Michael Mina is an immunologist, epidemiologist, and physician at Harvard. Please support this podcast by checking out our sponsors:
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EPISODE LINKS:
Michael's Twitter: https://twitter.com/michaelmina_lab
Michael's Time article: https://time.com/5912705/covid-19-stop-spread-christmas/
Rapid Tests: https://www.rapidtests.org/

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OUTLINE:
0:00 - Introduction
2:32 - Interacting between viruses and bacteria
6:45 - Deadlier viruses
10:17 - Will COVID-19 mutate?
11:51 - Rapid testing
29:15 - PCR vs rapid antigen tests
38:59 - Medical industrial complex
42:51 - Lex takes COVID test
49:35 - FDA and cheap tests
52:21 - Explanation of Elon Musk's positive COVID tests
59:29 - Role of testing during vaccine deployment 
1:02:58 - Public health policy
1:12:38 - A weather system for viruses
1:29:30 - Can a virus kill all humans?
1:35:09 - Engineering a deadly virus
1:39:51 - AlphaFold 2 and viruses
1:45:46 - Advice for young people
1:53:54 - Time as a buddhist monk
1:59:58 - Meditation
2:07:36 - Meaning of life

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The following is a conversation with Michael Mina.

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

The most defining characteristic of his approach to science and biology is that of a first principles thinker and engineer focused not just on defining the problem, but finding the solution.

In that spirit, we talk about cheap, rapid at home testing, which is a solution to COVID-19 that to me has become 1 of the most obvious, powerful and doable solutions that frankly should have been done months ago and still should be done now.

As we talk about its accuracy is high for detecting actual contagiousness and hundreds of millions can be manufactured quickly and relatively cheaply.

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

It respects our intelligence and basic common sense.

Quick mention of each sponsor, followed by some thoughts related to the episode.

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Please check out these sponsors in the description to get a discount and to support this podcast.

As a side note, let me say that I've always been solution-oriented, not problem-oriented.

It saddens me to see that public discourse disproportionately focuses on the mistakes of those who dare to build solutions, rather than applaud their attempt to do so.

Teddy Roosevelt said it well in his The Man in the Arena speech over 100 years ago.

I should say that both the critic and the creator are important, but in my humble estimation, there are too many now of the former and not enough of the latter.

So while we spread the derisive words of the critic on social media, making it viral, let's not forget that this world is built on the blood, sweat, and tears of those who dare to create.

If you enjoy this thing, subscribe on YouTube, review it with 5 Stars on Apple Podcast, follow us on Spotify, support on Patreon, or connect with me on Twitter at Lex Friedman.

And now, here's my conversation with Michael Mina.

What is the most beautiful, mysterious, or surprising idea in the biology of humans or viruses that you've ever come across in your work?

Sorry for the overly philosophical question.

You know, I love the pathogenesis of viruses and 1 of the things that I've worked on a lot is trying to understand how viruses interact with each other.

And so pre all this COVID stuff, I was really, really dedicated to understanding how viruses impact other pathogens.

So how if somebody gets an infection with 1 thing or a vaccine, does it either benefit or harm you from other things that appear to be unrelated to most people?

And so 1 system which is highly detrimental to humans, but what I think is just immensely fascinating is measles.

And measles gets into a kid's body, the immune system picks it up and essentially grabs the virus and does exactly what it's supposed to do, which is to take this virus and bring it into the immune system so that the immune system can learn from it, can develop an immune response to it.

It gets into the immune system, serves almost as a Trojan horse, and instead of getting eaten by these cells, it just takes them over, and it ends up proliferating in the very cells that were supposed to kill it.

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

And so it essentially, what I've found and what my research has found is that this 1 virus was responsible for as much as half of all of the infectious disease deaths in kids before we started vaccinating against it.

Because it was just wiping out children's immune memories to all different pathogens, which is, you know, I think just astounding.

It's just amazing to watch it spread throughout bodies.

We've done the studies in monkeys, and you can watch it just destroy and obliterate people's immune memories in the same way that some parasite might destroy somebody's brain.

Is that a evolutionary just coincidence, or is there some kind of advantage to this kind of interactivity between pathogens?

I think in that sense it's just coincidence.

It probably is a, it's a good way for measles to, It's a good way for measles to essentially be able to survive long enough to replicate in the body.

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

So it's utilizing our immune cells for its own replication, but in so doing, it's destroying the memories of all the other, the other immunological memories.

But there are other viruses, so a different system is influenza, and flu predisposes to severe bacterial infections.

And that, I think, is another coincidence, but I also think that there are some evolutionary benefits that bacteria may hijack and sort of piggyback on viral infections.

