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

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 one 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 science and data. It respects our freedom. It respects our intelligence and basic common sense. Quick mention of each sponsor followed by some thoughts related to the episode. Thank you to Brave a fast browser that feels like Chrome but has more privacy preserving features. Athletic greens, the all in one drink that I start every day with to cover all my nutritional bases. ExpressVPN, the VPN I've used for many years to protect my privacy and the Internet and Cash app, the app I use to send money to friends. 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 five stars on Apple Podcast, follow on Spotify, support on Patreon, or connect with me on Twitter lexfriedman. 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.

Wow. Well, that's a great question. You know, I love the pathogenesis of viruses and one 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 one thing or a vaccine, does it either benefit or harm you from other things that appear to be unrelated to most people? And so one 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. But instead, measles plays a trick. 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 one 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, 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, you know, some parasite might destroy somebody's brain. And, you know, it's.

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. 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. They replicate faster. 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 remarkable.

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?

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 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 these things are tricky. They're able to mutate quickly. 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. You know, same thing with H1N1 back in 2009. That terrifies me. 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, we're. Well, I hesitate to say that we're good at responding to things because there are some aspects that this particular virus, SARS, CoV2 and CoVid19, 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. A lot of people even think it's a hoax. 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 enough. 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 just takes one virus, just takes the wrong one, to just Obliterate us or not obliterate us, but. But really do much more damage than we've seen.

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

Yeah.

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. There's a rhyme and a rhythm to the way this whole evolutionary 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. You know, I've been. How it actually starts interacting with the biology of the virus. Masks, who's going to get vaccinated. Politics like these seem so external to virus biology, but it's become so intertwined and it's interesting. And I actually think we could find out that the virus actually becomes. We could find that choosing 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. We can look at vaccines. You know, we're about to have one 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. 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. I don't even know how many zeros are at the end of however many viral particles there are in the world right now, more than quadrillions. And so if you assume that at any given time somebody might have trillions of virus in them on any given individual. So then multiply trillions by millions and you get a lot of viruses out there. And if you start applying pressure, ecological pressure to this virus when it's that abundant. God, the opportunity for a virus to sneak around immunity, especially when all the vaccines are identical, essentially all it takes.

Is one to mutate and it jumps. Oh, takes one.

Takes one in the whole world, you know, and we have to. We have to not forget that this particular virus was one. It was one opportunity and it has spread across the globe. And there's no reason that can't happen tomorrow anew. You know, it's scary.

I have a million other questions in this direction, but I'd love to talk about one of the most exciting aspects of your work, which is testing or rapid testing. You wrote a great article in time on November 17th. 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?

Well, we use tests like these. So the only reason the virus continues spreading is because people spread it to each other. This isn't magic. 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 one 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 we could have done this, we still can. Today we could start. We have millions of these tests. These tests are simple paper strip tests. They are inside of this thing is just a little piece of paper now. And I can actually open it up here. There we go. So this, this is how we do it. Right here we have this little paper strip test. This is enough to let you know if you're infectious with somewhere around the order of 99% sensitivity, 99% 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 that they can use them twice a week, then we can know if we're infectious. Is it perfect? Absolutely not. But is it near perfect? Absolutely. And so if we can say, hey, the transmission of this is for every hundred people that get infected right now, they go on to infect maybe 130 additional people. And that's exponential growth. So 100 becomes 130. A couple days later, that 130 becomes another 165 people have now been infected and go over three weeks and 100 people become 500 people infected. Now it doesn't take much to have those hundred 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. So this doesn't need to be perfect. We don't have to go from 100 to zero. We just have to go and have those hundred people infect 90 and those 90 people infect 82, whatever it might be. And you do that for a few weeks and boom, you have now gone. Instead of 100 to 500, you've gone from 100 to 20.

Yes.

It's not very hard. And so the way to do that is to let people know that they're infectious. I mean, I w. We're a perfect example right now. I, this morning I used these tests to make sure that I wasn't infectious. Is it perfect? No, but it reduced my odds, 99%. I already was at extremely low odds because I spend my life quarantining these days.

Well, the interesting thing with this test, with 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 as it's one, an actual solution. Those 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, yes. So like you, it's, it gives you more information about your, like, 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, it's obvious that with that information, people would be able to protect their loved ones and also do, do their sort of quote unquote duty for their country. Right. Is protect the rest of the country.

That's exactly right. I mean, it's just, it's empowerment. But, you know, this is a problem. 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 use. Used. That sounds crazy. Why wouldn't they want them to be used? We have a very paternalistic approach to everything in this country, 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, they want to see perfection. And we have this issue of letting perfection get in the way of actually doing something at all, 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 five 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. And that's why, you know, I'm just, can I swear on this podcast, yes. I'm just so fucking pissed that these 10 tests don't exist. Meanwhile, and everyone says, oh, we couldn't make these, 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 one, phase two, phase three 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 with, when it comes to sort of medicine, you know, something you're injecting into somebody, then all of a sudden people say, oh yes we can. But you say, oh no, that's, 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, you know, frankly, is driven by big money, big. You know, 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.

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 that 40% would not be taken 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.

I completely think so. 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 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. 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. 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. It just doesn't Work. 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 information on this. I still can't believe this is not more popular. It's ridiculous. Okay, but One of the FAQs you have is. Are rapid tests too expensive? So can cost be brought down? Like I pay. I take a weekly PCR test and I think I pay 160, 170 bucks a week.

No, I mean, it's criminal. Absolutely. We can get cost. This. This thing right here costs less than a dollar to make with everything combined, plus the swabs. You know, Maybe it costs $1.50. Could be sold for. Frankly, it could be sold for $3 and still make a profit if they want to sell it for five. This one here, this is a slightly more complicated one, 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 one that the US Government bought and it is doing an amazing job. It has a 99.9% sensitivity and specificity. So it's really. It's really. Once you kind of 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. It takes 5, 10 minutes. This whole thing, this can be made so cheap that the US government was able to buy them by 150 million of them from Abbott for $5 apiece. So anyone who says that these are expensive, we have the proof is right here. This one. Abbott did not lose money on this deal. They got $750 million for selling 150 million of these at five bucks a piece. All of these tests can do the same. 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 want to 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. In our capitalistic Economy and sort of infrastructure. Why would I ever not sell this for $30 when insurance will pay for it or $100, you know, might only cost me 50 cents to make. But, but by pushing all of these tests through a medical pathway at the fda, they what, what extrudes out the other side is an expensive medical device that's erroneously expensive. It doesn't need to be inflated in cost. But the companies say, well, I'd rather make fewer of them and just sell them all for $30 a piece, then 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.

This is an obvious solution. To me. This is exciting. This is a solution. I wish like in April or something like that to launch like the larger scale manufacturing deployment of tests. Doesn't matter what tests they are. It's obviously the capitalist system would create cheaper and cheaper tests that would be hopefully driving down to $1. So what, what are we talking about in America? There's, I don't know, 300 plus million people. So that means you want to 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 want to 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 want to do that with these tests, we need about 20 million to 40 million of them every every day, which is not a lot in the United States. In the United States. So we could do it. There's other ways. You can have two people in a household swab each other, swab themselves rather, and then mix, put the swabs into the same tube and onto one test. So you can pool. So you can get a 2 or 3x gain in efficiency through pooling in the household. Could do that in schools or offices too, where everyone just uses swabby of A, there's two people. I mean, even if it's just standing in line at a public testing site or something, you could just say, okay, these two are the last people to test or swab themselves. They go into one thing and if it comes back positive, then you just do each person and it's rapid. So you can just say to the people, one 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, 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, one company that I don't have their test here, but one company is already producing 5 million tests themselves and shipping them overseas. It's an American company based in California called Inova. And they are giving 5 million 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 puts some support behind it, then yeah, you can get 20 million, probably easy.

Oh yeah, this, I mean, just here I have three different companies. They all look similar. Well, this one's closed. But these are three different companies right here. This is a fourth, Abbott. Now this is a fifth, this is a sixth. These two are a little bit different.

Do you mind if, in a little bit would you take some of these or.

Yeah, let's, let's do it. We can, we can, we can absolutely do them.

So you have a lot of tests in front of you. Could you maybe explain some of them?

Absolutely. So there's a few different classes of tests that I just have here. And there's more tests. There's many more different tests out in the world too. These are, these are one class of tests. These are rapid antigen tests that are just the most bare bones. Paper strip tests. This is the type that I want to see produced in the tens of millions every day. It's so simple. You don't even need the plastic cartridge. You can just make the paper strip and you could have a little tube like this that you just dunk the paper strip into. You don't actually need the plastic, which I'd actually prefer because if we start making tens of millions of these, this becomes a lot of waste. So I'd rather not see this kind of waste be out there. And there's a few companies. Quidel is making a test called the QuickView, which is just this, they've gotten rid of all the plastic.

And for people who are just listening to this, we're looking at some very small tests that fit in the palm of your hand. And they're basically paper strips fit into different containers. And that's hence the comment about the plastic containers.

