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Speaker 1: I think the next forty days will probably be the

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Speaker 1: forty worst days of the pandemic. It's really bad at

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Speaker 1: this point. I mean hundreds of thousands of Americans getting

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Speaker 1: infected every day, of two to three thousand people dying

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Speaker 1: every day. If we had widespread testing available, this would

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Speaker 1: make a huge difference. But we don't, and so we're

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Speaker 1: still stock and you're going to see more hospitals basically

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Speaker 1: say we can't take care of anybody else, not just

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Speaker 1: we can't take care of COVID patients, we just can't

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Speaker 1: take care of anybody else. It's gonna be awful, and

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Speaker 1: it's gonna be a very challenging months. Six weeks ahead.

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Speaker 1: This week, we watched as the first Americans received the

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Speaker 1: COVID vaccine, heroic health care workers who have been on

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Speaker 1: the front lines of this fight for months. It was

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Speaker 1: emotional and extraordinary, and it is something we should be

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Speaker 1: very excited about. But at the same time, we cannot

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Speaker 1: forget that most of us will not be getting this

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Speaker 1: vaccine four months, and we cannot lose sight of the

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Speaker 1: crisis at hand, because the spread of COVID has never

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Speaker 1: been worse. For almost nine months now, I have been

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Speaker 1: reporting on COVID, covering it every day, the stories of

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Speaker 1: healthcare workers, families, business owners, teachers. I thought I understood

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Speaker 1: the chaos of this moment, but a few weeks ago

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Speaker 1: I realized I didn't. I became one of the more

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Speaker 1: than sixteen million Americans who have contracted the virus SORTD

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Speaker 1: my family, and the experience of getting COVID made it

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Speaker 1: even more clear to me that we have failed and

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Speaker 1: continue to fail in some very key ways, namely testing

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Speaker 1: and tracing. I'm Stephanie Rule, MSNBC Anchor, NBC News Senior correspondent,

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Speaker 1: and this is Modern Rules, a podcast from NBC Think

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Speaker 1: and I heart radio. On this podcast, We're not gonna

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Speaker 1: waste your time. We're interested in getting straight to the point,

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Speaker 1: and then we're gonna leave you with some time to think.

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Speaker 1: And today we are looking at why the US is

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Speaker 1: failing the COVID test and how we can use the

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Speaker 1: tools we have at our disposal right now to maybe

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Speaker 1: get things under control. And I've got the perfect guest

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Speaker 1: here to help us try and make sense of it.

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Speaker 1: Dr she'sh Ja. He's the dean of Brown University School

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Speaker 1: of Public Health, and he has been a crucial voice

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Speaker 1: of science and reason throughout this pandemic. Dr Jah, thank

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Speaker 1: you for joining us. I want to start with COVID

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Speaker 1: nineteen tests. Can you explain to us what kind of

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Speaker 1: tests are available in the United States, the pros, the cons,

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Speaker 1: because I'm going to tell you when my husband woke

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Speaker 1: up with a scratchy throat and not feeling that well,

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Speaker 1: I foolishly thought let's run out and get a test.

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Speaker 1: There's no such thing as let's go out and get

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Speaker 1: a test. Zephanie, thank you so much for having me

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Speaker 1: on it. And this is a question that confuses people

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Speaker 1: still nine ten months into this pandemic. Right now, if

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Speaker 1: you want to think about a test to diagnose whether

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Speaker 1: you have the virus or not, you have two choices.

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Speaker 1: An anagen test and a PCR test. Most of the

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Speaker 1: tests we've used over the last nine months are these

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Speaker 1: PCR tests. They're really good. They pick up almost anybody

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Speaker 1: who's infected. They have to be running a major lab

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Speaker 1: and they can be turned around in twenty four hours,

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Speaker 1: but sometimes they take a week to come back. Let's

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Speaker 1: talk about that other kind of test, the anergine tests.

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Speaker 1: The test, Yeah, that's the rapid test, cheap ten to

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Speaker 1: fifteen bucks a test as opposed to HUD. For that

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Speaker 1: PCR test, you should be able to get a result

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Speaker 1: in fifteen minutes. So you're thinking cheap and fast. What's

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Speaker 1: wrong with this story? Um, it's a little less sensitive,

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Speaker 1: So let me explain what that means. The PCR test

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Speaker 1: will pick up somebody with the infection up to weeks

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Speaker 1: after they've been infected. The anergin test is really a

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Speaker 1: test for infectiousness. So if you are in that period

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Speaker 1: of time where you're spreading the virus and lots of people,

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Speaker 1: the anergin tests will be positive. But there are other times,

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Speaker 1: let's say later in the disease course, where you may

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Speaker 1: not have a lot of virus. You're still infected, but

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Speaker 1: the level of virus you have is very low because

