Michael Mina: Rapid COVID Testing
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"scaling them up. So on that front, I think finally there is success. People are actually understanding"
扩大规模。 So on that front, I think finally there is success.人们其实都在理解
— Michael Mina （03:59.920）
"the reason it's taking long, I think, is because every agency and government is generally deferential"
我认为，之所以需要很长时间，是因为每个机构和政府通常都很恭敬
— Michael Mina （18:06.240）
"vaccinate or test, if our goal is to actually stop transmission, that's confusing because vaccines are"
接种疫苗或进行测试，如果我们的目标是真正阻止传播，那就会令人困惑，因为疫苗是
— Michael Mina （1:03:09.440）
"think now we actually are in the time where it has been set and we have to deal with the crisis before"
想想现在我们实际上正处于既定的时间，我们必须在此之前应对危机
— Michael Mina （1:06:18.880）
"it's not that important. And the pandemic's going away. But this was like 100% predictable, everything"
这并不重要。大流行病正在消失。但这就像100%可预测的，一切
— Michael Mina （19:30.240）
🎙️ 完整对话（1040 条）
Lex Fridman (00:00.000)
The following is a conversation with Michael Mina, his second time on the podcast.
以下是与迈克尔·米纳的对话，这是他第二次参加播客。
Lex Fridman (00:04.720)
He's a professor at Harvard doing research on infectious disease and immunology. In my view,
他是哈佛大学的教授，从事传染病和免疫学研究。在我看来，
Lex Fridman (00:11.840)
the most powerful, doable, and obvious solution to COVID 19 from the very beginning is rapid
从一开始，针对 COVID 19 的最强大、可行且明显的解决方案就是快速
Lex Fridman (00:18.640)
at home testing. This is what Michael has been talking about and writing about since the beginning
在家测试。这就是迈克尔从一开始就一直在谈论和撰写的内容
Lex Fridman (00:24.080)
of the pandemic. The accuracy of these tests is high for the task of detecting contagiousness,
大流行病。对于检测传染性的任务来说，这些测试的准确性很高，
Michael Mina (00:30.400)
which is what matters. Hundreds of millions can be manufactured quickly and relatively cheaply.
这才是重要的。可以快速且相对便宜地制造数亿个。
Michael Mina (00:36.160)
Privacy and individual freedoms are preserved. I believe that if you give people the power of
隐私和个人自由得到保护。我相信如果你赋予人们力量
Michael Mina (00:41.920)
information, information about whether they are contagious or not, they will do the right thing
信息，关于他们是否具有传染性的信息，他们会做正确的事情
Michael Mina (00:47.760)
at scale, all while respecting their freedom and minimizing the destructive effects of the pandemic
大规模，同时尊重他们的自由并尽量减少大流行的破坏性影响
Michael Mina (00:54.560)
on our health and our economy. The solution was obvious in May of 2020. It was obvious when Michael
关乎我们的健康和经济。解决方案在 2020 年 5 月就已经显而易见。当 Michael
Lex Fridman (01:01.680)
and I spoke the first time a year ago, and it is obvious today. We talk about why it has not yet
一年前我第一次发言，今天就很明显了。我们讨论为什么还没有
Michael Mina (01:08.240)
been done and how we can still do it. This is the Lex Friedman podcast. To support it, please check
已经完成以及我们如何仍然可以做到这一点。这是莱克斯·弗里德曼的播客。要支持它，请检查
Michael Mina (01:15.600)
out our sponsors in the description. And now here's my conversation with Michael Mina.
在描述中注明我们的赞助商。现在这是我与迈克尔·米纳的对话。
Michael Mina (01:22.240)
We spoke a year ago about rapid at home testing, and I think you think it should have been,
我们一年前谈到过快速家庭测试，我认为你认为应该是这样的，
Michael Mina (01:30.000)
still should be a big part of the solution to COVID. So let's recap. Where do things stand
仍然应该成为解决新冠病毒问题的重要组成部分。让我们回顾一下。情况如何
Michael Mina (01:36.480)
today in terms of rapid at home testing? Well, it's certainly something that you're right,
今天在快速家庭测试方面？嗯，你确实是对的，
Michael Mina (01:44.640)
I do think we should have them today. We've now had almost 20 months of living in anxiety,
我确实认为我们今天应该拥有它们。我们现在已经快20个月生活在焦虑之中了，
Michael Mina (01:53.520)
uncertainty, being afraid for our health, for our family's health, for our friends, you know,
不确定性，担心我们的健康、家人的健康、朋友的健康，你知道，
Michael Mina (01:59.360)
shutdowns, economic instability, everything has been uncertain because of this virus.
由于这种病毒，停工、经济不稳定，一切都变得不确定。
Lex Fridman (02:05.280)
And then there's this little test, and it's the first time for many people that they're using it
然后是这个小测试，对于很多人来说这是第一次使用它
Lex Fridman (02:10.480)
and they're feeling empowered. They're feeling like they can control their little slice
Michael Mina (02:16.160)
of this pandemic. So as these tests have come out and more and more and more Americans have
Michael Mina (02:22.160)
had an opportunity to go and buy them from, you know, CVS or Walgreens or wherever they're at,
Michael Mina (02:28.720)
I think that it's really shifting the tenor of the discussion. For a long time, all of 2020,
Michael Mina (02:35.200)
it was like, I often felt like it was me and a few other people against the world, you know,
Michael Mina (02:41.840)
these tests should be public health tools, these tests are infectiousness indicators,
Michael Mina (02:47.120)
they shouldn't be compared to PCR, you know, all of these different things. And we could,
Michael Mina (02:51.600)
of course, go through and recap what the benefits and the metrics are that we should be looking at.