Viruses can, they just grow so much quicker than bacteria.

And so there's this system with viruses, with flu and bacteria, where the influenza has these proteins that cleave certain receptors.

And the bacteria want to cleave those same receptors.

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

So instead the bacteria found out like, hey, we could just piggyback on these viruses.

They'll do it 100 or 1000 times faster than we can.

And so then they just piggyback on and they let flu cleave all these sialic acids and then the bacteria just glom on in the wake of it.

So there's all different interactions between pathogens that are just

So does this whole system of viruses that interact with each other and so damn good at getting inside our bodies, does that fascinate you or terrify you?

I'm very much a scientist, and so it fascinates me much more than it terrifies me.

But knowing enough, I know just how well, you know, we get the wrong virus in our population, whether it's through some random mutation or whether it's this same COVID-19 virus.

And it, you know, these things are tricky.

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

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

This could have been a virus that is much worse than it is.

If a virus like that was much more detrimental, you know, that would be, it could be much more devastating.

Although it's hard to say, you know, the human species were, well, I hesitate to say that we're good at responding to things because there are some aspects that were, this particular virus, SARS-CoV-2 and COVID-19 has found a sweet spot where it's not quite serious enough on an individual level that humans just don't, we haven't seen much of a useful response by many humans.

And so it's led us down this path of it's not quite serious enough to get everyone to respond immediately and with the most urgency, but it's bad enough that it's caused our economies to shut down and collapse.

And so I think I know enough about virus biology to be terrified for humans that it can, it just takes 1 virus, just takes the wrong 1 to just obliterate us, or not obliterate us, but really do much more damage than we've seen.

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

Like figuring out how we can sneak past the defenses of the humans, so it's not bad enough.

And then the misinformation, all that kind of stuff together is operating in such a way that the virus can spread effectively.

I wonder, I mean, obviously a virus is not intelligent, but there's a rhyme and a rhythm to the way this whole evolution process works and creates these fascinating things that spread throughout the entire civilization.

Absolutely, it's, yeah, I'm completely fascinated by this idea of social media in particular, how it replicates, how it grows, how it actually starts interacting with the biology of the virus, masks, who's going to get vaccinated, politics.

These seem so external to virus biology, but it's become so intertwined.

And I actually think we could find out that, you know, the virus actually becomes, obviously not intentionally, but we could find that people choosing not to wear masks, choosing not to counter this virus in a regimented and sort of organized way, effectively gives the virus more opportunity to escape.

You know, we're about to have 1 of the most aggressive vaccination programs the world has ever seen.

But we are unfortunately doing it right at the peak of viral transmission when millions and millions of people are still getting infected.

And when we do that, that just gives this virus so many more opportunities.

I mean, orders of magnitude more opportunity to mutate around our immune system.

Now, if we were to vaccinate everyone when there's not a lot of virus, then there's just not a lot of virus.

And so, there's not going to be as many, you know, I don't even know how many zeros are at the end of however many viral particles there are in the world right now, you know, more than quadrillions, you know, and so, if you assume that at any given time, somebody might have trillions of virus in them on any given individual, so then, you know, multiply trillions by millions and, you know, you get a lot of viruses out there, and if you start applying pressure, ecological pressure to this virus that when it's not abundant, had the opportunity for a virus to sneak around immunity, especially when all the vaccines are identical, essentially.

You know, and we have to not forget that this particular virus was 1.

It was 1 opportunity and it has spread across the globe and there's no reason that can't happen tomorrow.

I have a million other questions in this direction, but I'd love to talk about 1 of the most exciting aspects of your work, which is testing or rapid testing.

You wrote a great article in Time on November 17th, so this is like a month ago, about rapid testing titled, how we can stop the spread of COVID-19 by Christmas.

Let's jot down the fact that this is a month ago, so maybe your timeline would be different, but let's say in a month.

So you've talked about this powerful idea for quite a while throughout the COVID-19 pandemic.

How do we stop the spread of COVID-19 in a month?

So the only reason the virus continues spreading is because people spread it to each other.

And so there's a few ways to stop the virus from spreading to each other, And that is you either can vaccinate everyone and vaccinating everyone is a way to immunologically prevent the virus from growing inside of somebody and therefore spreading.

We don't know yet actually if this vaccine, if any of these vaccines are going to prevent onward transmission.

So that may or may not serve to be 1 opportunity.

Certainly I think it will decrease transmission.

But the other idea that we have at our disposal now, We had it in May, we had it in June, July, August, September, October, November, and now it's December.

We still have it, we still choose not to use it in this country and in much of the world, and that's rapid testing.

That is giving, It's empowering people to know that they are infected and giving them the opportunity to not spread it to their loved ones and their friends and neighbors and whoever else.