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Speaker 1: you're on the tail end of your illness. The nigen

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Speaker 1: tests will then turn negatives. It's just not gonna be

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Speaker 1: as good at taking those people up. Could there have

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Speaker 1: been a scenario where people would have gotten antigen tests

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Speaker 1: to their homes and if they woke up saying, maybe

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Speaker 1: I was exposed, maybe I don't feel great, you can

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Speaker 1: take your tests immediately and that would dictate whether or

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Speaker 1: not you leave your house that day, absolutely, and for

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Speaker 1: that the anergen test is really good. We've had this

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Speaker 1: technology since May, and we should have had billions of

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Speaker 1: these tests widely available so people could test themselves all

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Speaker 1: the time. You wake up, you have a sore throat,

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Speaker 1: you could go to a CBS, pick up a ten

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Speaker 1: dollar tests and test yourself. We just never made those investments.

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Speaker 1: Remember how the disease spreads. Majority of people who are

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Speaker 1: spreading the disease have no symptoms at all. If you

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Speaker 1: could test yourself, what that would do is it would

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Speaker 1: take people who are infected out of commission. They wouldn't

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Speaker 1: be spreading it to others. So there's very good data

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Speaker 1: now that if we had those tests available the level

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Speaker 1: of infection in the community would go way down. But

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Speaker 1: also you could start implementing those tests in schools, in

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Speaker 1: business and that would make a big difference. And here's

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Speaker 1: the big issue. We still don't have a plan. Test

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Speaker 1: can take a week just to come back in, which time,

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Speaker 1: if you're out and about, you're spreading the virus. If

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Speaker 1: you haven't, they tell you to isolate. But unless you

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Speaker 1: have a place to isolate and a supportive job or family,

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Speaker 1: many many people can't afford to follow the guidelines when

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Speaker 1: you think you may have exposure to COVID nineteen. Do

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Speaker 1: we in the United States of America actually have the

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Speaker 1: choice to say, here are my nearby testing facilities. This

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Speaker 1: is where I can get a PCR test, and the

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Speaker 1: turnaround time is x. You could get results in a day,

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Speaker 1: but many, many, many are five, six, seven days. Why

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Speaker 1: would that be? Basically, there are two major lab testing companies,

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Speaker 1: Lab Corps in Quest Diagnostics. When they get backed up,

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Speaker 1: everything gets to lay. Let's say go to your doctor's office,

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Speaker 1: you got a fever, you got a sore throat, you

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Speaker 1: got a swab. It gets sent off to a lab.

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Speaker 1: That lab sends it to some processing place. Machine are

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Speaker 1: starting to break down, workers are becoming a short supply,

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Speaker 1: and your sample could sit for three days, four days.

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Speaker 1: That's just the reality of where we are. Had we

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Speaker 1: had an operation warp speed for testing, where do you

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Speaker 1: think we'd be right now? Oh? I think if we

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Speaker 1: had an operation warp speed for testing the way we

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Speaker 1: did for vaccines, we would have widespread testing available. You

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Speaker 1: could wake up in the morning and you could test

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Speaker 1: yourself at home before you went to school, before you

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Speaker 1: went to work. And if we had really made the

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Speaker 1: kind of investments that we needed to, and these would

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Speaker 1: not have cost us that much money. I believe all

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Speaker 1: the schools would be open, most businesses would be open,

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Speaker 1: the level of infections in the community that would be

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Speaker 1: much much lower, our hospitals would not be overwhelmed, and

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Speaker 1: we'd have far fewer debts. I'm thrilled that we did

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Speaker 1: operation works feed for vaccines. I love it. I think

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Speaker 1: it was exactly the right thing to do, But that

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Speaker 1: didn't prevent us from doing an operational warp speed for treatments,

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Speaker 1: for testing, for protective equipment to protect our doctors and nurses.

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Speaker 1: Like there's no rule that said you only get to

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Speaker 1: do one operation warp speed, like we needed four different things.

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Speaker 1: The government chose to do one and ignore the other three.

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Speaker 1: And I have to tell you that I'm not convinced

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Speaker 1: that if we hadn't done the vaccine that the Trump

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Speaker 1: administration would have then put more money on testing. So

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Speaker 1: I am like glad they put investments in vaccines, because

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Speaker 1: if they hadn't, they would have put investments in nothing.

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Speaker 1: Vaccines are great, but they are not the end all

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Speaker 1: be all. They will not make the pandemic go away.

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Speaker 1: They'll certainly end the horrible nets will take a long time,

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Speaker 1: but the disease will not be gone forever, and we

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Speaker 1: will need to continue to deal with it, and testing

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Speaker 1: will be a really important part of that. We'll be

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Speaker 1: back after the break. I want to talk about contact tracing.