Lex Fridman (02:58.400)
But the point is, last year and most of this year was about educating scientists, educating
Michael Mina (03:05.520)
public health leaders, educating physicians to get them to understand that there is a different
Michael Mina (03:12.640)
reason to test in a pandemic than purely diagnostics and transmission blockade and
Michael Mina (03:17.200)
severing transmission chains is a big one. So now, I think we're at a point where people
Michael Mina (03:21.360)
are now understanding and they're understanding because they are feeling it, they're holding it
Lex Fridman (03:26.000)
and they're doing it and they're seeing, they're feeling the delight of seeing a negative
Lex Fridman (03:29.760)
and saying, I feel more comfortable. It's not perfect, but it's pretty darn close to perfect
Michael Mina (03:35.760)
to allowing me to go and see my mom without mistakenly infecting her, you know, or whatever
Michael Mina (03:42.640)
the story might be. And now that that's happening, I think all of a sudden we're seeing a massive
Michael Mina (03:48.480)
change politically for these tests. Biden just came out the COVID 19 action plan the other day
Lex Fridman (03:54.960)
and one of the main pillars of it was testing and in particular, bringing rapid tests,
Michael Mina (03:59.920)
scaling them up. So on that front, I think finally there is success. People are actually understanding
Michael Mina (04:08.240)
and, you know, I haven't stopped beating this drum for far too long and I like hate rapid tests now.
Lex Fridman (04:15.120)
So maybe it's good to step back. Would you say most Americans have not taken a rapid at home test?
Michael Mina (04:21.120)
Absolutely. Most have definitely not taken a rapid test. So like many of them probably don't know.
Michael Mina (04:26.480)
They kind of probably say testing, they have like memories of testing, like PCR testing,
Michael Mina (04:33.200)
they have to go into somewhere and they have to like a swab deep in their nose and that's
Michael Mina (04:39.440)
the experience. So maybe when, if you have to travel like Canada or something like that,
Lex Fridman (04:43.440)
you have to get tested, that kind of stuff. So what are rapid at home tests?
Michael Mina (04:48.160)
Yeah. So the rapid at home tests are, I like to call them paper strip tests. They're simple tests
Michael Mina (04:56.720)
that, I wish I brought some today, but I didn't. They're simple tests that you swab. At the moment,
Michael Mina (05:05.600)
most of them use a swab that you just swab the front of your nose. So it's not one of the deep
Michael Mina (05:10.560)
swabs that goes into your brain. And so it's not very uncomfortable. It's just like picking your
Michael Mina (05:16.480)
nose, if you will, and you put that swab into a little tube and the tube has some liquid in it.
Lex Fridman (05:27.040)
And then you put a few drops of that liquid onto a paper strip or you drop the paper strip
Michael Mina (05:32.560)
into the tube, just like one of those indicators for the pool. And if you, just like a pregnancy
Michael Mina (05:39.680)
test, then if you get two lines, you're positive, one line, you're negative. It's super simple. It
Michael Mina (05:45.120)
takes 30 seconds, once you know how to do it, of hands on time. And you wait around 10 minutes,
Lex Fridman (05:50.400)
and then you read the result. They are extraordinarily effective to answer one
Michael Mina (05:57.280)
question, am I infectious? And that is the public health question that we need to answer and
Michael Mina (06:05.120)
consistently ask during this pandemic. Are you infectious? Am I infectious? Because it's only
Michael Mina (06:11.680)
when we know that we're infectious that we can be empowered to not mistakenly infect others.
Michael Mina (06:19.200)
The PCR test is a little different. And we can go into the pros and cons, but one of the major
Michael Mina (06:28.560)
differences is that a PCR test gets a lot of... A lot of people talking about the PCR test say it's
Michael Mina (06:36.000)
much more sensitive. And at an analytical level, it is. It can detect one molecule instead of
Michael Mina (06:44.640)
100,000. But for public health, we don't want a test that can detect one molecule. In fact,
Lex Fridman (06:52.640)
that has created a net negative for public health. We just want to know, am I infectious?
Lex Fridman (06:58.560)
And to know that question, to know if I'm infectious, I only need a test that is going
Michael Mina (07:04.240)
to be positive if I have a high viral load, like a million. And the virus grows so fast,
Michael Mina (07:10.800)
it will grow from zero to a billion in a day. So you don't really need, even on the front end of an
Michael Mina (07:16.640)
infection, you don't need better sensitivity. If the trade off is that you don't get the result
Michael Mina (07:21.760)
for one, two or three days, you absolutely want a rapid result that can tell you, yes,
Michael Mina (07:27.760)
you're infectious, you're transmitting to others right now. And I'm going to give you the result
Michael Mina (07:33.760)
right now. So it is a much more effective tool because it's fast, because it's accessible. We
Michael Mina (07:38.720)
can use them in the home. And there's some issues with using them at home. We can talk a little bit
Michael Mina (07:43.680)
about what those issues are, like reporting and how do you use everything on the honor system if
Michael Mina (07:49.440)
you have a test that you're taking at home and you use it to go to work. But they can be accessible.
Michael Mina (07:55.520)
PCR has to go into a lab. It takes a lot of time for somebody to get a PCR test. They either have
Michael Mina (08:00.560)
to go online and order it. It takes the next day for it to come back. They swab themselves,
Michael Mina (08:04.960)
they ship it out the next day, and then they get a result two days later. That's four days minimum
Michael Mina (08:10.480)
for the most part. And at that point, you're not even infectious, even if you did happen to be
Michael Mina (08:15.040)
infectious when you first ordered the test. So it's really the speed of these tests and the
Lex Fridman (08:20.000)
accessibility and distribution of them that makes them so immensely powerful.
Lex Fridman (08:23.520)
So you have this like amazing graphic you tweeted. It's exactly what you're saying,
Michael Mina (08:28.720)
which is rapid antigen test answers the question, am I currently infectious? And you have, I think,
Michael Mina (08:36.000)
a comparison of seven different tests based on the viral load. And based on the viral load across
Lex Fridman (08:43.920)
these different tests, you look at the likelihood of infectiousness. So what does this graphic show?
Michael Mina (08:50.400)
We can overlay that for people. I think it's just really nice and really clear.