These tests are simple paper strip tests.

They are inside of this thing is just a little piece of paper.

So this, this is how we do it right here.

This is enough to let you know if you're infectious.

With somewhere around the order of 99% sensitivity,

specificity, you can know if you have infectious virus in you.

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

You know, we make more bottles of Dasani water every day.

We can make these little paper strip tests.

And if we do that, and we get these into people's homes so that they can use them twice a week, then we can know if we're infectious.

You know, And so if we can say, hey, the transmission of this is, for every 100 people that get infected right now, they go on to infect maybe 130 additional people.

A couple days later, that 130 becomes another 165 people have now been infected, and you know, go over 3 weeks and 100 people become 500 people infected.

Now it doesn't take much to have those 100 people not infect 130 but infect 90.

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

And then instead of exponential growth, you have exponential decay.

just have to go and have those 100 people infect 90, and those 90 people infect

And you do that for a few weeks, and boom, you have now gone, instead of

And so the way to do that is to let people know that they're infectious.

I mean, we're a perfect example right now.

This morning, I used these tests to make sure that I wasn't infectious.

I already was at extremely low odds because I spend my life quarantining these days.

Well, the interesting thing with this test, with the testing in general, which is why I love what you've been espousing, and it's really confusing to me that this has not been taken on, is it's 1, an actual solution that's been available for a long time.

There doesn't seem to have been solutions proposed at a large scale.

And a solution that it seems like a lot of people would be able to get behind.

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

And there's a worry, especially in the American spirit of freedom, like you can't tell me what to do.

The thing about tests is it like empowers you with information essentially.

So like, it gives you more information about your role in this pandemic, and then you can do whatever the hell you want.

Like it's all up to your ethics and so on.

So like, and it's obvious that with that information, people would be able to protect their loved ones and also do their sort of quote unquote duty for their country, right?

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

We have a political and a regulatory industry that doesn't want to see them be used.

We have a very paternalistic approach to everything in this country.

Now, despite this country kind of being founded on this individualistic ideal, pull yourself up from your bootstraps, all that stuff.

When it comes to public health, we have a bunch of ivory tower academics who want data.

And we have this issue of letting perfection get in the way of actually doing something at all, you know, doing something effective.

And so we keep comparing these tests, for example, to the laboratory-based PCR test.

And sure, this isn't a PCR test, but this doesn't cost $100 and it doesn't take 5 days to get back, which means in every single scenario, this is the more effective test.

And we have, unfortunately, a system that's not about public health.

We have entirely eroded any ideals of public health in our country for the biomedical complex, you know, this medical industrial complex which overrides everything.

I'm just so fucking pissed that these tests don't exist.

Meanwhile, and everyone says, you know, oh, we couldn't make these, you know, that we could never do it.

That would be such a hard, a difficult problem.

Meanwhile, the vaccine gets, we have, at the same time that we could have gotten these stupid little paper strip tests out to every household, we have developed a brand new vaccine, we've gone through phase 1, phase 2, phase 3 trials, we've scaled up its production, And now we have UPS and FedEx and all the logistics in the world getting freezers out to where they need to be.

We have this immense, we see when it comes to medicine, something you're injecting into somebody, then all of a sudden people say, oh yes, we can.

But you say, oh no, that's too simple a solution, too cheap a solution, no way could we possibly do that.

It's this faulty thinking in our country, which frankly is driven by big money, big, the only time when we actually think that we can do something that's maybe aggressive and complicated is when there's billions and billions and billions of dollars in it, you know?

I mean, on a difficult note, because this is part of your work from before the COVID, it does seem that I saw a statistic currently is that

of Americans would not be taking the vaccine, some number like this.

So you also have to acknowledge that all the money that's been invested, like there doesn't appear to be a solution to deal with like the fear, distrust that people have.

I bet, I don't know if you know this number, but for taking a strip, like a rapid test like this, I bet you people would say, like the percentage of people that wouldn't take it is in the single digits probably.

And you know, there's a lot of people who don't want to get a test today.

And that's because it gets sent to a lab, it gets reported, it has all this stuff.

And we're a country which teaches people from the time they're babies to keep their medical data close to them.

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

And then a pandemic comes around and we just assume that all that the average person is going to wipe all that away and say, oh no, I'm happy giving out not just my own medical data, but also to tell the authorities, everyone who I've spent my time with so that they all get a call and are pissed at me for giving up their names.

You know, so people aren't getting tested and they're definitely not giving up their contacts when it comes to contact tracing.

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

And so this is a whole different approach, but it's an approach that empowers people and takes the power a bit away from the people in charge.

