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

Key Takeaways

  • Manmade and genetically engineered viruses should be high on the list of great concerns for humanity
  • COVID-19 landed in a sweet spot of not quite being fatal enough to elicit urgent action but just bad enough that it collapsed sectors of the economy and warrants response
  • Social media has taken biology and systematically intertwined it with politics
  • There are many complications with the COVID-19 vaccine – including the fact that we don’t actually know whether it will prevent transmission in the long-run
  • “In this country, we’ve almost entirely defunded and devalued public health. Period….That makes it difficult when we’re facing a public health crisis.” – Michael Mina
  • Mass rapid testing would empower people to know their status and choose not to spread it
  • Frequent, rapid home testing is the major solution to the current pandemic even with a vaccine
  • FDA regulation of medical products started with good intention but is now interfering with us having a tool (rapid tests) to open the economy and prevent death
  • Rapid tests mailed to people’s homes and taken twice per week could slow or stop the progression of the pandemic in one month

Introduction

Michael Mina M.D., Ph.D. (@michaelmina_lab) is a Physician and Assistant Professor of Epidemiology at Harvard University. Dr.Mina’s research combines mathematical and epidemiological models with serological laboratory investigations, the development of new technologies, and statistical pipelines to better understand the population and immunological consequences, and patterns underlying infectious diseases.

In this episode of the Lex Fridman Podcast, Lex and guest Michael Mina discuss approaching COVID-19 with an engineering mindset, focusing on solutions such as the necessity of increasing testing.  

Host: Lex Fridman (@lexfridman)

Pathogen Interactions

  • New influenza strains can be unique and deadly to humans with high transmission
  • The replication cycles of influenza are always a concern – on any occasion you can have a whole new virus that didn’t exist yesterday
  • Flu predisposes to bacterial infections
  • Bacteria may highjack and piggyback on viral infections
  • Viruses replicate so much faster, bacteria join on for the ride  
  • Manmade viruses and genetically engineered viruses should also be high on the list of great concerns for humanity

“Sweet Spot” of COVID-19

  • It is not quite serious enough on an individual level that we’ve activated urgent responses
  • However, it bad enough that it’s collapsed economy and some sectors
  • It just takes one virus to do tremendous damage
  • Social media has been an interesting component because it’s external to virus biology but has become intertwined
  • The choice to wear masks, counter virus systematically – even belief in the virus has heavily been influenced by social media
  • The intersection of politics, social media, and biology is something unparalleled in our time

Complication of Vaccinating Right Now

  • We’re vaccinating at the peak of viral transmission
  • The COVID-19 vaccination deployment is going to go down as one of the most aggressive vaccination programs the world has ever seen
  • “Unfortunately, we’re [vaccinating] at the peak of viral transmission when millions and millions of people are still getting infected and when we do that, it gives the virus so many opportunities – orders of magnitude more opportunity to mutate around our immune system.” – Michael Mina
  • We don’t actually know whether the vaccines will prevent transmission – we still need rapid testing
  • Complications with vaccine: not everyone wants to get the vaccine, we don’t know how effective the vaccine will be in long term, we aren’t sure whether the vaccine will stop transmission, most hospitals are not equipped to hire enough people to distribute

Paradox of Contact Tracing & Why Rapid Testing Is Better

  • “In this country, we’ve almost entirely defunded and devalued public health. Period….That makes it difficult when we’re facing a public health crisis.” – Michael Mina
  • Americans have been trained to not want to disclose medical information
  • We go to great lengths in this country to keep our information private
  • Why would we publicly give out our status and information now?

Rapid Testing As A Major Solution

  • It’s not a mystery, the virus spreads because people spread it  
  • We’re choosing not to use rapid testing in this country and much of the world
  • “Our regulatory landscape has failed to identify this pandemic as a public health problem and use public health tools to solve” – Michael Mina
  • Mass rapid testing would empower people to know their status and choose not to spread it
  • Rapid testing could’ve been heavily deployed in May – it’s not too late
  • We have millions of rapid tests available which could get society open
  • The test has around 99% sensitivity and specificity
  • If we send tests to people’s homes to use twice per week, we’d have much better outcomes
  • Frequent rapid testing at home would allow us to reduce transmission in its tracks and go towards exponential decay
  • We don’t need to eliminate all transmission, just reducing transmission would have a huge impact
  • “We have this issue of letting perfection prevent us from doing something at all, something effective.” – Michael Mina
  • We can’t compare the rapid test to a PCR test but PCR testing costs way more and takes longer
  • Home tests cost anywhere from $1-$5/test
  • We eroded the ideals of public health in our company and caved to biomedicine
  • At the same time we could’ve gotten testing to every house, we’ve gone through phases of vaccine testing and mass logistic deployment
  • For more information, visit: Rapidtests.org