Michael Mina (08:54.960)
Yeah. So what that's showing is that we can never ask what's the sensitivity of a test and just let
Michael Mina (09:01.360)
that be the answer. That's what the FDA does currently. And that question doesn't mean
Michael Mina (09:06.160)
anything. We have to say, what is the sensitivity of the test to detect what? And so we can have
Michael Mina (09:12.560)
different viral loads. For example, you can have a viral load of one or you can have a viral load
Michael Mina (09:18.320)
of a trillion. And a PCR test will tell you that you are positive regardless of whether it's one
Lex Fridman (09:25.760)
or a trillion. Now, so we can't ask the question, how sensitive is a rapid test compared to PCR?
Michael Mina (09:33.520)
Because that covers the whole gamut. What we really want to say is, how sensitive is the rapid test
Michael Mina (09:38.000)
to detect me if I am infectious? And that gets to about 97% or so sensitive. If the question is,
Lex Fridman (09:46.960)
how likely is it to detect me if I'm a super spreader? That's a really important one to be
Michael Mina (09:51.120)
able to detect. They're all about 100% sensitive. So if you have extraordinarily high viral loads
Michael Mina (09:56.720)
to the point where you might be a super spreader, these simple rapid tests will essentially always
Michael Mina (10:01.600)
catch you and tell you you're positive. And then as you go down the line, if you're no longer
Michael Mina (10:06.960)
infectious at all, then these rapid tests might have a 0% sensitivity compared to PCR.
Lex Fridman (10:14.400)
But that's actually a good thing. The FDA and others look at it as though it's a bad thing
Michael Mina (10:19.200)
because they average it all together and say, oh, this is only a 40% sensitive test compared to PCR.
Lex Fridman (10:26.160)
But that's not the right way to look at it. You want to say, well, out of all of the samples,
Lex Fridman (10:30.080)
how many of them were not transmissible? How many were mid, moderate, high, extremely high,
Michael Mina (10:34.640)
super spreader? And you should at the very least create a weighted average based on
Michael Mina (10:38.480)
transmissibility potential. We don't do that. And that's why nobody in America has these tests,
Michael Mina (10:44.160)
because that's why they're very rare. Because we have slowed down their authorization because of
Michael Mina (10:50.560)
that misunderstanding that they don't have to be 80% or 90% sensitive compared to any time PCR
Michael Mina (10:56.880)
positivity. They need to be 80% or 90% or more if you're infectious. And for that question,
Lex Fridman (11:03.760)
they're like 95% up to 100% sensitive when you're most infectious.
Lex Fridman (11:08.240)
So when you have a lot of virion particles in you, that's what it means when you say viral load,
Michael Mina (11:14.720)
that means you're going to be very infectious. The more you have, the more infectious you are.
Lex Fridman (11:18.960)
And this test is basically very good at detecting when you're very infectious.
Lex Fridman (11:25.760)
Why don't we have rapid at home tests? You said there's a bit of confusion. FDA is involved.
Michael Mina (11:33.200)
You've talked about, you continue to talk about that these at home tests are classified as,
Michael Mina (11:40.560)
I guess, medical devices. And so because of that, FDA is looking at them differently
Michael Mina (11:47.440)
than they probably should be looked at. So what's the problem here? Can you sort of explain
Lex Fridman (11:54.880)
what does it mean to be a medical device? Why is that an issue? Where is the FDA messing up?
Lex Fridman (11:59.360)
So when we declare something as a medical device and we evaluate as a medical device,
Michael Mina (12:05.840)
then it makes sense that the comparison, if you're trying to get a new one onto the market,
Michael Mina (12:11.600)
that the comparison would be against a gold standard medical device for that purpose.
Lex Fridman (12:17.040)
So PCR is currently the gold standard, or at least in the eyes of the FDA,
Michael Mina (12:24.640)
the PCR test is the gold standard medical device. And that's because it's so sensitive.
Michael Mina (12:33.280)
As a physician, I have one patient in front of me at a time. And that patient comes to me and I
Michael Mina (12:39.280)
don't have to care about the 99.9999% of people in the world who are not in front of me. I only
Michael Mina (12:47.120)
care about that one patient. And so when I get a sample from that patient and that patient's saying,
Michael Mina (12:51.920)
Doc, I don't feel well. I haven't been feeling well for the last few weeks. Do you think this
Michael Mina (12:56.480)
is COVID? Well, for that question, I want to have the absolute best sensitivity test,
Michael Mina (13:04.080)
regardless of what it means for transmissibility, because my patient isn't sitting in my office
Michael Mina (13:08.800)
saying, Doc, do you think I'm infectious? They're saying, Doc, do you think I have recently been or
Michael Mina (13:14.080)
am infected? And these are totally different things. One is medicine. And if the patient's
Michael Mina (13:20.320)
infected, the time isn't of the essence because they're sitting there in my office. I can say,
Michael Mina (13:24.720)
look, I'm sorry you're not feeling well. Let's get a PCR test on you. We'll be able to tell
Michael Mina (13:29.680)
you if you have any evidence that there has been recently an infection inside of you.
Lex Fridman (13:35.920)
And you'll get the results in a couple of days. And it might be expensive. And so insurance is
Michael Mina (13:41.760)
going to pay for it. And you're just one person. And so I don't really care how many resources it
Michael Mina (13:46.480)
takes to get you this answer. On the other hand, there's public health testing. And public health
Michael Mina (13:53.120)
testing has to account for all of the people you're not seeing as well as the person you're
Michael Mina (13:59.520)
testing at the moment. So accessibility becomes a central theme. Frequency of tests, it has to
Michael Mina (14:05.840)
account for all the days that you're not sitting there in front of your doctor's office getting a
Michael Mina (14:10.160)
test as well as the one you are. So it has to say how frequently. What if you're infected tomorrow,
Lex Fridman (14:15.280)
but you're at the doctor's office today getting a negative COVID test? That PCR test at the doctor's
Michael Mina (14:20.880)
office today is going to do nothing to let you know that you get exposed and infected tomorrow.
Lex Fridman (14:26.160)
The only way to know that is to be testing yourself frequently.
Lex Fridman (14:31.440)
And the reason it matters is that these tests can be accessible if we are okay with saying
Lex Fridman (14:37.440)
the real purpose of a public health test is to answer the question, am I infectious?