These are just injection molded, I think, and got it. They're, you know, they can build them at high numbers, but then they have to like place them in there appropriately and all this stuff. So it is a, it is a bottleneck or some somewhat of a bottleneck in manufacturing. The actual bottleneck, which the government I think should use the Defense Productions act to build up is the. There's a nitro cellulose membrane, laminated membrane on this that allows the material, the buffer with a swab mixture to flow across it. So the way these work, they're called lateral flow tests. And you take a swab, you swab the front of your nose, you dunk that swab into some buffer, and then you put a couple drops of that buffer onto the lateral flow. And just like paper, if you dip a piece of paper into a cup of water, the paper will pull the water up through capillary action. This actually works very similarly. It flows through somewhat a capillary action through this nitrocellulose membrane. And there's little antibodies on there, these little proteins that are very specific in this case for antigens or proteins of the virus. So these are antibodies similar to the antibodies that our body makes from our immune system, but they're just printed on these lateral flow tests. And they're printed just like a little line. So then you slice these all up into individual ones. And if there's any virus on that buffer, as it flows across, the antibodies grab that virus and it creates a little reaction with some colloids in here that cause it to turn dark. Just like a pregnancy test. One line means negative, it means a control strip worked. And two lines mean positive. Means if you get two lines, it just means you have virus there, you're very, very likely to have virus there. And so they're super simple. This is, it is the exact same technology as pregnancy tests. The technology, this particular one from Abbott, this has been used for other infectious diseases like malaria. And actually a number of these companies have made malaria tests that do the exact same thing. So they just co opted the same form factor and just changed the antibody so it picks up SARS CoV2 instead of other infections.

Is it also the Abbott one? Is it also strip?

Yep. Yeah, this Abbott One here is. There's the, in this case, instead of being put in a plastic sheath, it's just put in a cardboard thing and literally glued on. I mean it's, it looks like nothing. You know, it's just, it looks like a, like, I mean, it's just the simplest thing you could, you could imagine.

The exterior packaging looks very apple like. That's nice.

It does, yeah, yeah, yeah. So it's nice. And it comes in. This is the, this is how they're packaged, you know, so. And they don't have to, you know, these are coming in individual packages against again because they're really considered individual medical devices. But you could package them in bigger packets and stuff. You want to be careful with humidity. So they all have a little one of those humidity removing things and oxygen removing things. So this is one class, these antigen tests.

If we could just pause for a second if it's okay. And could you just briefly say what is an antigen test and what other tests? There are out there, like categories of tests.

Sure.

Just really quick.

So the testing landscape is a little bit complicated, but it's, but I'll break it down. There's really just three major classes of tests. We'll start with the first two. The first two tests are just looking for the virus or looking for antibodies against the virus. So we've heard about serology tests or maybe some people have heard about it. Those are a different kind of test. They're looking to see has somebody in the past, does somebody have an immune response against the virus which would indicate that they were infected or exposed to it. So we're not talking about the antibody tests. I'll just leave it at that. They actually can look very similar to this or they can be done in a laboratory. Those are usually done from blood and they're looking for an immune response to the virus. So that's one. Everything I'm talking about here is looking for the virus itself, not the immune response to the virus. There's two ways to look for the virus. You can either look for the genetic code of the virus, like the rna, just like the DNA of somebody's human cells, or you can look for the proteins themselves, the antigens of the virus. So I like to differentiate them. If you were a PCR test that looks for RNA in, let's say if we made it against humans, it would be looking for the DNA inside of our cells that would be actually looking for our genetic code. The equivalent to an antigen test is sort of a test that actually is looking for Our eyes or our nose or physical features of our body that would delineate. Okay, this is Michael, for example. So you're either looking for a sequence or you're looking for a structure. The PCR tests that a lot of people have gotten now, and they're done in labs, usually are looking for the sequence of the virus, which is rna. This test here by a company called Detect, this is one of Jonathan Rothberg's companies. He's the guy who helped create modern day sequencing and all kinds of other things. So this Detect device, that's just the name of the company, this is actually a rapid RNA detection device. So it's almost like a PCR like test and we could even do it here. It's really a beautiful test, in my opinion. Works exceedingly well. It's going to be a little bit more expensive. So I think it could confirm, could be used as a confirmatory test for these.

Is there a greater accuracy to it?

Yes, I would say that there is a greater accuracy. There's also a downfall though of PCR and tests that look for rna. They can sometimes detect somebody who is no longer infectious. So you have the RNA test and then you have these antigen tests. The antigen tests look for structures, but they're generally only going to turn positive if people have actively replicating virus in them. And so what happens after an infection dissipates? You've just gone from having sort of a spike. So if you get infected maybe three days later, the virus gets into exponential, exponential growth and it can replicate to trillions of viruses inside the body. Your immune system then kind of tackles it and beats it down to nothing. But what ends up in the wake of that, you just had a battle. You had this massive battle that just took place inside your upper respiratory tract. And because of that you've had trillions and trillions of viruses go to zero, essentially, but the RNA is still there. It's these remnants in the same way that if you go to a crime scene and blood was, was sort of spread all over the crime scene, you're going to find a lot of DNA. There's tons of DNA. There's no people anymore, but there's a lot of DNA there. Same thing happens here. And so what's happening with PCR testing is when people go and use these exceedingly high sensitivity PCR tests, people will stay positive for weeks or months after their infection has subsided, which has caused a lot of problems in my opinion. It's problems that the CDC and the FDA and doctors don't want to deal with. But I've tried to publish on it. I've tried to suggest that this is an issue both to New York Times and others. And now it's unfortunately kind of taken on a life of its own of conspiracy theorists thinking that they call it a case demic. They say, oh, PCR is detecting people who are false positive. They're not false positives. They're late positives no longer transmissible.

I think the way you like what I saw in rapid tests, I really like the distinction between diagnostic sensitivity and contagiousness sensitivity. That's. It's so. That website is so obvious that it's painful because it's like, yeah, that's what we should be talking about is how accurately is a test able to detect your contagiousness? And you have different plots that show that actually there's, you know, that antigen tests. The tests we're looking at today, like rapid tests, are actually really good at detecting contagiousness.

Absolutely. It all mixes back with this whole idea that of the medical industrial complex. You know, in this country and in most countries, we have almost entirely defunded and devalued public health, period. You know, we just have. And what that means is that we don't have a language for it. We don't have a lexicon for it, we don't have a regulatory landscape for it. And so the only window we have to look at a test today is as a medical diagnostic test. And that becomes very problematic when we're trying to tackle a public health threat and a public health emergency. By definition, this is a public health emergency that we're in. And yet we keep evaluating tests as though the diagnostic benchmark is the gold standard, where if I'm a physician, I am a physician. So I'll put on that physician hat for a moment. And if I have a patient who comes to me and wants to know if their symptoms are a result of them having Covid, then I want every shred of evidence that I can get to see does this person currently, or did they recently have this infection inside of them? And so in that sense, the PCR test is the perfect test. It's really sensitive. It will find the rna, if it's there at all, so that I could say, you know, yeah, you have a low amount of RNA left. You might have been. You said your symptoms started two weeks ago, you probably were infectious two weeks ago, and you have lingering symptoms from it. But that's a medical diagnosis. It's kind of like a detective recreating A crime scene. They want to go back there and recreate the pieces so that they can assign blame or whatever it might be. But that's not public health. In public health, we need to only look forward. We don't want to go back and say, well, was this person, Are there symptoms because they had an infection two weeks ago? In public health, we just want to stop the virus from spreading to the next person. And so that's where we don't care if somebody was infected two weeks ago. We only care about finding the people who are infectious today. And unfortunately, our regulatory landscape fails to apply that knowledge to evaluate these tests as public health tools. They're all only evaluating the tests as medical tools. And therefore we get all kinds of complaints that say this test, which detects 99 plus, you know, 99.8% of current infectious people, by the FDA's rubric, they'll say, no, no, that's. It's only 50% sensitive. And that's because when you go out into the world and you just compare this against PCR positivity, most people who are PCR positive in the world right now at any given time are post infectious. They're no longer infectious, because you might only be infectious for five days, but then you'll remain PCR positive for three or four or five weeks. And so when you go and just evaluate these tests and you say, okay, this person's PCR positive, does the rapid antigen test detect that? More often than not, it's no, but that's because those people don't need isolation. You know, they, they're post infectious. And this is a. It's become much more of a problem than I think even the FDA themselves is recognizing, because they are unwilling at this point to, to look at this as a public health problem requiring public health tools.

We'll definitely talk about this a little bit more because the concern I have is that like a bigger pandemic comes along. What are the lessons we draw from this and how we move forward? Let's talk about that in a bit, but sort of. Can we discuss further the lay of the land here, of the different tests before us?

Absolutely. So I talked about PCR tests, and those are done in the lab, or they're done essentially with a rapid test like this, the detect, and we can even try this in a moment. It goes into a little heater. So you might have one of these in a household or one of these in a nursing home or something like that, or in an airport, or you could have one that has 100 different outlets. This is just to heat the tube up. These are the rapid tests. They are super simple, no frills. You just swab your nose and you put the swab into a buffer and you put the buffer on the test. So we can use these right now if you want. Yeah, we can try it out.

And all the tests we're talking about, they usually swabbing the nose like, that's the.

That's still the main. Yeah. There are some saliva tests coming about and these can all work, potentially with saliva. They just have to be recalibrated. But these, these swabs are really not bad. This isn't the. The deep swab that goes like way back into your nose or anything. This is just the. Just a swab that you do yourself, like right in the front of your nose. So if you want to do it.

Yeah. Do you mind if I.

Sure. Yeah, yeah. Why don't we start with this one? Because this is. This is Abbott's BinaxNOW test and it's really. It's really pretty simple.

This is the swab from the Abbot test.

That's correct. That's the swab from the Abbot test. So what I'm going to do to start is I'm going to take this buffer here, which is. This is just the buffer that goes onto this test. So this is a brand new one. I just opened this test out. I'm going to just take six drops of this buffer and put it right onto this test here.

2, 3, 4, 5, 6.

Okay. And now you're going to take that swab, open it up. Yep. And now just wipe it around inside the. Into the front of your nose. Do a few circles on each nostril. That looks good.

This always makes me want to sneeze.

Yeah. Okay, now I'm going to have you do it yourself.

I'm getting emotional.

Hold it parallel to the test. So put the test down on the table. Yep. And then go into that bottom hole. Yep. And push forward so that you can start to see it in the other hole. There you go. Now turn. If it's. Once it hits up against the top, just turn it three times. One, two, three. And. Yep. And now you just close to. Pull off that adhesive sticker there. And now you just close the whole thing.