Logistics of Rapid Testing

  • Rapid testing would allow “herd effects”: R-value (the average number of people each person with a disease goes on to infect) below 1 to reduce transmission
  • Ideally need 20-40 million tests per day in the United States
  • Can pool testing in the same household, school, or office
  • We have American companies manufacturing millions of tests per day and distributing them to Europe
  • Realistically, we can distribute 20 million tests per day in the U.S.
  • With the support of the American government, we could easily manufacture and distribute 20 million tests per day

How Rapid Tests Work

  • Tests look for antibodies (looking for immune response; had exposure to the virus at some point) or antigens (test looks for proteins and active virus)
  • There are several classes of tests: antigen tests, PCR tests, antibody tests
  • Most people who are PCR positive in the world at any given time are post-infection period
  • People can stay positive for weeks or months after the virus has subsided
  • Not everyone who tests positive is highly contagious: there’s a difference between diagnostic sensitivity and contagion sensitivity
  • Rapid antigen tests are the most barebone, effective tests suitable for mass distribution
  • Technology in lateral flow tests is the same as pregnancy tests
  • Steps to lateral flow test: (1) take a swab; (2) swab nose; (3) dunk swab into the buffer; (4) put buffer on lateral flow – if there is virus on the buffer as it flows across, a reaction will appear
  • False-positive rate is very low: 0.1%-1%
  • Confirmatory testing: if positive, you want to confirm a positive antigen test with a second, separate test

Elon Musk & Testing Discrepancy

  • Elon Musk got discrepant results: two positives, two negatives in the same day
  • In actuality had a low positive on PCR test when confirmed
  • He was likley tested on the tail end of infectiousness and would’ve been all positive if he tested days earlier
  • The test worked as it should but discrepant results instilled doubt in his mind
  • Rapid tests faltered because he was no longer infectious
  • If the viral load is below the threshold, we don’t expect a positive result

The Complexity of the FDA

  • There needs to be a difference between medical devices and public health
  • The FDA won’t authorize rapid tests as public health tools which would enable mass distribution
  • FDA’s role in hindering mass home testing deployment: FDA is only seeing tests as medical devices  
  • Regulation of medical products started with good intention but is now interfering with us having a tool to open the economy and prevent death
  • Definition of a medical tool: any tool or test that gives a result back to an individual
  • The FDA is currently in a gray area, only evaluating medical tools – but rapid tests should be a distinct category
  • No one has ownership over testing
  • Testing purgatory: the FDA doesn’t even have a remit to evaluate public health tools, deferring to CMS who say they don’t evaluate testing   
  • Heads of government agencies think the FDA is the end all be all and won’t pick that battle
  • Solution: presidential order, NIH, CDC interfere and take over testing

The Future of Medicine and Epidemiological Models

  • Goal: be able to tell people what virus they’ve ever had and detect allergies with a drop of blood mailed to a lab
  • Using AI and mathematical models, we could trace a life story in the space of viruses and pathogens
  • Participant gets the information they want and scientists can generate models and start tracing the origin and appearance of virus and pathogens  
  • Privacy is important – samples can be 100% anonymous, mailed in without a name just a date and location of the collection
  • With this technology, we could detect the next pandemic or contagious virus because we would see patterns in immune responses

Meditation and Changing Your Mindset

  • Meditation allows you to find the space in the movement
  • When you learn to experience life in a much deeper way, you never run out of ways to live
  • “Get out of the mode of thinking about things as problems.” – Michael Mina
  • When you start breaking down actions into small little steps, you start to see the excitement and interest in the mundane and the world slows down
  • “Barrier” implies that there is a way around it and a solution
  • Think big
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Notes By Maryann

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