Michael Mina (14:42.800)
The reason we want to answer that is if you're infectious, that's when you isolate. We actually
Michael Mina (14:47.680)
don't want to isolate PCR positive individuals who are no longer infectious. That's bad public
Michael Mina (14:56.880)
health practice. If I haven't been infectious for three weeks, I don't want to have somebody tell
Michael Mina (15:01.680)
me that I need to go and isolate for 10 days just because I happen to use a PCR test today,
Michael Mina (15:08.080)
three weeks after I was infectious. And furthermore, I definitely don't want the public
Michael Mina (15:13.600)
health agency to come and round up all the people I was with last night and say, you guys have to
Michael Mina (15:18.320)
quarantine for 14 days because you were with Michael who wasn't infectious yesterday.
Michael Mina (15:23.840)
It's nonsensical to do that. And it's a huge disincentive to actually get tested. That's
Michael Mina (15:29.200)
exactly right. Huge disincentive to get tested. People, if it's too sensitive, especially with
Michael Mina (15:33.840)
flights, things like that, we shouldn't be stopping people from taking a flight if they haven't been
Michael Mina (15:39.760)
infectious for 60 days. And to be clear, people are only infectious for somewhere between three
Lex Fridman (15:46.480)
and seven days, but can be positive on a PCR test for 30 to 70 days. So, I mean, it's potentially
Michael Mina (15:54.800)
a tenfold difference in terms of how long you're PCR positive versus how long you're infectious.
Michael Mina (16:00.400)
So, we don't want to be taking people during those 30 to 70 days and saying you need to isolate just
Michael Mina (16:05.520)
because you go and get a swab, or you can't go on your trip just because you had COVID last month.
Michael Mina (16:11.280)
That's not good use of a test. So, the reason we don't have these tools right now is because
Michael Mina (16:20.080)
when we evaluate a rapid test as a medical device, the FDA says, well, this has to achieve
Michael Mina (16:28.240)
the properties that we expect from a medical device, which again, doesn't have to take time
Michael Mina (16:34.400)
into account, doesn't really have to take cost or resources or scalability or access into account.
Michael Mina (16:39.520)
It only takes sensitivity and specificity to catch molecules. And so, just by definition, I mean, it
Michael Mina (16:48.400)
is a mathematical fact, you know, that if you have a perfect public health test for COVID, which means
Michael Mina (16:55.280)
that it would be 100% sensitive and 100% specific for contagious people or for the infectious stage
Michael Mina (17:03.760)
of an infection, then it literally can't, it is an impossibility for that test to achieve an 80%
Michael Mina (17:13.440)
sensitivity at a population level against a medical device, which is what the FDA asks for.
Lex Fridman (17:19.040)
And that's because you're only infectious for maybe 20%. So, theoretically, it should only have
Michael Mina (17:26.160)
a 20% sensitivity against the PCR while still being a perfect medical, a perfect public health
Michael Mina (17:33.040)
test. And the test is answering the question, am I infectious? That's what you're testing for,
Michael Mina (17:37.280)
not for the exact counting of the virion particles in your system. That's exactly right. Okay. So,
Lex Fridman (17:43.200)
why are we still here? So, have you had conversations with folks? You said that there's a
Michael Mina (17:50.960)
bunch of leaders that are kind of starting to wake up to this idea, but why is this taking this so
Michael Mina (17:58.000)
long? Why don't we still have hundreds of millions of at home tests? The reason it's taking long,
Michael Mina (18:06.240)
the reason it's taking long, I think, is because every agency and government is generally deferential
Michael Mina (18:15.040)
to the FDA. And in this context, I would argue that government hasn't been particularly creative.
Michael Mina (18:24.000)
So, for example, last year, when Trump was still president, I would, or in the transition,
Lex Fridman (18:29.680)
and I recall talking to the White House a number of times and saying,
Michael Mina (18:32.800)
here's a plan to give us our lives back. I think that was actually the title of the Atlantic
Michael Mina (18:37.760)
article. And this plan can stop shutdowns, it can stop outbreaks, it can allow society to keep
Michael Mina (18:45.360)
running and could have prevented the outbreaks of last winter and fall and saved hundreds of
Michael Mina (18:51.920)
thousands of lives. So, when I bring that to the White House or to the government, the federal
Michael Mina (18:57.760)
government, whoever it might be, and I say, here's a plan, this would work. They say, what I get back
Michael Mina (19:03.760)
is, this sounds really interesting, Michael. It looks like it checks out. But there's one problem,
Michael Mina (19:09.360)
we don't have the test, there's no scale. And that's kind of where it all dropped. It's like
Michael Mina (19:13.840)
this defeatist attitude of like, don't have the test, so we can't act on it. But now it's really
Michael Mina (19:20.880)
changing. Well, and so that's really where things have been. And so nobody's paid attention. It's
Michael Mina (19:25.200)
always been this like esoteric thing that, yeah, maybe one day we'll get around to it, but really
Michael Mina (19:30.240)
it's not that important. And the pandemic's going away. But this was like 100% predictable, everything
Michael Mina (19:36.400)
that's happening today. We predicted it last year. It's not, this isn't like rocket science or
Michael Mina (19:41.360)
anything. The variants and all those kinds of things. So the FDA, we can start to understand
Lex Fridman (19:46.160)
why, but also like one question I want to ask, is it possible to go around the FDA?
Lex Fridman (19:52.240)
Yeah. So why has the FDA not changed? And why has nobody tried to push the FDA to change?
Michael Mina (1:00:00.000)
Exactly. The problem that I have with that vaccinate or test idea is it's great if you
Michael Mina (1:00:05.440)
want to use it as a coercive effort to get people vaccinated. I'm not going to wade into that
Michael Mina (1:00:12.160)
argument. Do I agree with it or not? I'm just not going to even put my words under.
Michael Mina (1:00:17.840)
I disagree with it. Let me say, I disagree. As opposed to doing great science communication,
Michael Mina (1:00:25.360)
this weird, people talking down to the populace as if they're children trying to trick them.
Michael Mina (1:00:31.600)
Here, have some candy. Everyone with common sense. Somebody told me I was having a conversation.