And.

And that's it.

That's it.

Now what we will see is, we will see a line form. What's happening now is the. The buffer that you put in there is now moving up onto the paper strip test and it has the material from the swab in there. And so what we'll see is a line will form and that's going to be the control line. And then we'll also see the, the ideally we'll see no line for the actual test line. And that's because you should be negative. So one line will be positive and two lines will be negative.

That's very cool. There's this purple thing creeping up onto the control line.

That's perfect. That's what you want to be seeing. So you want to see that. So right now you essentially want to see that that blue line turns pink or purpley color. There's a blue line that's already there printed. It should turn sort of a purple pink color. And ideally there will be no additional line for the sample.

And if there is, that's the 99 point whatever percent accuracy on that means I have, I'm contagious.

That would mean that you're likely contagious or you likely have infectious virus in you. What we can do, because one of the things that my plan calls for is because sometimes these tests can get false positive results. It's rare, maybe 1%, or in the case of this binaxnow, this Abbott test, 0.1%. So one in a thousand, one in five hundred, something like that can be falsely positive. What I recommend is that when somebody is positive on one of these, you turn around and you immediately test on a different test. You could either do it on the same, but for good measure, you want to use a separate test that is somewhat orthogonal, meaning that it shouldn't turn falsely positive for the same reason. This particular test here, this detect test, because it is looking for the RNA and not the antigen, this is an amazingly accurate test and it's sort of a perfect gold standard or confirmatory test for any of these antigen tests. So one of the recommendations that I've had, especially if people start using antigen tests before you get onto a plane or you know, as what I call entrance screening, if somebody's positive, you don't immediately tell them you're positive. Go isolate for 10 days. You tell them, let's confirm on one of these, on a detect test that is a, because it's completely orthogonal, you, it's looking for the RNA instead of the antigen. There's no reason, no biological reason that both of these should be falsely positive. So if one's falsely positive and the other one is negative, especially because this one's more sensitive, then I would trust this as a confirmatory test. If this one's negative, then the antigen test would be considered falsely positive.

It does look like there's only a single line. So this is very exciting news.

That's right. Yep. It says wait 15 minutes to see both lines. But in general, if somebody's really gonna be positive, that line starts showing up within a minute or two. So you want to keep the whole. We'll keep watching it for the whole 15 minutes as it's sitting there. But I would say you're knowing that you've had PCR tests recently and all that.

You know, the odds are pretty good.

The odds are very.

The packaging, very iPhone. Like, I'm digging the sexy pack, Sam. I'm a sucker for good packaging.

Okay, so then there's this. There's this test here which is, you know, this is another. You know, it's funny. This. Let me open this up and show you. This is a really nice test. It's another antigen test. Works the exact same way as this, essentially. But what you can see is it's got like lights in it and a power button and stuff. This is called an alum test, which is, you know, fine. And it's a really nice test, to be honest. But it's. But it has to pair with an iPhone. And so it's good as a. I think that this is going to become. There's a lot of use for this from a medical perspective. You know, where you want good reporting. This can. Because it pairs with an iPhone, it can immediately send the report to a department of health. Whereas these paper strip tests that. They're just paper, they don't report anything unless you want to report it. So I'm going to just pick it apart. And so you can see is there's like fluorescent readers and little lasers and LEDs and stuff in there. You can actually see the lights going off. And there's a paper strip test right inside there. But you can see that there's like a whole circuit board and all this stuff. Right. And so this is the kind of thing that, you know, the FDA is looking for for, like home use and things like that. Because it's kind of foolproof. You can't go wrong with it. It pairs with an iPhone, so you need Bluetooth. So it's going to be more limited. It's a great test. Don't get me wrong. It's as good as any of these. But, you know, when you compare this thing with a battery and a circuit board and all this stuff, it's got its purpose, but, you know, it's not a public health tool. I Don't want to see this made in the tens of millions a day and thrown away.

But FDA likes that kind of stuff.

FDA loves this stuff, you know, because they can't get it out of their mind that this is a public health crisis. You know, we need, we need. I mean, just look at the difference here.

Something with flashing lights is essential.

It's got batteries, it's got a Bluetooth thing. It's a great test. But, you know, to be honest, it's not any better than this one. And so, you know, I want this one. It's nice and all the form factor is nice, and it's really nice that it goes to Bluetooth, but it goes.

Against the principle of just 20 million a day.

Exactly.

The easy solution. Everybody has it. You can manufacture and probably. You could have probably scaled this up in a couple of weeks.

Oh, absolutely. These companies, I mean, the rest of the world has these. They can be scaled up. They already exist. You know, SD biosensors. One company is making tens of millions a day, not coming to the United States, but going all over Europe, going all over Southeast Asia and East Asia. So they exist. The US Is just, you know, we can't get out of our own way.

I wonder why somebody, I don't know if you were paying attention, but somebody like an Elon Musk type character. So he was really into doing some obvious engineering solution like this at home. Rapid test seems like a very Elon Musk thing to do.

I don't know if you saw, but I had a little Twitter conversation with Elon Musk.

Does he not like. Do you know what his thoughts are on rapid testing?

Well, he was using a slightly different one, one of these, but that requires an instrument called the BD Veritor. And he got a false positive or. No, I shouldn't say. He didn't necessarily get a false positive. He got discrepant results. He did this test four times. He got two positives, two negatives. But then he got a PCR test and it was a very low positive result. So I think what happened is he just tested himself at the tail end of. And this was actually right before he was about to send those. It was the day of, essentially that he was sending the astronauts up to the space station the other day. So he used. He was using these rapid tests because he wanted to make sure that he was to go in and he got discrepant results. Ultimately, they were correct, but two were negative, two were positive. But what really happened once he shared his PCR results And they were very low positive. So really what was happening is my guess is he found himself right at the edge of his positivity, of his infectiousness. And so the test worked how it was supposed to work. Probably had he used it two days earlier, it would have been screaming positive. He wouldn't have gotten discrepant results. But he found himself right at the edge by the time he used the test. So the PCR would always pick it up because it will still stay positive then for weeks potentially. But the rapid antigen test was starting to falter, not in a bad way, but just he probably was really no longer particularly infectious. And so it was kind of when it gets to be a very low viral load, it becomes stochastic.

It's fascinating, this duality. So one you can think from an individual, individual perspective, it's unclear when you take four and half are positive, half are negative, like what are you supposed to do? But from a societal perspective, it seems like if just one of them is positive, just stay home for a couple days, for a while. So when you're a CEO of a company, you're launching astronauts to space, you may not want to rely absolutely on the antigen test as a thing by which you steer your decisions of like 10,000 plus people, companies, but us individuals just living in the world, if you can, if it comes up positive, then you make decisions based on that and then that scales really nicely to an entire society of hundreds of millions of people. And that's how you get that virus to stop spreading.

That's exactly right. You don't have to catch every single one. And, and the nice thing is that these will catch the people who are most infectious. So with Elon Musk, generally that test, we don't have the counterfactual. We don't have his results from three days earlier when he was probably most infectious. But my guess is the fact that it was catching two out of the four, even when he was down at a CT value, a really, really, very, very low viral load on the PCR test suggest that it was doing its job and you just want to. And the nice thing is, because these can be produced at Such scale, getting one positive doesn't immediately have to mean 10 days of isolation. That's the CDC's more conservative stance to say if you're positive on any test, stay home for 10 days and isolate. But here people would just have more tests. So the recommendation should be test daily. If you turn positive, test daily until you've been negative for 24, 48 hours and then go back to work. And the nice thing there is right now, people just aren't testing because they don't want to take 10 days off. They're not getting paid for it, so they can't take 10 days off.

Do you know what Elon thinks about this idea of rapid testing for everybody? So I understood, I need to look at that whole Twitter thread. So I understand his perhaps criticism of. He had a conspiratorial tone from my vague look at it, of like, what's going on here with these tests? But what does he actually think about this very practical, to me engineering solution of just deploying rapid tests to everybody? It seems like that's a way to open up the economy in April.

Well, to be honest, I've been trying to get in touch with him again. I think take somebody like Elon Musk with the engineering prowess within his ranks to easily, easily build these at the tens of millions a day, he could build the machines from scratch. A lot of the companies, they buy the machines from South Korea or Taiwan, I believe we don't have to. We can build these machines. They're simple to build. Put somebody like Elon Musk on it. Take some of his best engineers and say, look, the US Needs a solution in two weeks. Build these machines, figure it out. He'll do it. He could do it. This is a guy who is literally, he has started multiple entirely new industries. He has the capital to do it without the US Government if he wanted to. And you know what, the return on investment for him would be huge. But frankly the return on investment in the country would be hundreds of billions of dollars because it means we could get society open. So I know that his first experience with these rapid tests was confusing, which is how I ended up having this Twitter kind of conversation with him very briefly. But I think that if he understood sort of a little bit more, and I think he does, I really love to talk to him about it because I think he could totally change the course of this pandemic in the United States single handedly. He loves grand things. Yeah.

I think out of all the solutions I've seen, this is the obvious engineering solution to at least a pandemic of this scale.

I love that you say the engineering solution. So this is something I've been really trying to. I'm an engineer. My previous history was all engineering and that's really how I think. I then went into medicine and PhD world, but I think that the world, like one of the major catastrophes or one of the major problems is that we have physicians making the decisions about public health and a pandemic when really we need engineers. This is an engineering problem. And so what I've been trying to do, I actually really want to start a whole new field called public health engineering. You know, and so I've been, I love that eventually I want to try to bring it to MIT and get MIT to want to start a new department or something.

