot more
Speaker 1: testing than we're doing at present. That was the good news.
Speaker 1: On the other hand, Olmi also made it very clear
Speaker 1: that there are significant limits to how many tests we
Speaker 1: can do under current circumstances. We have the shortage of
Speaker 1: chemicals in the existing tests, we have limited capacity, and
Speaker 1: when it comes to antibody testing, we still don't really
Speaker 1: know how well the various tests work. Last, but not least,
Speaker 1: Although Omai thinks that some of the most fascinating experimental
Speaker 1: techniques being proposed to test hundreds of thousands of people
Speaker 1: at the same time have a good shot of working,
Speaker 1: he's concerned that it may not be possible for that
Speaker 1: kind of testing at that kind of scale to be
Speaker 1: ramped up in time to help us address the COVID
Speaker 1: nineteen epidemic as opposed to future epidemics. Above all, a
Speaker 1: doctor Omai Garner is a kind of model of the
Speaker 1: clear speaking, clear thinking scientist who can explain things to
Speaker 1: all of us, and I feel very lucky that he's
Speaker 1: at the helm of an important lab like the one
Speaker 1: at UCLA. Until the next time I speak to you.
Speaker 1: Be careful, be safe, and be well. Deep Background is
Speaker 1: brought to you by Pushkin Industries. Our producer is Lydia Gencott,
Speaker 1: with research help from Zooe Wynn. Mastering is by Jason
Speaker 1: Gambrel and Martin Gonzalez. Our showrunner is Sophie mckibbon. Our
Speaker 1: theme music is composed by Luis GERA special thanks to
Speaker 1: the Pushkin Brass, Malcolm Gladwell, Jacob Weisberg, and Mia Lobel.
Speaker 1: I'm Noah feld I also write a regular column for
Speaker 1: Bloomberg Opinion, which you can find at Bloomberg dot com
Speaker 1: slash feld To discover Bloomberg's original slate of podcasts, go
Speaker 1: to Bloomberg dot com slash Podcasts. You can follow me
Speaker 1: on Twitter at Noah R. Feldman. This is Deep Background.