Michael Mina (1:00:40.240)
If the government is going to give you money to take the vaccine,
Michael Mina (1:00:43.840)
people that were already hesitant about the vaccine are not going to trust whatever the
Michael Mina (1:00:49.680)
heck you're doing. Don't trick people into taking the vaccine. Be honest and communicate
Michael Mina (1:00:54.080)
transparently everything that's known about the vaccine. Communicate the data. Inspire people with
Michael Mina (1:01:04.480)
transparency and real communication of all the uncertainty around it and all the difficult
Michael Mina (1:01:10.320)
decisions of risk and all those kinds of things. As opposed to trying to trick them like children
Michael Mina (1:01:16.320)
into taking the vaccine anyway. Yes. Okay. Well, I didn't have to say that.
Lex Fridman (1:01:22.480)
So there we go. But you're saying it should not be like vaccinate or test. That tradeoff
Michael Mina (1:01:28.880)
does not make sense. Exactly. By saying vaccinate or test is absolutely confusing
Michael Mina (1:01:35.920)
because it implies for anyone who's thinking about it, it is implying. And I've seen this
Michael Mina (1:01:40.480)
because I have business leaders call me, Fortune 500 business leaders who call me and say,
Lex Fridman (1:01:44.960)
what do I do? I have 8,000 employees. Where am I going to get my tests? And a lot of people are
Michael Mina (1:01:50.080)
saying, they're calling this a pandemic of the unvaccinated. These types of divisive language
Michael Mina (1:01:58.240)
doesn't help. This isn't a pandemic of the unvaccinated. This is a pandemic of a fucking
Michael Mina (1:02:02.480)
virus. Don't ever put it on the unvaccinated who frankly are just scared. They don't know who to
Michael Mina (1:02:09.120)
trust. And we haven't given them a lot of reason to trust public health, to be frank. So I agree.
Michael Mina (1:02:17.440)
I mean, now that you've opened the door, I'll just say my piece. Absolutely, we need to be the most
Michael Mina (1:02:22.800)
honest we can with all of this. This is confusing language to say vaccinate or test. We need to be
Michael Mina (1:02:30.400)
very upfront and say, look, vaccines aren't stopping transmission very well. Unfortunately,
Michael Mina (1:02:37.840)
this is the world we have. We have Delta. We're going to have new mutants. We have a vaccine that
Michael Mina (1:02:43.120)
wanes somewhat over time. This is biology. I'm sorry. This is just what it is. And then we say,
Lex Fridman (1:02:50.560)
but the vaccines are really protective for your personal health. They're going to keep you out of
Michael Mina (1:02:55.280)
the hospital. This is what you should care about as an individual. And as a population,
Lex Fridman (1:03:01.280)
we need to figure out, okay, we have to stop transmission if that's our goal.
Lex Fridman (1:03:05.760)
So we should use the tools that are going to stop transmission if that's our goal. And saying
Michael Mina (1:03:09.440)
vaccinate or test, if our goal is to actually stop transmission, that's confusing because vaccines are
Michael Mina (1:03:15.120)
not stopping it. There may be mildly lowering the risk of transmission. So I'm just not a fan of that
Michael Mina (1:03:22.880)
language. I think we should be being very, very clear, like you said, and upfront about what are
Michael Mina (1:03:26.880)
the limitations of the vaccine and of the test. And we should be very clear that it can only help.
Michael Mina (1:03:34.560)
The American public in aggregate is extremely intelligent. They will figure out when you say
Michael Mina (1:03:41.920)
that vaccine breakthrough cases are rare, and then they start seeing story after story of whole
Michael Mina (1:03:47.840)
parties of people who are vaccinated have outbreaks. And everyone knows more people now
Michael Mina (1:03:52.480)
who are having breakthrough cases than they knew who had regular cases before the vaccine.
Michael Mina (1:03:57.120)
People start to wonder, hmm, well, this is weird. They say that the vaccines are working,
Michael Mina (1:04:02.160)
breakthrough cases are rare. Maybe the whole vaccine program is failing entirely.
Lex Fridman (1:04:06.240)
And so it ends up shooting ourselves in the foot if we try to create false expectations,
Michael Mina (1:04:11.680)
because we think it's going to be beneficial for one thing when it's not for the other.
Lex Fridman (1:04:16.720)
And so to get back to the action plan, vaccinate or test, I think, and the increase in rapid tests,
Michael Mina (1:04:25.920)
I do think it was a bold move. I would say that it was the most prominent sort of display,
Michael Mina (1:04:33.600)
encouraging display of the fact that rapid tests are indeed effective public health tools.
Michael Mina (1:04:40.720)
My real concern now is that 280 million tests, that's like less than one per person per year
Michael Mina (1:04:46.880)
in the United States. So that's not the way that he said and delivered it. And what most people
Michael Mina (1:04:52.480)
think of when they hear the word 280 million, you don't usually put a lot of thought into,
Lex Fridman (1:04:56.000)
what does that number mean? It sounds a big number. Most people are now going to be expecting
Michael Mina (1:05:01.040)
that these tests are actually going to be staying in stock on the shelves at CVS and Walgreens and
Michael Mina (1:05:06.320)
Amazon or whatever. So that's crisis number one is like, now the expectation is set for having rapid
Michael Mina (1:05:13.120)
tests, but they're not going to scale that well. We won't have them. And then there's vaccinate or
Michael Mina (1:05:18.160)
test. And that's going to bring millions and millions of people who are not currently testing
Michael Mina (1:05:23.600)
to have to start testing. So that's going to overwhelm our PCR labs. And it's going to create
Michael Mina (1:05:28.400)
five day delays again with PCR, if not longer, because we'll have backlogs. And so the only real
Michael Mina (1:05:34.800)
solution to this is to just scale up the tests that are actually scalable. And that's the simple
Michael Mina (1:05:39.920)
rapid tests. And it's not even to scale them up through production and manufacturing here.