That's, that's a doubly awesome idea that this is really. Okay, I love this. I love every aspect. I love everything you're, you're talking about. Now. A lot of people believe because vaccines started being deployed currently that, you know, we are no longer in need of a solution, that we're no longer in.

Need of.

Slowing the spread of the virus. To me, as I understand it seems like this is the most important time to have something like a rapid testing solution. Can you kind of break that apart? What's the role of rapid testing currently in the next, you know, what is it, three, four months, maybe even more.

The vaccine rollout isn't going to be as peachy as everyone, you know, and I hate to be the Debbie Downer here, but there's a lot of unknowns with this vaccine. You've already mentioned one, which is there's a lot of people who just don't want to get the vaccine. You know, I hope that that might change as things move forward and people see their neighbors getting it and their family getting it and it's safe and all. We don't know how effective the vaccine is going to be after two or three months. We've only measured it in the first two or three months, which is a massive problem which we can go into biologically because there's reasons to, very good reasons to believe that the efficacy could fall way down after two or three months. We don't know if it's going to stop transmission and if it doesn't stop transmission, then we're transmission blockade and frankly, we don't know how easily we're going to be able to roll it out. Some of the vaccines need really significant cold chains have very short half lives outside of that cold chain. We need to organize massive numbers of people to be able to distribute these. Most hospitals today are saying that they're not equipped to hire the right people to be even administering enough of these vaccines. And then a lot of the hospitals are frustrated because they're getting much smaller allocations than they were expecting. So I think right now, like you say, right now is the best time besides Three or four or five or six months ago. Right now is the best time to get these rapid tests out. And we need to. I mean, the country has the capacity to build them. We're shipping them overseas. Right now. We just need to flip a switch. Get the FDA to recognize that there's more important things than diagnostic medicine, which is the effectiveness of the public health program when we're dealing with a pandemic. They need to authorize these as public health tools, or frankly, the President could. There's a lot of other ways to get these tests to not have to go through the normal FDA authorization program, but maybe have the NIH and the CDC give a stamp of approval. And if we could, we could get these out tomorrow. And that's where that article came from. How we can stop the spread of this virus by Christmas. We could. Now it's getting late, and so we have to keep updating that timeframe. Maybe putting Christmas in the title wasn't I should have said how we can stop the spread of this virus in a month. It would be a little bit more timeless. But we could do it. We really could do it. And that's the most frustrating part here, is that we're just choosing not to as a country. We're choosing to bankrupt our society because some people at the FDA and other places just can't seem to get their head around the fact that this is a public health problem, not a bunch of medical problems.

Is there a way to change that policy wise? So this is a much bigger thing that you're speaking to, which I love in terms of the MIT engineering approach to public health. Is there a way to push this? Is this a political thing, like where some Andrew Yang type characters need to, like, start screaming about it? Is it more of an Elon Musk thing where people just need to build it and then on Twitter start talking crap to politicians for not doing it? What are the ideas here?

I think it's a little both. I think it's political on the one hand, and I've certainly been talking to Congress a lot, talking to senators.

Are they receptive?

Oh, yeah. I mean, that's the crazy thing. Everyone but the FDA is receptive. I mean, it's astounding. I mean, I advise, you know, informally. I advise the President, and the president elects teams. I talk to Congress, I talk to senators, governors, you know, and then all the way down to, you know, mayors of towns and things. And I held. I mean, months ago, I held a roundtable discussion with Mayor Garcetti, who's The mayor of LA and I brought all the companies who make these things. This was in like July or August or something. I brought all the companies to the table and said, okay, how can we get these out? And unfortunately it went nowhere because the FDA won't authorize them as public health tools. The nice thing is that this is one of the nice and frustrating things. This is one of the few bipartisan things that I know of and like you said, it's a real solution. Yeah, lockdowns aren't a solution. They're an emergency band aid to a catastrophe that's currently happening. They're not a solution and they're definitely not a public health solution. If we're taking a more holistic view of public health, which includes people's well being, includes their psychological well being, their financial well being. Just stopping a virus, if it means that all those other things get thrown under the bus is not a public health solution. It's a myopic or very tunnel visioned approach to a virus that's spreading. This is a simple solution with essentially no downfall. There is nothing bad about this. It's just giving people a result. And it's bipartisan. The most conservative and the most liberal people, everyone just wants to know their status. Nobody wants to have to wait in line for four hours to find out their status on Monday, a week later on Saturday. It just doesn't make any sense. It's a useless test at that point and everyone recognizes that.

So why do you think the mayor of la, why do you think politicians are going for these free, from my perspective, like kind of half assed lockdowns, which is not so I have seen good evidence that like a complete lockdown can work. But that's in, in theory it's just like communism. In theory can work. Yeah, like theoretically speaking, but it just doesn't. At least in this country we don't. I think it's just impossible to have complete lockdown and still politicians are going for these kind of lockdowns that everybody hates. That's really, really hurting small businesses.

Like why are they going Big businesses.

And yeah, all businesses but like basically not just hurting, they're destroying small businesses. Right. Which is going to have potentially, I mean, long lasting. Yeah, I've been reading as I don't shut up about the, the rise and fall, the Third Reich and, and you know, there, there's economic effects that take a decade to, you know, there's going to be long lasting effects that may maybe destructive to the very fabric of this nation. So why are they doing it and why are they not using this solution? Is there, is there an intuition? I mean, you've said that FDA has a stranglehold, I guess, on this whole public health problem. Is that, is that all it is?

That's honestly, it's pretty much all it is. The companies. So somebody like Mayor Garcetti or Governor Baker, Cuomo, Newsom, any of these. DeWine, I've talked to a lot of governors in this country at this point and of course the federal government, including the president's own teams and the heads of the nih, the heads of the CDC about this. The problem is the tests don't exist in this country at the level that we need them to right now to make that kind of policy, to make that kind of program. They could, but they don't. And so what that means is that when Mayor Garcetti says, okay, what are my actual options today, despite these sounding like a great idea, he looks around and he says, well, they're not authorized. You know, they don't exist right now for at home use. And from his perspective, he's not about to pick that fight with the fda. And it turns out nobody is.

Why are people afraid of it? Seems like an easy strongman to fight.

It's like, well, it's not a. So they don't see it as a fight. They think that the FDA is the end all, be all. Everyone thinks the FDA is the end all, be all. And so they just defer. Everyone is deferential, including the heads of all the other government agencies, because that is their role. But what everyone is failing to see is that the FDA doesn't even have a mandate or a remit to evaluate these tests as public health tools. So they're just falling in this weird gray zone where the FDA is saying, look, we evaluate medical products. That's the only thing that I meant. Like Tim Stenzel, head of in vitro diagnostics at the fda, he's doing what he's what his job is, which is to evaluate public, which is to evaluate medical tools. Unfortunately, this is where I think the CDC has really blundered. They haven't made the right distinction to say, look, okay, the FDA is evaluating these for doctors to use and all that, but we're the CDC and we're the public health agency of this country, and we recognize that these tools require a different authorization pathway and a different use.

Not for there's a difference between medical devices and public health. And I guess FDA is not designed for this public health, especially in emergency situations.

And they, they, they actually explicitly say that. I mean, when I go and talk to Tim, you know, and he's a very reasonable guy, but when I talk to him, he says, look, we don't, we just do not evaluate a public health tool. If you're telling me this is a public health tool, great, go and use it. And, and so I say, okay, great, we'll go and use it. And then the comment is, but does it give a result back to somebody? I say, well, yes, of course it gives a result back to somebody. It's being done in their home. So, well, then it's defined as a medical tool, can't use it. So it's stuck in this gray zone where unfortunately, there's this weird definition that any tool, any test that gives a result back to an individual is defined by cms, Centers for Medicaid Services, as a medical device requiring medical authorization. But then you go and ask. It gets crazier. Because then you go and ask Seema Verma, the head of cms, you know, okay, can these be authorized as public health tools and not fall under your definition of a medical device? So then the FDA doesn't have to be the ones authorizing it as a public health tool. And Seema Verma says, oh, well, we don't have any jurisdiction over point of care and sort of rapid devices like this. We only have jurisdiction over lab devices. So it's like nobody has ownership over it, which means that they just keep, they stay in this purgatory of not being approved. And so this is where I think, frankly, it needs a president, it needs a presidential order to just unlock them, to say, this is more important than, you know, having a prescription. And in fact, I mean, really, what's happening now, because there is this sense that tests are public health tools, even if they're not being defined as such. The FDA now is pretty much, not only are they not authorizing these as public health tools, what they're doing by authorizing what are effectively public health tools as medical devices, they're just diluting down the practice of medicine. Right. I mean, his answer right now, unfortunately, is, well, I don't know why you want these to be sort of available to everyone without a prescription. We've already said that a doctor can write a whole prescription for a whole college campus. It's like, well, if you're going in that direction, then that's no longer medicine, having a doctor write a prescription for a college campus for everyone on the campus to have repeat testing. Now we're just in the territory of eroding medicine and eroding all of the legal rules and reasons that we have prescriptions in the first place. So it's just. Everything about it is just destructive instead of just making a simple solution, which is these are okay as public health tools as long as they meet X and Y metrics go and CDC can put their stamp of approval on them.

What do you think? Sorry if I'm stuck on this. Your mention of MIT and public health engineering. Right. I mean, it has a sense of. I talk to computational biology folks. It's always exciting to see computer scientists start entering the space of biology. And there's actually a lot of exciting things that happen because of that, trying to understand the fundamentals of biology. So from the engineering approach to public health, what kind of problems do you think can be tackled? What kind of disciplines are involved? Like, do you have ideas on this in this space?