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Speaker 1: We had no known exposure in my family, and I

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Speaker 1: contact traced to myself. I called the people who we

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Speaker 1: had seen. I called a big box store with my

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Speaker 1: receipt and I was like, so my husband was there

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Speaker 1: at four pm. That big box story called had no

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Speaker 1: interest in taking my call. There's no way they wrote

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Speaker 1: any of it down. But it wasn't just me. I

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Speaker 1: wasn't contacted by the state of New Jersey. And that's

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Speaker 1: where we were. We talked so much about the importance

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Speaker 1: of contact tracing. Thousands of people were hired, they were trained,

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Speaker 1: they were to be the contact tracers. Are we even

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Speaker 1: doing it? No? I mean some states are doing a

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Speaker 1: little bit, and a little bit is better than zero.

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Speaker 1: But we never built up the contact tracing infrastructure, partly

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Speaker 1: because it would cost money. Again, this is the place

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Speaker 1: where like our government, our federal government, our Congress has

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Speaker 1: just fallen down on the job. When you look at

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Speaker 1: other countries and how they are doing testing and tracing,

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Speaker 1: is there one that you can point to that you

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Speaker 1: would say they're doing it right. The classic model that

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Speaker 1: we all point to is South Korea. South Korea is

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Speaker 1: unbelievable because they did such a good job with testing

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Speaker 1: and tracing. They were able to open up nightclubs. Somebody

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Speaker 1: with a some thematic disease went to like six nightclubs

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Speaker 1: in one evening. What an amazing evening, right, But unfortunately,

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Speaker 1: like he infected like eighty people that one evening. Within

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Speaker 1: five days, South Korea had tested like forty thousand people,

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Speaker 1: not just everybody who was at one of those nightclubs,

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Speaker 1: but all of their contacts and their contacts and contacts

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Speaker 1: and isolated everybody and shut that outbreak down within five days.

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Speaker 1: That's how you do it, and what that means is

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Speaker 1: their economy has barely suffered. In other countries, it's not

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Speaker 1: about following the guidelines. There are punitive consequences. You test positive.

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Speaker 1: You are checking into a COVID hotel for fourteen days.

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Speaker 1: Like it or not. There's no decisions to be made here.

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Speaker 1: It's about goodwill, being honest and decision making. Do you

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Speaker 1: think the majority of the American people actually know what

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Speaker 1: the CDC guidelines are. I don't think that what we

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Speaker 1: need is like harsh mandates on this stuff. What we

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Speaker 1: need is support. But the point is there are ways

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Speaker 1: of allowing the right thing to be done by people,

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Speaker 1: right because I think most people want to do the

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Speaker 1: right thing. If you push them and say, well, you

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Speaker 1: have a choice, do the right thing or put food

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Speaker 1: on the table for your kids, well, people can put

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Speaker 1: food on the table for their kids. Don't force people

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Speaker 1: into those choices. And the only way we could have

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Speaker 1: done this is if we had an active government trying

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Speaker 1: to help the American people do the right thing. We

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Speaker 1: just did. To your point, we're not offering any incentive

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Speaker 1: to those who can't afford to quarantine, who maybe have

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Speaker 1: mild symptoms and are out there living their lives and

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Speaker 1: going to work, or people who are simply defiant and

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Speaker 1: choose not to. Why wouldn't we do that. I have

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Speaker 1: to say that the failure of Congress to act after

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Speaker 1: the first couple of actions that took, the failure for

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Speaker 1: it to act over the summer the fall even now

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Speaker 1: is baffling to me. It is the most phenomenal, pennywise,

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Speaker 1: pound foolish thing I have ever seen. This pandemic has

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Speaker 1: cost our three about sixteen trillion dollars with a capital T,

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Speaker 1: and Congress is fighting about a couple hundred billion dollars

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Speaker 1: money that would go to the pockets of the American

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Speaker 1: people and would help them through a difficult time like

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Speaker 1: this is such a no brainer. Imagine if in World

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Speaker 1: War two Congress said, you know what, We're just not

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Speaker 1: going to fund the war effort. Good luck people. That

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Speaker 1: would have been a disaster, right, it would have been

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Speaker 1: a disaster. Not thankfully Congress did not do that. But

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Speaker 1: essentially after May Congress said we're just not going to

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Speaker 1: fund the effort to fight COVID, good luck people, But

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Speaker 1: we're going to spend the money, mountains more of it

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Speaker 1: for years to come. This is the result of the

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Speaker 1: federal government just completely throwing in the towel about two

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Speaker 1: months ago and saying we're just not even gonna bother

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Speaker 1: trying anymore. Then, seeing that we've botched testing and tracing

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Speaker 1: so badly, are you concerned that we're not going to

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Speaker 1: get the implementation of or distribution of this vaccine right?