Michael Mina (1:05:44.560)
It's to open the doors so that the companies that already exist here and can scale are allowed to do
Michael Mina (1:05:50.240)
it and to bring in the international market. Some of the biggest diagnostic companies in the world
Michael Mina (1:05:56.160)
are not selling their millions and millions and millions of tests in the billions of tests in the
Michael Mina (1:06:00.640)
United States because they don't want to play the game that the FDA is currently requiring of them.
Lex Fridman (1:06:07.840)
So we have an opportunity and I am very encouraged that the president actually did put these into the
Michael Mina (1:06:12.640)
action plan. And I do want to say for the record that I'm supportive of it in principle. But I
Michael Mina (1:06:18.880)
think now we actually are in the time where it has been set and we have to deal with the crisis before
Michael Mina (1:06:25.840)
it happens. Otherwise, there could be some real political points taken off. I do worry that the
Michael Mina (1:06:32.160)
president, if he doesn't pull through with this and really make the tests available and we end
Michael Mina (1:06:36.080)
up getting into this other test crisis this fall, there could be political consequences to that.
Lex Fridman (1:06:41.360)
And the reason is these rapid tests are so personal, they become emotional almost.
Michael Mina (1:06:46.480)
They give people that empowerment that I was talking about earlier. And when people can't get
Michael Mina (1:06:51.360)
that because the shelves are out of stock, they actually feel frustrated and then that converts
Michael Mina (1:06:57.360)
into anger and blame. And so I do think that we have to be really smart about making a policy
Michael Mina (1:07:04.560)
like this and then ensuring that we can carry through with what the average American is actually
Michael Mina (1:07:09.600)
expecting. And speaking of politics, one of the great things about testing, maybe you can correct
Michael Mina (1:07:16.560)
me, but from my sense, it's one of the only solutions to COVID that has not yet been politicized.
Lex Fridman (1:07:23.440)
So masks and vaccines, whether you like it or not, have been heavily politicized where there's
Michael Mina (1:07:30.640)
literally a red blue split on the use of those or like proud use, effective use of those tools.
Lex Fridman (1:07:42.000)
And it seems like everybody I talked to about testing, everybody's on board, red or blue.
Michael Mina (1:07:47.680)
They are, which is why I am particularly concerned about the vaccinate or test policy.
Lex Fridman (1:07:53.840)
Because all of a sudden we just politicized it. We just
Michael Mina (1:07:56.720)
brought it with this thing that was fully bipartisan, really bipartisan. I mean, I've
Michael Mina (1:08:01.360)
talked to the fully, the really right side of Congress and the super liberal side of Congress,
Michael Mina (1:08:08.080)
the Senate, the same politicians, governors everywhere in this country have asked me for
Michael Mina (1:08:14.880)
support around these rapid tests because it's just, you can have it reported or not. You can
Michael Mina (1:08:20.160)
have it in the home, in the privacy of your own home or not, or you do it at school.
Lex Fridman (1:08:24.240)
And these tools are just so powerful to identify infectious people. They didn't have to be
Michael Mina (1:08:29.280)
politicized. They still don't. I don't think that the action plan went so far that it's going to
Michael Mina (1:08:34.080)
politicize them. But I do think already it's starting to conjure up emotion saying, well,
Michael Mina (1:08:39.360)
now I have to get tested. The have to part, right. And that is where we go wrong. I have to get
Michael Mina (1:08:46.960)
we go wrong. I have to get tested or vaccinated. Screw that. I am independent, whatever. And
Michael Mina (1:08:57.360)
I do worry that this thing that was purely bipartisan, that we could have just scaled
Michael Mina (1:09:02.240)
up months ago. People would have, we could have delivered it to every household. Didn't even have
Michael Mina (1:09:05.760)
to ask people to request it. Just delivered packages to every home in America by now easily.
Lex Fridman (1:09:12.160)
And if we were smart about it, you know, we could have done it. The most unpleasant thing about
Michael Mina (1:09:17.600)
COVID is the uncertainty. And that's what leads to fear on both the vaccine hesitant,
Michael Mina (1:09:24.560)
is the uncertainty about the vaccine and people who have taken the vaccine, the uncertainty around
Michael Mina (1:09:32.080)
like, am I in danger walking around? Can I go, can I walk down the hall? Like this fear of the world
Michael Mina (1:09:38.240)
around you. And I think testing allows you to remove a lot of that uncertainty. Like you,
Michael Mina (1:09:45.040)
you gain back confidence that you can operate in this world and not get infected and you become
Michael Mina (1:09:50.640)
like a nicer person. I find myself every time I get tested, I become a nicer person to others
Michael Mina (1:09:56.560)
because I know I'm not putting them in danger. I'm not putting people in danger.