Oh, yeah. I mean, I can speak to one of the major activities that I want to do. So what I normally do in my research lab is develop technologies that can take a drop of somebody's blood or some saliva and profile for hundreds of thousands of different antibodies against every single pathogen that somebody could be possibly exposed to. So this is all new technology that we've been developing more from a bioengineering perspective. But then I use a lot of the mathematics tools to a interpret that. But what I really want to do, for example, to kind of kick off this new field of what I consider public health engineering, is to create, maybe it's a little ambitious, but create a weather system for viruses. I want us to be able to open up our iPhones, plug in our zip code, and get a better sense, get a probability of why my kid has a runny nose today. Is it Covid, Is it a rhinovirus, an adenovirus, or is it flu? And we can do that. We can start building the rules of virus spread across the globe, both for pandemic preparedness, but also for just everyday use. In the same way that people used to think that predicting the weather was going to be impossible. Of course we know that's not impossible now. Is it always perfect? No. But does it offer. Does it completely change the way that we go about our days? Absolutely. I envision, for example, right now, we open up our iPhone, we plug in a zip code, and if it tells us it's going to rain today, we bring an umbrella. So in the future, it tells us, hey, there's a lot of SARS COV2 in your community. Instead of grabbing your umbrella you grab your mask. You know, we don't have to have masks all the time, but if we know the rules of the game that these viruses play by, we can start preparing for those. And, you know, every year, we go into every flu season blindfolded, with our hands tied behind our back, just saying, I hope this isn't a bad flu season this year. Why don't. I mean, this is. You know, we're in the 21st century. It's becoming. I mean, we have the tools at our disposal now to not have that attitude. This isn't like 1920s. We can just say, hey, this is going to be a bad flu season this year. Let's act accordingly and with a targeted approach. For example, we don't just use our umbrellas all day long every single day in case it might rain. We don't board up our homes every single day in case there's a hurricane. We wait. And if we know that there's one coming, then we act for a small period of time accordingly. And then we go back and we've prepared ourselves in these little bursts to not have it ruin our days.

I can't tell you how exciting that vision of the future is. I think that's incredible. And it seems like it should be within our reach.

The.

Just these weather maps of viruses floating about the Earth. And it seems obvious. It's one of those things where right now it seems like maybe impossible, and then looking back, like 20 years from now, we'll wonder why the hell this hasn't been done way earlier. The one difference between weather, I don't know if you have interesting ideas in the space, the difference between weather and viruses is it includes the collection of the data, includes the human body, potentially. And that means that there is some. As with the contact tracing question, there's some concern about privacy. There seems to be this dance that's really complicated with Facebook getting a lot of flack for basically misusing people's data or, you know, just whether it's perception or reality, there's certainly a lot of reality to it, too, where they're not good stewards of our private data. So there's this weird place where it's, like, obvious that if we do. If we collect a lot of data about human beings and maintain privacy and maintain all basic respect for that data, just like, honestly, common sense respect for the data, that we can do a lot of amazing things for the world, like a weather map for viruses. Is there a way forward to gain trust of people or to do this? Well, do you have ideas here. How big is this problem?

I think it's a central problem. There's a couple central problems that need to be solved. One, how do you get all the samples? That's not actually too difficult. I'm actually. I have a pilot project going right now with getting samples from across all the United States. Tens of thousands of samples every week are flowing into my lab and we process them.

So it's taking like one of the. Basically, there's biology here in chemistry and converting that into numbers.

That's exactly right. So what we're doing, for example, there's a lot of people who go to the hospital every day, a lot of people who donate blood, people who donate plasma. So one of the projects that I have. I'll get to the privacy question in a moment. So what I want to do is the name that I've given this is a global immunological observatory. There's no reason not to have that good name. I've said, instead of saying, well, how do we possibly get enough people on board to send in samples all the time? Well, just go to the source. So there's a company In Massachusetts that makes 8, 80% of all the instruments that are used globally to collect plasma from plasma donors. So I went to this company, Heminetics, and said, is there a way you have 80% of the global market on plasma donations? Can we start getting plasma samples from healthy people that use your machines? So that hooked me up with this company called Octapharm. And Octopharm has a huge reach and offices all over the country where they're just collecting people's plasma. They actually pay people for their plasma, and then that gets distributed to hospitals and all this stuff as anonymous plasma. So I've just been collecting anonymous samples and we're processing them, in this case for Covid antibodies. To watch. From January up through December, we're able to watch how the virus entered into the United States and how it's transmitting every day across the US So we're getting those results organized now, and we're going to start putting them publicly online soon to start making at least a very rough map of COVID But that's the type of thinking that I have in terms of, like, how do you actually capture huge numbers of specimens? You can't ask everyone to participate on sort of a. I mean, maybe could, if you have the right tools and you can offer individuals something in return, like 23andMe does. That's a great way to get people to give specimens and they get results back. So with these technologies that I've been building along with some collaborators at Harvard, we can come up with tools that people might actually want. So I can offer you your immunological history. I can say, give me a drop of your blood on a filter paper, mail it in, and I will be able to tell you every infectious disease you've ever encountered and maybe even when you encountered it. Roughly, I could tell you, do you have Covid antibodies right now? Do you have Lyme disease antibodies right now? Flu, triple E, and all these different viruses. Also peanut allergies, milk allergies, anything. If your immune system makes a response to it, we can detect that response. So all of a sudden we have this very valuable technology that on the one hand, gives people maybe information they might want to know about themselves, but on the other hand becomes this amazingly rich source of big data to enter into this global immunological observatory, sort of mathematical framework to start building these maps, these epidemiological tools. But you asked about privacy, and absolutely that's essential to keep in mind, first and foremost. So privacy can be. You can keep these samples 100% anonymous. They are just. When I get them, they show up with nothing. They're literally just tubes. I know a date that they were collected and a zip code that they're collected from, or even just sort of a county level id with an IRB and with ethical approval and with the people's consent, we can maybe collect more data. But that would require consent. But then there's this other approach which I'm really excited about, which is certainly going to gain some scrutiny, I think, but we'll have to figure out where. Where it comes into play. But I've been recognizing that we can take somebody's immunological profile and we can make a biological fingerprint out of it, and it's actually stable enough so that I could take your blood. Let's say I don't know who you are, but you sent me a drop of blood a year ago, and then you send me a drop of blood today. I don't know that those two blood spots are coming from the same person. They're just showing up in my lab. But I can run our technology over, and it just gives me your immunological history. But your immunological history is so unique to you. And the way that your body responds to these pathogens is so unique to you that I can use that to tether your two samples. I don't know who you are. I know nothing about you. I only know when those Samples came out of a person, but I can say, oh, these two samples a year apart from. Actually belong to the same person. Yeah.

So there's sufficient information that immunological history to match the samples. Or from a privacy perspective, that's really exciting. Does that generally hold for humans? So you're saying there's enough uniqueness to match?

Yeah, because it's very stochastic. Even twins. So this, I believe we haven't published this yet. We will soon.

You have a twin too, right?

I do have a twin. I have an identical twin brother, which makes me interested in this. He looks very much like me.

Oh, is that how that works?

And, you know, DNA can't really tell us apart, but this tool is one of the only tools in the world that could tell twins apart from each other. Could still be accurate enough to say, this blood, you know, it's like 99.999% accurate to say that these two blood samples came from the same individual. And it's because it's a combination both of your immunological history, but also how your unique body responds to a pathogen, which is random. The way that we make antibodies is, by and large, it's got an element of randomness to it. How the cells, when they make an antibody, they chop up the genetic code to say, okay, this is the antibody that I'm going to form for this pathogen. And you might form, if you get a coronavirus, for example, you might form hundreds of different antibodies, not just one antibody against the spike protein, but hundreds of different antibodies against all different parts of the virus. So that gives this really rich resolution of information that when I then do the same thing across hundreds of different pathogens, some of which you've seen, some of which you haven't, it gives you an exceedingly unique fingerprint that is sufficiently stable over years and years and years to essentially give you a barcode, you know, and. And I don't have to know who you are, but I can know that these two specimens came from the same person somewhere out in the world.

So fascinating that there's this trace, your life story, in the space of viruses, in the space of pathogen, like, like these or, you know, because there's this entire universe of these organisms that are trying to destroy each other, and then your little trajectory through that space leaves a trace, and then you can look at that trace. That's fascinating. And that, I mean, there's. Okay, that data, period, is just fascinating. And the vision of making that data universally connected to where you can make, like, infer things and just like with the weather is really fascinating. And there's probably artificial intelligence applications there. Start making predictions, start finding patterns.

Exactly. We're doing a lot of that already. And that's how do we had this going. I've been trying to get this funded for years now. And I've spoken to governments. Everyone says, cool idea, not going to do it. Why do we need it?

Oh, really? The why do you need it?

Why do you need it? And of course, now I wrote in 2015 about this, why we would. Why this would be useful. And of course, now we're seeing why it would be useful. Had we had this up and running in 2019, had we had it going, we were drawing blood from, you know, or getting blood samples from hospitals and clinics and blood donors from New York City. Let's just say, you know, that could have. We didn't run the first PCR test for coronavirus until probably a month and a half or two months after the virus started transmitting in New York City.

So it's like with the rain, we didn't start wearing umbrellas or taking out umbrellas.

Exactly.

For two months, getting wet.