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Speaker 1: The Biden team very much understands that effective distribution of

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Speaker 1: the vaccine is the whole ball game for them in

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Speaker 1: the short run for getting economy going again. I think

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Speaker 1: the Biden team is gonna be putting a lot of

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Speaker 1: very good people into making sure that the vaccine distribution

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Speaker 1: continues to go well, that we get that last smile,

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Speaker 1: we get vaccines into people's arms. So I guess I

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Speaker 1: remain reasonably optimistic that a good team is coming and

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Speaker 1: they understand the importance of getting this right. We've seen

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Speaker 1: the President got the best possible medical care and experimental

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Speaker 1: drugs that works. His close advisor Rudy Giuliani, same thing.

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Speaker 1: Do you think a lot of rich people are going

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Speaker 1: to cut side deals and get the vaccine before anybody else?

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Speaker 1: They're getting better treatment than everyone else. Because here's the thing.

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Speaker 1: I had a frustrating process getting tested, but it wasn't crippling,

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Speaker 1: and if I didn't have the privilege that I have,

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Speaker 1: it would be way worse. So I can tell you

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Speaker 1: testing is for the privileged. Will the vaccine be for

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Speaker 1: the privileged? I think in the first past, it's gonna

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Speaker 1: be very very hard for people to cut in line,

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Speaker 1: and I think that's gonna be very tightly controlled. I

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Speaker 1: am very worried about what happens after that, because I'm

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Speaker 1: already hearing stories of concierge practices who are trying to

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Speaker 1: figure out how to get some for their business travelers.

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Speaker 1: The finance guy who wants to start being able to

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Speaker 1: fly to Hong Kong again and needs to be vaccinated. Look,

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Speaker 1: it's fine go to Hong Kong, but you should not

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Speaker 1: be able to cut in line on the vaccine. This

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Speaker 1: is one of the big jobs that the Biden administration

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Speaker 1: has is to make sure that we don't do this,

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Speaker 1: because it will be I mean, if you think about

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Speaker 1: who has been so disproportionately affected in this pandemic, it's

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Speaker 1: been the black community, the Latino community, the Native American community,

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Speaker 1: It's been horror people. But I do think there is

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Speaker 1: going to be a real effort to make sure we

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Speaker 1: don't do that. I'm also a realist. I'm sure there

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Speaker 1: will be some cutting in line, because that's just the reality.

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Speaker 1: Somebody will figure out how to get stuff on the

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Speaker 1: black market, but I am hopeful that most of it

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Speaker 1: will be tightly enough control that the right people get

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Speaker 1: it first. M H. The reality is that COVID is

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Speaker 1: not easy for anyone, but COVID is much easier to

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Speaker 1: confront when you've got the benefit of privilege. Throughout the

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Speaker 1: last nine months, I have counted my blessings nearly every

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Speaker 1: day because I know that my secure home, my family unit,

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Speaker 1: and the fact that I can work from home makes

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Speaker 1: all the difference in what our new normal looks like.

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Speaker 1: But when my family and I contracted the virus, I

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Speaker 1: saw firsthand how far that privilege extends. The reality is

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Speaker 1: many families and many individuals are put between a rock

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Speaker 1: and a hard place, and many of our government leaders

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Speaker 1: both sides have completely skirted their responsibility. And I want

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Speaker 1: to leave you sometime to think about this. We could

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Speaker 1: have done better in basically every aspect of containing this virus,

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Speaker 1: particularly when it comes to supporting American families. So as

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Speaker 1: a vaccine rolls out and more sophisticated tests are developed,

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Speaker 1: how can we make sure vulnerable Americans are not left

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Speaker 1: behind again? And how can we change what has been

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Speaker 1: a haphazard strategy into our recovery that serves us all.

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Speaker 1: Next week we are taking off it is the holiday,

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Speaker 1: but I want you to unplug. Please take a week

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Speaker 1: to decompress, give yourself a break, have a beautiful holiday,

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Speaker 1: and be well. And thank you so much for listening.

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Speaker 1: I'm Stephanie Rule and you're listening to Modern Rules, a

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Speaker 1: podcast from NBC Think, MSNBC and I Heart Radio. This

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Speaker 1: podcast is hosted by me Stephanie Rule. Mike Biette and

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Speaker 1: Katrina Norvell are executive producers. Meredith Bennett Smith is Senior

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Speaker 1: editor for NBC Think and our editorial lead. The podcast

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Speaker 1: is engineered and edited by Josh Fisher. Additional production support

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Speaker 1: provided by Charles Herman, Rachel Rosenbaum, and Lauren Wynn and

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Speaker 1: special thanks to Katherine Kim are Global head of Digital

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Speaker 1: News right here at NBC News and MSNBC. For more

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Speaker 1: thought provoking analysis, visit NBC news dot com slash thank