Michael Mina (1:10:00.800)
It's a, it's a heavy burden to carry to worry. Am I infectious? Like I was out last night,
Lex Fridman (1:10:07.760)
but I do want to go see my mom today, you know, like, am I infectious? I don't know. And this has
Michael Mina (1:10:12.320)
created massive anxiety and I can't, I completely agree that it is, it's a relieving feeling and,
Lex Fridman (1:10:22.160)
and it's an amazing feeling to be in a room when, and I did this in the middle of the pandemic when
Michael Mina (1:10:27.520)
everyone was supposed to be wearing a mask indoors and everyone rapid tests, you know, and I said,
Michael Mina (1:10:34.000)
everyone should rapid test before you walk into this room. And it was a wonderful experiment
Michael Mina (1:10:40.640)
because everyone was just so relaxed. You know, the other, the alternative is everyone, nobody
Michael Mina (1:10:46.960)
tests and everyone wears a mask. You have a mask that maybe gives you 20% maybe protection during,
Michael Mina (1:10:54.800)
if you're all in the same room together, if that, or you have a rapid test program where everyone
Michael Mina (1:10:59.920)
rapid test before, and that gives you like 95% to a hundred percent protection, not a hundred
Michael Mina (1:11:04.960)
percent, but close. And all of a sudden that allows everyone to take a big sigh and be like,
Michael Mina (1:11:10.560)
wow, this is the first time I've seen people without masks indoors in a long time. And I feel
Michael Mina (1:11:15.520)
pretty good. And restaurants, like restaurants are scary right now because you just don't know
Michael Mina (1:11:20.160)
who might be infectious and nobody's masked. And like, wouldn't it be great to just go into
Michael Mina (1:11:27.520)
a restaurant where you know that everyone just tested negative that day? It just really reduces
Michael Mina (1:11:32.800)
anxiety. It makes individuals feel empowered. And I mean, at the end of the day, COVID and
Michael Mina (1:11:39.760)
our response to COVID is a, it's truly an information problem. You know, why do we
Michael Mina (1:11:45.760)
quarantine anyone? Why did we ever close anything down? We didn't close things down because everyone
Michael Mina (1:11:49.840)
is positive. We closed things down because we didn't know if anyone was positive. We quarantine
Michael Mina (1:11:56.000)
a whole classroom of kids, not because they're all positive, but because we don't know if one
Michael Mina (1:12:01.120)
of them are positive. And so we just quarantine everyone when there's a positive in the case,
Michael Mina (1:12:05.760)
in the, in the classroom, like one day, we'll then ask the whole classroom not to come to school for
Michael Mina (1:12:09.600)
10 days. That's not a biological problem. That's an information problem. And the crazy thing is we
Michael Mina (1:12:17.600)
have the tool to solve that information problem. It's literally our eyes on the virus. It's how
Michael Mina (1:12:23.520)
we see this virus. And if everyone glowed green, when they were infectious, we would have never
Michael Mina (1:12:27.760)
had to close down anyone, any society. And we would have never had the outbreaks because we
Michael Mina (1:12:31.760)
would have been able to stay away from the green people, you know? And yeah, I like what you said,
Michael Mina (1:12:36.480)
the quarantine is an information problem. That's absolutely right. What, is there something you
Michael Mina (1:12:40.560)
can say to what people can do, like listening to this, individuals? Do you just complain like
Michael Mina (1:12:48.160)
loudly? Like, why can't we do this? Can you speak with your money somehow? What, what can people do
Michael Mina (1:12:55.040)
to help? God, it's, it's amazing to think you're asking me this question and this video will go
Michael Mina (1:13:01.680)
out to, you know, the web and all the people that watch you. And last year in July, maybe
Michael Mina (1:13:08.880)
something like that, June, I forget exactly when it was, I was on Twiv this week in virology.
Michael Mina (1:13:14.400)
Shout out to Twiv. Those guys are awesome. They are awesome. I love, I love Twiv.
Lex Fridman (1:13:19.120)
And they asked me the exact same question towards the end. They said, this makes so much sense. You
Michael Mina (1:13:23.680)
know, why wouldn't we do this? What can people do? And so I said, oh, you know, just send me an email,
Michael Mina (1:13:29.040)
like write to me. I'm sure you could find my email somewhere online and get in touch and I will,
Michael Mina (1:13:35.120)
you know, and we can try to figure out how to make something happen. Bad idea.
Lex Fridman (1:13:41.280)
Very smart.
Michael Mina (1:13:43.440)
Way too many emails. I didn't, I feel bad because I didn't end up getting back to anyone because I
Michael Mina (1:13:47.280)
just got inundated. But it did lead to the development of rapidtest.org where we did
Michael Mina (1:13:53.280)
automate the process of writing letters to congressional members and elected representatives.
Lex Fridman (1:13:59.440)
So that helps. Fast forward to today. What can, what can people do? I honestly don't know. Like,
Lex Fridman (1:14:07.760)
what can the average person at this point do? We have tried everything. The FDA is immutable on
Michael Mina (1:14:13.360)
this. They will not change and we shouldn't ask them to change because they have decided that this
Michael Mina (1:14:19.200)
is how they regulate medical devices and they're going to stick to it. So what we need to do,
Lex Fridman (1:14:23.440)
what we need to do, and maybe this is something to do, is get, if you know people who have sway
Michael Mina (1:14:31.120)
over politicians, lobbyists, whatever it might be, let people know to request that the president,
Michael Mina (1:14:37.520)
literally the president of the United States, uses executive powers to just do a simple,
Michael Mina (1:14:45.360)
something as simple as designating these powerful public health tools as public health tools.
Michael Mina (1:14:50.800)
Allow the CDC and the NIH or whomever it must be or academic centers of excellence designated by
Michael Mina (1:14:58.080)
the CDC to evaluate the tests in a very fast fashion with the appropriate metrics that these
Michael Mina (1:15:05.360)
tests need to achieve for public health. And within two days we can have 10 new tests authorized.
Michael Mina (1:15:12.480)
You know, this doesn't have to be a six to 12 month endeavor. This could be a two day
Michael Mina (1:15:16.400)
endeavor. We actually did it. I judged the rapid test XPRIZE and it went great. We actually got
Michael Mina (1:15:22.880)
incredible metrics about how well does each test work and no clinical trials, you know,
Michael Mina (1:15:28.880)
just a couple days worth of work in the lab and boom. And if we actually systematize it,
Michael Mina (1:15:33.200)
it would be an hour or so in the lab. You know, so simple. So I don't know. I mean,
Michael Mina (1:15:39.280)
I don't know how to really impact change. Thankfully, you know, I have a platform and
Michael Mina (1:15:44.080)
I've been able to start talking with people who are very close to the President and the White
Michael Mina (1:15:49.840)
House. And I do think that some change is finally happening because the silver bullet of the vaccine
Michael Mina (1:15:57.360)
has not panned out to be the silver bullet. So now we got to now I think we're moving from a country
Michael Mina (1:16:03.440)
that was a vaccine only approach to finally recognizing at the highest levels that there's
Michael Mina (1:16:08.800)
other tools. Do you think it's possible to reopen fully without solving the testing problem
Michael Mina (1:16:15.200)
completely? Like, do you think this vaccine approach will get us to reopen fully? I do.