But different than the rain, we couldn't actually see that it was spreading. And so Andrew Cuomo had no choice but to leave the city open. There were hints that maybe the virus was spreading in New York City, but, you know, he didn't have any data to back it up. No data. And so it was just week on week on week, and he didn't have any information to really go by to allow him to have the firepower to say, we're closing down the city, this is an emergency, we have to stop spread before it starts. And so they waited until the first PCR tests were coming about. And then the moment they started running PCR tests, they find out it's everywhere. And so that was a disaster because of course, New York City was just hit so bad because nobody was. We were blind to it. We didn't have to be blind to it. And the nice thing about this technology is we wouldn't have. With the exact same technology we had in 2017, we could have detected this novel coronavirus spreading in New York City in 2020. Not because we changed, not because we are actually actively looking for this novel coronavirus, but because we would see, we would have seen patterns in people's immune responses. Using AI or just, frankly, using just the raw data itself, we could have said, hey, it looks like there's something that looks like known coronavirus is spreading in New York. But there's Gaps. You know, there's, for some reason people aren't developing an immune response to this coronavirus that seems to be spreading to these normal things that, you know, and it just looks, the profile looks different. Different. And we could have seen that. And immediately, especially since we had an idea that there was a novel coronavirus circulating in the world, we could have very quickly and easily seen, hey, clearly we're seeing a spike of something that looks like a known coronavirus, but people are responding weirdly to it. Our AI algorithms would have picked it up and just our basic, heck, you could put, you could have put it in an Excel spreadsheet. We would have seen it.

Yeah, so some basic visualization would have shown.

Exactly. We would have seen spikes and they would have been kind of like off, you know, immune responses that the shape of them just looked a little bit different, but they would have been growing and we would have seen it and it could have saved tens of thousands of lives in New York City.

So to me, the fascinating question, everything we've talked about, so both the huge collection of data at scale, which is super exciting, and then the kind of obvious at scale solution to the current virus and future ones is the rapid testing. Can we talk about the future of viruses that might be threatening the. Our very existence? So do you think like a future natural virus can have an order of magnitude greater effect on human civilization than anything we've ever seen? So something that either kills all humans or kills, I don't know, 60, 70% of humans. So some, like something, something we can't even imagine. Is that, is that something that you think is possible? Because it seems to have not have happened yet. So maybe like the entirety, whoever the programmer is of the simulation that sort of launched the evolution from the big bang seems to not want to destroy us humans. Or maybe that's a natural side effect of the evolutionary process that humans are useful. Do you think it's possible that the evolutionary process will produce a virus that will kill all humans?

I think it could. I don't think it's likely. And the reason I don't think it's likely is. Well, on the one hand, it hasn't happened yet, in part because mobility is a recent phenomena. People weren't particularly mobile until fairly recently. Now, of course, now that we have people flying back and forth across the globe all the time, the chances of global pandemics has escalated exponentially, of course. And so on the one hand, that's part of why it hasn't happened yet. We can look at things Like Ebola. Now Ebola, we haven't generally had major Ebola epidemics in the past, not because Ebola wasn't transmitting and infecting humans, but because it was largely affecting and infecting humans in disconnected communities. So you see out in rural parts of Africa, for example, in western Africa, you might end up having isolated Ebola outbreaks, but there weren't connections that were fast enough that would allow people to then spread it into the cities. Of course, we saw back in 2014, 15, a massive Ebola outbreak. That wasn't because it was a new strain of Ebola, but it was because there's new inroads and connections between the communities and people got it to the city. And so we saw it start to spread. So that should be a little bit foreshadowing of what's to come. And now we have this pandemic. We had 2009, we have this. There is a benefit or there is sort of a natural check. And this is like kind of Latke, Voltaire, predator, prey, dynamic kind of systems, ecological systems in mathematics, that if you have something that's so deadly, people will respond more, maybe with a greater panic, a greater sense of panic, which alone could destroy humanity. But at the same time, we now know that we can lock down, we know that that's possible. And so if this was a worse virus that was actually killing 60% of people it was infecting, we would lock down very quickly. My biggest fear though is let's say that was happening. You need serious lockdowns if you're going to keep things going. So the only reason we were able to keep things going during our lockdowns is because it wasn't so bad that we were still able to have people work in the grocery stores, still have people work in the shipping to get the food onto the shelves. So on the one hand we could probably figure out how to stop the virus, but can we stop the virus without starving? And I'm not sure that if this was another acute respiratory virus that say had a slightly say it transmitted the same way, but say it actually did worse damage to your heart. But it was like a month later that people started having heart attacks in mass. It's like not just one offs, but really severe. Well, that could be a serious problem for humanity. So in some ways I think that there are lots of ways that we could end up dying at the hand of a virus. I mean, we're already seeing it. Just, I mean, my fear still, I think coronaviruses have demonstrated a keen Ability to destroy or to create outbreaks that can potentially be deadly to large numbers of people. Flu strains, though, are still, by and large my concern.

So you think the bad one might come from the flu? The influenza?

Yeah, their replication cycle. They're able to genetically recombine in a way that coronaviruses aren't. They have segmented genomes, which means that they can just swap out whole parts of their genomes, no problem, repackage them, and then, boom, you have a whole antigenic shift, not adrift. What that means is that on any occasion, any day of the year, you can have, boom, a new, whole new virus that didn't exist yesterday. And now with farming and industrial livestock, we're seeing animals and humans come into contact much more. Just the opportunities for an influenza strain that is unique and deadly to humans increases. All the while transmission and mobility has increased. It's just a matter of time, in my opinion.

What about from immunology perspective of the idea of engineering a virus so not just the virus leaking from a lab or something, but actually being able to understand the protein, like the. Everything about what makes a virus enough to be able to figure out ways.

To.

Maybe targeted or untargeted attack by, obviously immunity. Yeah. Is that something. Obviously that's somewhere on the list of concerns, but is that anywhere close of the top 10 highlights, along with nuclear weapons and so on, that we should be worried about, or is the natural pandemic really the one that's much greater concern?

I would say that the former, that man made viruses and genetically engineered viruses should be right up there with the greatest concerns for humanity right now. We know that the tools, for better or worse, the tools for creating a virus are there. We can do it. I mean, heck, the human species is no longer vaccinated against smallpox. I didn't get a smallpox vaccine. You didn't get a smallpox vaccine. At least I don't think. And you know, so if somebody wanted to make smallpox and distribute it to the world in some way, it could be exceedingly deadly and detrimental to humans. And that's not even sort of using your imagination to create a new virus. That's one that we already have. Unlike the past, when smallpox would circulate, you had large fractions of the community that was already immune to it. And so it wouldn't spread or it would spread a little bit slower. But now we have, essentially, in a few years, we'll have a whole global population that is susceptible. Let's look at measles. We have an entire, I mean, measles I have, you know, there are some researchers in the world right now which for various reasons are working on creating a measles strain that evades immunity. It's not for bioterrorism, at least that's not the expectation. It's for using measles as an oncolytic virus to kill cancer. And the only way you can really do that is if your immune system doesn't. You know, if you take a measles virus and there's, you know, we don't have to go into details of why it would work, but it could work. Measles likes to target potentially cancerous cells, but to get your immune system not to kill off the virus. If you're trying to use the virus to target it, you maybe want to make it blind to the immune system. But now imagine we took some virus like measles, which has an R0 of 18, transmits extremely quickly, and now we have essentially, let's say we had a whole human race that is susceptible to measles. And this is a virus that spreads orders of magnitude easier than this current virus. Imagine if you were to plug something toxic or detrimental into that virus and release it to the world.

So it's possible to be both accidental and intentional?

Absolutely, yeah. So Mark Lipsich, who's a good colleague of mine at Harvard, he's the director of the center for Communicable Disease Dynamics, where I'm a faculty member, he's spoken very, very forcefully and he's very outspoken about the dangers of gain of function testing, where in the lab we are intentionally creating viruses that are exceedingly deadly under the auspices of trying to learn about them. So that if. The idea is that if we kind of accelerate evolution and make these really deadly viruses in the lab, we can be prepared for if that virus ever comes about naturally or through unnatural means. The concern though is, okay, that's one thing, but what if that virus got out on somebody's shoe? Just what if the effects of an accident are potentially catastrophic? Is it worth taking the chances just to be prepared a little bit for something that may or may not ever actually develop? And so it's a serious ethical quandary we're in. How to both be prepared but also not cause a catastrophic mistake.

As a small tangent, there's a recent, really exciting breakthrough of alpha 2, of alpha fold 2, solving protein folding or achieving state of the art performance on protein folding. And then I thought, proteins have a lot to do with viruses. It seems like being able to use machine learning to design proteins that Achieve certain kinds of functions will naturally allow you to use, maybe down the line, not yet, but allow you to use machine learning to design basically viruses, maybe like measles, like for good, which is like to attack cancerous cells, but also for bad. Is that a crazy thought or is this a natural place where this technology may go? I suppose, as all technologies can, which is for good and for bad. Do you think about the role of machine learning in this?

Oh, yeah, absolutely. I mean, AlphaFold is amazing. It's an amazing algorithm, series of algorithms. And it does demonstrate to me, it demonstrates just how powerful, you know, everything in the world has rules. We just don't know the rules. You know, we often don't know them. But you know, our brain has rules, how it works. Everything is plus and minus. There's nothing in the world that's really not at its most basic level, positive, negative, you know, it's all, obviously it's all just charge. And that means everything. You can figure it out with enough computational power and enough. In this case, machine learning and AI is just one way to learn rules. It's an empirical way to learn rules, but it's a profoundly powerful way. And certainly now that we are getting to a point where we can take a protein and know how it folds, given its sequence, we can reverse engineer. Then we can say, okay, we want a protein to fold this way. What does the sequence need to be? We haven't done that yet so much, but it's just the next iteration of all of this. So let's say somebody wants to develop a virus. It's going to start with somebody wanting to develop a virus to defeat cancer, something good, you know. And so it would start with a lot of money from the federal government, you know, for all the positives that will come out of it. But we have to be really careful because that will come about. There's no doubt in my mind that we will develop. We're already doing it. We engineer molecules all the time for specific uses. Oftentimes we take them from nature and then tweak them. But now we can supercharge it. We can accelerate the pace of discovery. To not have it just be discovery. We have it be true. Ground up engineering. Let's say you're trying to make a new molecule to stabilize somebody with some retinal disease, right? So we come up with some molecule that can improve the stability of somebody with retinal degeneration. You know, just a small tweak to that to say, make a virus that causes the human race to Become blind. You know, I mean, it sounds really conspiracy theory, ish, but. But it's not. You know, it's. We're learning so much about biology and there's always nefarious reasons. I mean, heck, look at how AI and you know, just Google searches, those can be, you know, they are every single day being leveraged by nefarious actors to take advantage of people, to steal money, to do whatever it might be eventually probably to create wars or already to create wars. And I mean, I don't think there's any question at this point behind disinformation campaigns. And so it's being leveraged. This thing that could be wholly good is always going to be leveraged for bad. And so how do you balance that as a species? I'm not quite sure.