You know, and that's what's really grating on, I think, public health officials who say, no, we need the data.

So they're effectively saying, if I can't have the data, I don't want the individuals, I don't want the public to have their own data either.

Which is a terrible approach to a pandemic where we can't solve a public health crisis without actively engaging the public.

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

So first of all, you have a really nice, informative website, rapidtest.org, with information on this.

I still can't believe this is not more popular.

Okay, but 1 of the FAQs you have is a rapid test too expensive.

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

This thing right here costs less than a dollar to make.

With everything combined plus the swabs, maybe it costs a dollar 50.

Could be sold for, Frankly, it could be sold for $3 and still make a profit if they want to sell it for $5.

This 1 here, this is a slightly more complicated 1, but you can see it's just got the exact same paper strip inside.

This is really, it doesn't look like much, but it's kind of the cream of the crop in terms of these rapid tests.

This is the 1 that the US government bought, and it is doing an amazing job.

sensitivity and specificity, so it's really good.

And so Essentially the way it works is you use a swab, you put the, once you use the swab on yourself, you put the swab into these little holes here, you put some buffer on it and you close it, and a line will show up if it's positive, and a line won't show up if it's negative, and it takes 5, 10 minutes.

This whole thing, this can be made so cheap that the US government was able to buy 150 million of them from Abbott for $5 a piece.

So anyone who says that these are expensive, we have the proof is right here.

This 1 at its, you know, was Abbott did not lose money on this deal.

You know, they got $750 million for buying, for selling 150 million of these at 5 bucks a piece.

So anyone who says that these should be, unfortunately what's happening though is the FDA is only authorizing all of these tests as medical devices.

So what happens when you, If I'm a medical company, if I'm a test production company and I wanna make this test and I go through and the FDA at the end of my authorization, the FDA says, okay, you now have a medical device, not a public health tool, but a medical device.

And that affords you the ability to charge insurance companies for it.

Why would I ever, as a, you know, in our capitalistic economy and sort of infrastructure, why would I ever not sell this for $30 when insurance will pay for it or

It might only cost me 50 cents to make, but by pushing all of these tests through a medical pathway at the FDA, what extrudes out the other side is an expensive medical device that's erroneously expensive.

But the companies say, well, I'd rather make fewer of them and just sell them all for

a piece than make tens of millions of them, which I could do, and sell them at a dollar marginal profit.

And so it's a problem with our whole medical industry that we see tests only as medical devices.

And what I would like to see is for the government, in the same way that they bought 150 million of these from Abbott, they should be buying all of these tests.

They should be buying 20 million a day and getting them out to people's homes.

This virus has cost trillions of dollars to the American people.

It's closed down restaurants and stores, and obviously the main streets across America have shuttered.

It's killing people, it's killing our economy, it's killing lifestyles and lives.

I wish in April or something like that to launch the larger scale manufacturing deployment of tests.

It's obviously the capitalist system would create cheaper and cheaper tests that would be hopefully driving down to $1.

In America, there's, I don't know, 300 plus million people.

So that means you wanna be testing regularly, right?

So how many do you think is possible to manufacture?

What would be the ultimate goal to manufacture per month?

Yep, so if we wanna slow this virus and actually stop it from transmitting, achieve what I call herd effects, like vaccine herd immunity, herd effects are when you get that R value below 1 through preventing onward transmission.

If we wanna do that with these tests, we need about 20 million to 40 million of them every day, which is not a lot.

So we could do it, there's other ways, you can have 2 people in a household swab each other, you know, swab themselves rather, and then mix, you know, put the swabs into the same tube and onto 1 test.

So you can get a 2 or 3x gain in efficiency through pooling in the household.

You could do that in schools or offices too, where everyone just uses a swab.

You have a, there's 2 people, like, I mean, even if it's just standing in line at a public testing site or something, you know, you could just say, okay, these 2 are the last people to test or swab themselves, they go into 1 thing.

And if it comes back positive, then you just do each person and, you know, it's rapid.

So you can just say to the people, 1 of you is positive, let's test you again.

So there's ways to get the efficiency gains much better.

But let's say I think that the optimal number right now that matches sort of what we can produce more or less today if we wanted, is 20 million a day.

Right now, 1 company that, I don't have their test here, but 1 company is already producing 5000000 tests themselves and shipping them overseas.

It's an American company based in California called Inova, and they are giving 5000000 tests to the UK every day.

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

So without the support of the government.

So yeah, So essentially if the government just put some support behind it, then yeah, you can get 20 million probably easy.

Oh yeah, this, I mean just here I have 3 different companies.

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Michael Mina: Rapid Testing, Viruses, and the Engineering Mindset | Lex Fridman Podcast #146