The hope is, as you mentioned previously, that there's some. That we're able to also develop defense mechanisms. And there's something about the human species that seems to keep coming up with like, ways to just, just like on the deadline, just at the last moment, figuring out how to avoid destruction. I think I'm like eternally optimistic about the human race not destroying ourselves. But you could do a lot of things that would be very painful.

Yes, well, we're doing it already. You know, just. I mean, we are seeing how our regulation today, right? We did this thing, it started as a good thing, regulation of medical products, but now it is unwillingly and unintentionally harming us. Our regulatory landscape, which was developed wholly for good in our country, is getting in the way of us deploying a tool that could stop our economies from having to be sort of sputteringly closed, that could stop deaths from happening at the rate that they are. And I think we will come to a solution. Of course, now we're going to get the vaccine and it's going to make people lose track of why we even bother testing, which is a bad idea. But we're already seeing that we have this amazing capacity to both do damage when we don't intend to do damage and then also to pull up when we need to pull up, stop complete catastrophe. And so it's. We are an interesting species in that way, that's for sure.

So there's a lot of young folks, undergrads, grads, they're also young. Listen to this. So is there. You've. You've talked about a lot of fascinating stuff that's like, there's ways that things are done and there's actual solutions and they're not always like, intersecting. Do you have advice for undergraduate students or graduate students or even people in high school now about a life, about career, of how they might be able to solve real big problems in the world, how they should live their life in order to have a chance to solve big problems in the world.

It's hard. I struggle a little bit sometimes to give advice because the advice that I give from my own personal experience is necessarily decision distinct from the advice that would make other people successful. I have unending ambitions to make things better, I suppose. And I don't see barricades where other people sometimes see barricades now. Even just little things like when this virus started. I'm a medical director at Brigham Women's Hospital and so I oversee or help to oversee molecular virology diagnostics. So when this virus started wearing my epidemiology hat and wearing my sort of viral outbreak hat, I recognized that this was going to be a big virus that was important at a global level. Even if the CDC and WHO weren't ready to admit that it was a pandemic. It was obvious in January that it was a pandemic. So I started trying to get a test built at the Brigham, which is one of Harvard's teaching hospitals. The first encounters I had with the upper administration of the hospital were pretty much, no, why would we do that? That's silly. Who are you? And I said, well, okay, don't believe me? Sure. But I kept pushing on it. And then eventually I got them to agree. It was really only a couple of weeks before the biogen conference happened. We started building the test. I think they started looking abroad and saying, okay, this is happening. Sure, maybe he was right. But then I went a step further and I said, we're not going to have enough tests at the hospital. And so my ambition was to get a better testing program started. And so I figured, what better place to scale up testing than the Broad Institute? Broad Institute is amazing, very high throughput, high efficiency research institute that does a lot of genomic sequencing, things like that. So I went to the Broad and I said, hey, you know, there's this coronavirus that's obviously going to impact our society greatly. Can we start modifying your high efficiency instruments and robots for coronavirus testing? Everyone in my orbit in the hospital world just said, that's ridiculous. You know, how could you possibly plan to do that? It's impossible. And to me it was like the most dead simple thing to do. But the higher ups and the people who think about. I think one of the most important things is to recognize that Most people in the world don't see solutions, they just see problems. Because it's an easy thing to do. Thinking of problems and how things will go wrong is really easy because you're not coming up with a brand new solution. And this to me was just a super simple solution. Hey, let's get the Broad to help build tests. Every single hospital director told me, no, it's impossible. My own superiors, the ones I report to in the hospital, said, mike, you're a new faculty member. Your ideas probably would be right, but you're too naive and young to know that it's impossible. Obviously now the Broad is the highest throughput laboratory in the country. And yes, and so I think my recommendation to people is as much as possible, get out of the mode of thinking about things as problems. Sometimes you piss people off. I could probably use a better filter sometimes to try to be not so upfront with certain things. But it's just so crucial to always just see, to just bring think about things in new ways that, that other people haven't because usually there's something else out there. And one of the things that has been most beneficial to me is that my education was really broad. It was engineering and physics and then I became a Buddhist monk for a while and so that gave me a different perspective. But then it was medicine and immunology, and now I've brought all of it together from a mathematics and biology and medicine perspective and policy and public health. And I think that I'm not the best in any one of these things. I recognize that there are going to be geniuses out there who are just worlds better than me at any one of these things that I try to work on. But my superpower is bringing them all together and just thinking. And that's, I think, how you can really change the world. I don't know that I'll ever change the world in the way that I.

Hope, but that's how you can have a chance.

Yeah, that's how you can have a chance. Exactly. And I think it's also what this, to me, this rapid testing program, this is the most dead simple solution in the world.

And this literally could change the world.

Actually, it could change the world. And it is. There's countries that are doing it now. The US isn't, but I've been advising many countries on it. And I would say that some of the early papers that we put out earlier on, a lot of the things actually are changing. Unless you really look hard, you don't know where you're actually having an effect. Sometimes it's more overt than other times. In April I published a paper that was saying, hey, with the PCR values from these tests, we need to really focus on the CT values, the actual quantitative values of these lab based PCR tests. At the time, all the physicians and laboratory directors told me that was stupid. Why would you do that? They're not accurate enough. And, and of course now it's headline news that Florida, they just mandated reporting out the CT values of these tests because there's a real utility of them. You can understand public health from it. You can understand better clinical management. That was a simple solution to a pretty difficult problem. And it is changing the way that we approach all of the lab testing in this country is starting to, it's taken a few months, but it's starting to change because of that. And that was just me saying, hey, this is something we should be focusing on. Got some other people involved and other people, and now people recognize, hey, there's actual value in this number that comes out of these lab based PCR tests. So sometimes it does grow fairly quickly. But I think the real answer, my only answer, I don't know what. I recognize that some people are going to be really focused on and have one small but deep skill set. I go the opposite direction. I try to bring, bring things together and, but the biggest thing I think is just don't see problem, don't, don't see barriers. Like, just see like there's always a solution to a barrier. If there's a barrier that literally means there's a solution to it. That's why it's called a barrier.

And just like you said, most people will just present to you, only be thinking about it and present to you with barriers. And so it's easy to start thinking that's all there is in this world.

And just think big. I mean, God, there's nothing wrong with thinking big. Elon Musk thought big and then thinking big builds on itself. You get a billion dollars from one big idea and then that allows you to make three new big ideas and.

There'S a hunger for it. If you think big and you communicate that vision with the world, all the most brilliant and passionate people will just, you'll attract them and they'll come to you and then it makes your life actually really exciting. The people I've met at like Tesla and Neuralink, I mean there's just like this fire in their eyes. They just love life. And it's amazing, I think, to, to be around those people. I have to ask you about what was the philosophy, the journey that took you to becoming a Buddhist monk and what.

What were.

What did you learn about life? What did you take away from that experience? How did you return back to Harvard and the world? That's unlike that experience, I imagine.

Yeah, well, I was at Dartmouth at the time. Well, I went to Sri Lanka. I was already pretty interested in developing countries and sort of under resourced areas and I was doing a lot of engineering work and I went there. But I was also starting to think maybe health was something of interest. So I went to Sri Lanka because I had a long interest in Buddhism as well. Just kind of interested in it as a thing.

Which aspect of the philosophy attracted you?

I would say that the thing that interested me most was really this idea of kind of a butterfly effect of, you know, what you do now has ripple effects that extend out beyond what you can possibly imagine, both in your own life and in other people's lives. And in some ways, Buddhism has not. In some ways, in a pretty deep way, Buddhism has that as part of its underlying philosophy in terms of rebirth and sort of your actions today propagate to others, but also propagate to sort of what might happen in your circle of what's called samsara and rebirth. And I don't know that I subscribe fully to this idea that we are reborn, which always was a little bit of a debate internally, I suppose, when I was a monk, but it has always been. It was that and then it was also meditation. At the time, I was a fairly elite rower. I was rowing at the national level and rowing, to me was very meditative. It was just. Even if you're in a boat with other people, I mean, on the one hand it's the extreme of a team sport, but it's also the extreme sort of focus and concentration that's required of it. And so I was always really into just meditative type of things. I was doing a lot of pottery too, which was also very meditative. And so Buddhism just kind of really. There are a lot of things about meditating that just appealed. And so I moved to Sri Lanka, planning to only be there for a couple of months. But then I was shadowing in this medical clinic and there was this physician who was just really. I mean, it's just kind of a horrible situation, frankly. This guy was trained decades earlier. He was an older physician, and he was still just practicing these fairly barbaric approaches to medicine because he had a rural town and he just didn't have a lot of he didn't have any updated training, frankly. And so I just remember this girl came in with shrapnel in her hand, and his solution was to air it out. And so he was like. Without even numbing her hand, he was cutting it open more with this idea that the more oxygen and stuff. And I think there was something about all of this. And I was already talking to these monks at the time. I would be in this clinic in the morning and I'd go. And my idea was to teach English to these monks in the evening. Turned out I'm a really bad English teacher. So they just taught. They allowed me just to sit with them and meditate. And they were teaching me more about Buddhism than I could have possibly taught them about English or being an American or something. And so just slowly, I just couldn't take. I couldn't handle being in that clinic. So more and more, I just started moving to spending more and more time at this monastery. And then after about two months, I was supposed to come back to the States, and I decided I didn't want to. So I moved to this monastery in the mountains, primarily because I didn't have the money to just keep living. So living in a monastery is free. And so I moved there and just started meditating more and more. And then months went by, and it just really gravitated. I gravitated to the whole notion of it. I mean, it sounds strange, but meditating, almost just like anything that you've put your mind to became exciting. You know, it became like there weren't enough hours in the day to meditate. And I would do it for, you know, 18 hours a day, 15 hours a day, just sit there and you. And like. I mean, I hate sleeping anyway, but I wouldn't want to go to sleep because I felt like I didn't accomplish what I needed to accomplish in meditation that day, which is so strange because there is no end, you know, but it was always. But there are these. There are these steps that happen during meditation that are very prescribed in a way. Buddha talked about them. And these are ancient writings which exist. I mean, the writings are real. They're thousands of years old now. So whether it was Buddha writing them or whoever, there are lots of different people who have contributed to these writings over the years. But they're very prescribed, and they tell you what you're going to go through. And I didn't really focus too much on them. I read a little bit about them. But your mind really does. When you actually start meditating at that level, like, not an hour here and there, but, like, truly just spending your days meditating. It becomes kind of like this other world where it becomes exciting and you're actively working, you're actively meditating, not just kind of trying to quiet things. That's sort of just the first stage of trying to get your mind to focus. Most people never get past that first stage, especially in our culture.

Could you briefly summarize what's waiting beyond the stage of just quieting the mind? It's hard for me to imagine that there's something that could be described as exciting there.

Yeah, it's an interesting question. So I would say. So the first thing. The first step is truly just to be able to close your eyes, focus on your breath, and not have other thoughts enter into your mind. That alone is just so hard to do. Like, I couldn't do it now if I wanted, but I could then. And. But once you get past that stage, you start entering into, like, all these other. You go through kind of. I went through this, like, pretty trippy stage, which is a little bit euphoric, where you just kind of start not hallucinating. I mean, it wasn't like some crazy thing that would happen in a movie, but definitely just weird. You start getting to the stage where you're able to quiet your mind for so long, for hours at a time, that, like, for me, I started getting really excited about this idea of mindfulness, which is part of Buddhism in general, but it's part of Theravada Buddhism in particular, in this way, which was you start focusing on your daily activities, whether that's sipping a cup of tea or walking or sweeping around. I lived on this mountainside in this cottage thing. It was built into the rock, so every morning I would wake up early and sweep around it and stuff, because that's just what we did. And you meditate on all those activities. And one of the things that was so exciting, which sounds completely ridiculous now, was just almost learning about your daily activities in ways that you never would have thought about before. So what's involved with picking up this glass of water? If I said, okay, I'm just going to pick. I'm going to take a drink of water. To me, right now, it's a single activity. But during meditation, it's not a single activity. It's a whole series of activities of, like, little engineering feats and feelings. And it's gripping the water and it's feeling that the glass is cold and it's lifting and it's moving and dragging and dragging. And you start to learn a whole new language of life. And that, to me, was like this really exhilarating thing. That it was an exhilarating component of meditation, that there was never enough time. It's kind of like learning a new computer language. It gets really exciting when you start coding and all these new things you can do.

You learn how to experience life in a much richer way. And so you never run out of ways to go deeper and deeper and deeper in the way you experience. Just the drinking of the glass of water.

That's exactly right. And what becomes kind of exhilarating is you start to be able to predict things that you never. Or I don't even know if prediction's the right word. But I always think of the Matrix where I forget who it was. Somebody was shooting at Neo and he leans backwards and he dodges the bullets. In some ways, when you start breaking every little action that your hands do or that your feet do or that your body does down into all these little actions that make up one, what we normally think of as an action all of a sudden you can start to see things almost in slow motion. I like to think of it very much like language. The first time somebody hears a foreign language that your hands do or that your feet do or that your body does down into all these little actions that make up one what we normally think of as an action all of a sudden you can start to see things almost in slow motion. I like to think of it very much like language. The first time somebody hears a foreign language, it sounds really fast. Usually you don't hear the spaces between words and it just sounds like. Just like a stream of consciousness. It just sounds like a stream of noises. If you've never heard the language before and as you learn the language, you hear clear breaks between words and it starts to gain. It sounds really fast. Usually you don't hear the spaces between words and it just sounds like. Just like a string context. And all of a sudden, like that what once sounded very fast slows down and it has meaning. That's our whole life. There's this whole language happening that we don't speak generally. But if you start to speak it and if you start to learn it and you start to say, hey, I'm picking up this glass is actually 18 little movements. Then all of a sudden, it becomes extremely exciting and exhilarating to just breathe, breathing alone. And the rise and fall of your abdomen or the way the air pushes in and out of your nose becomes almost interesting. And what's really Neat is the world just starts slowing down. And I'll never forget that feeling. And if there was one euphoric feeling from meditation, I want to gain back, but I don't think I could without really meditating like that again, and I don't think I will. Was this, like, slow motion of the world. It was finding the spaces between all the movements in the same way that the spaces between all the words happen. And then it almost gives you this new appreciation for everything. It was really amazing. And so I think it came to an abrupt end, though, when the tsunami hit. I was there in the Indian Ocean. Tsunami hit in 2004, and it was like this dichotomy of being a monk and just meditating in this extraordinary place. And then the tsunami hits and kills 40,000 people in a few minutes on the coast of this really small little country in Sri Lanka. And then my whole world of being a monk came crashing down when I go to the coast. And, I mean, that was just a devastating visual sight and emotional sight. But the strangest thing happened, which was that everyone just wanted me to stay as a monk. You know, people in that culture, they wanted to. The monks largely fled from the coastlines. Those. You know, and. And so then there I was, and people wanted me to be a monk. They wanted me to stay on the coast but be a monk and not help. Like, not help in the way that I considered helping. They wanted me just to keep meditating so they could bring me dana like offerings and get and have their sort of karmic responsibilities attended to as well. And so that was really bizarre to me. It was like, how could I possibly just sit around while all these people, half of everyone's family, just died? And so, in any case, I stopped being a monk and I moved to this refugee camp and lived there for another six months or so and just stayed there, not as a monk, but tried to raise some money from the US and tried to. Like, I didn't know what I was doing, Frankly. I was 22, and I don't think I appreciated at the time how much of a role I was having in that community's life. But it's taken me many years to process all of this since then. But I would say it's what put me into the public health world, living in that refugee camp. And that difference that happened from being a monk to being in this devastating environment just really changed my whole view of what sort of why I was existing, I suppose.

Well, so there's this richness of life in a single drink. Of water that you experience. And then there's this power of nature that's capable to take lives of thousands of people. So given all that, the absurdity of.

That.

Let me ask you, and the fact that you study things that could kill the entirety of human civilization, what do you think is the meaning of this all? What do you think is the meaning of life? This whole orchestra we got going on, does it have a meaning? And maybe from another perspective, how does one live a meaningful life if such is possible?

Well, you know, from what I've seen, I don't think there's a single answer to that by any stretch. One of the most interesting things about Buddhism to me is that the human existence is part of suffering, which is very different from Judeo Christian existence, which is that human existence is something to be is a very different. You know, it's something to. There's a richness to it. In Buddhism, it's just another one of your lives, but it's your opportunity to attain nirvana and become a monk, for example, and meditate to attain nirvana. Else you kind of just go back into the samsara, the cycle of suffering. And so, you know, when I look at, I mean, in some ways the notion of life and what the purpose of life is, you know, they're kind of completely distinct. This sort of Western view of life, which is that this life is the most precious thing in the world, versus this is just another opportunity to try to get out of life. I mean, the whole notion of nirvana and in Buddhism, it getting out of this sort of cycle of suffering is to vanish. If you could attain nirvana throughout this life, the idea is that you don't get reborn. And so when I look at these two, on the one hand, you have Christian faith and other things that want to go to heaven and live forever in heaven. Then you have this other whole half of humans who want nothing more than to get out of the cycle of rebirth and just poof, you know, not exist anymore.

The cycle of suffering.

Yeah. And so how do you reconcile those two? And I guess, do you have both.

Of them in you? Do you basically oscillate back and forth?

I don't think. I think I just. I look at us in a. I think we're just a bunch of proteins that, you know, we form and they work in this really amazing way. And they might work in a bigger scale. Like there might be some connections that we're not really clear about, but they're still biological. I believe that they're biological.

How do these proteins become conscious and why do they want to help civilization by having at home rapid tests at scale?

Well, I think I don't have an answer to that one, but I really do believe this is just an evolution of consciousness. I don't personally think is. My feeling is that we're a bunch of pluses and minuses that have just gotten so complex that they're able to make rich feelings, rich emotions. And I do believe, though, on the one hand, I sometimes wake up some days. My fiance doesn't always love it, but I kind of think we're all just a bunch of robots with pretty complicated algorithms that we deal with. And in that sense, okay, if the world just blew up tomorrow and nothing existed the day after that, it's just another blip in the universe. But at the same time, I don't know. So that's kind of probably my most core basic feeling about life is like we're just a blip and we may as well make the most of it while we're here blipping.

It's one hell of a fun blip though it is.

It's an amazing blink of an eye in time.

Michael, you're one of the most interesting people I've met. One of the most interesting conversations. Important ones now. I'm going to publish it very soon. I really appreciate taking the time. I know how busy you are. It was really fun. Thanks for talking today.

Well, thanks so much. This was a lot of fun.

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