Michael Mina (1:16:22.320)
Yeah, I think over time, though. I mean, if we a lot of people ask me, like, what's what's like
Michael Mina (1:16:29.440)
happening? Like, what's the end game here? Like, where does this end? And it's actually not a
Michael Mina (1:16:36.800)
mystery. The end game is we will grow out of this virus. And by that, I mean, you and I
Lex Fridman (1:16:46.320)
and most people who are watching this are adults, right? Adults don't like to get infected with a
Michael Mina (1:16:53.920)
virus for the very first time as adults. Babies are OK with it. And so what we have to do to
Michael Mina (1:16:59.680)
understand how we're getting out of this virus is to look at babies like at newborns and say, OK,
Lex Fridman (1:17:06.400)
how does a baby get out of their high risk time period? They get exposed. They get exposed multiple
Michael Mina (1:17:12.320)
times or vaccinated, of course. And eventually they get exposed enough that they build up this
Michael Mina (1:17:18.320)
nice cushion of immunity that's sufficiently diverse that they can battle whatever gets
Michael Mina (1:17:22.720)
thrown at them because they've seen it all already. But one exposure doesn't do it. I mean,
Michael Mina (1:17:28.480)
over the course of the first few years of life, kids get exposed to coronaviruses tons of times,
Lex Fridman (1:17:33.600)
lots of different viruses they get. So unfortunately, what's happening with us,
Lex Fridman (1:17:37.600)
why this is so bad for us, is that as we're adults, we don't regenerate tissue very well.
Michael Mina (1:17:43.040)
We have like overabundant inflammatory response. We have all these problems that when we get an
Michael Mina (1:17:47.120)
infection for the first time, it sucks. It harms us. It causes us problems. But over time, just
Michael Mina (1:17:53.120)
like a baby, we're going to start building up our immunity through vaccines and exposures.
Lex Fridman (1:17:58.320)
And I hate to say it, but tons of people are getting exposed to Delta right now who don't
Michael Mina (1:18:03.280)
know it. Tons. And if you're vaccinated, you don't know it, is my point there. And at the end of the
Michael Mina (1:18:12.400)
day, this is actually, I do not want this to be misconstrued as like saying, go get infected.
Lex Fridman (1:18:18.080)
But the fact that people are getting infected will add to our level of protection later on.
Lex Fridman (1:18:23.360)
And so... Yeah, but the question is how long that whole process takes. I think, you know,
Michael Mina (1:18:28.480)
my guess is probably by the end of next year, early 2023, we will probably start looking at
Michael Mina (1:18:34.640)
this as though it is not a particularly dangerous virus for most people. The elderly though,
Michael Mina (1:18:39.200)
it will still be, but that's because their immunity... Variants and stuff. And I've heard
Michael Mina (1:18:43.920)
other people say the statement you just said a year ago about the spring, right? Well, that
Michael Mina (1:18:50.080)
probably was not wise. Well, I mean, it's because the intuition is like, okay, now that there's a
Michael Mina (1:18:56.880)
vaccine, you're either going to take the vaccine or get infected and then there'll be herd immunity
Michael Mina (1:19:01.680)
over, like it'll be very quick. So, you know, that's the intuition, but it seems like that's not
Michael Mina (1:19:09.120)
happening. It seems like we're in this constant state of fear mongering for different reasons.
Michael Mina (1:19:16.320)
It's almost like the virus got deeply integrated, not into just our biology, but
Michael Mina (1:19:24.080)
in the game of politics and in the fear mongering around the news because the virus now started
Michael Mina (1:19:31.920)
being together with the vaccine and the masks and it started getting integrated into the division
Lex Fridman (1:19:39.200)
and that's so effective at monetizing social media, for example. And so it's like, all right,
Lex Fridman (1:19:47.200)
so how do you get out of that? Because you can always kind of present certain kinds of numbers
Michael Mina (1:19:52.480)
about number of cases or how full hospitals are and start making claims about that we're still,
Michael Mina (1:20:01.280)
this is as bad as it's ever been, those kinds of statements. And so I'm not sure exactly what the
Michael Mina (1:20:06.640)
way out is except the same way out as it was originally, which is testing is information.
Lex Fridman (1:20:13.440)
Yeah.
Michael Mina (1:20:13.920)
It's information.
Michael Mina (1:20:15.200)
Yeah. And I think we can do that. We can keep outbreaks suppressed with testing because it's
Michael Mina (1:20:21.040)
information. Like people keep thinking of tests as being medical things. They're not,
Michael Mina (1:20:24.160)
they're information. It can allow us to control things. Just like we drive down a road and we
Michael Mina (1:20:31.760)
look at the cars and we don't hit other cars because we have the information that they're
Lex Fridman (1:20:35.360)
in the lane next to us and they're moving over. That's just information.
Michael Mina (1:20:39.520)
Like you said, glow green. The problem with the virus, you don't see. You're walking around
Lex Fridman (1:20:45.280)
and everybody is a potential infectious creature. And so if you see the world as a potential for
Michael Mina (1:20:54.960)
infection, you're going to be terrified of that.
Michael Mina (1:20:56.880)
That's exactly right. And that is what has happened. And that's why I've been pushing so
Michael Mina (1:21:01.360)
hard for these tests because they can allow people, if you use them at a community level,
Michael Mina (1:21:06.880)
you can have enough people know that they're positive, enough people are good people that
Michael Mina (1:21:10.160)
they won't go out and infect others. And the other great thing about them is again,
Michael Mina (1:21:15.280)
a 10 day isolation period, especially for a vaccinated person, but in either case,
Michael Mina (1:21:21.440)
is also an information problem. We don't have to isolate for 10 days if we're infected. What if
Michael Mina (1:21:26.960)
we're only infectious for two, especially if we're vaccinated? Why are we telling people the only
Michael Mina (1:21:31.520)
reason the CDC ever and the WHO ever suggested a 10 day isolation or a 14 day quarantine is because
Michael Mina (1:21:38.240)
we didn't know when people stopped being infectious. There's actually some people stay infectious for
Michael Mina (1:21:43.040)
14 days. It's rare. But there's a lot of people who stay infectious for like four. And that's
Michael Mina (1:21:48.720)
a whole nother week that we're asking people to isolate. People would probably be much more likely
Michael Mina (1:21:53.600)
to comply if they only had to isolate as long as they wake up each morning and see two lines,
Michael Mina (1:21:58.800)
because you're actually seeing it for your own two eyes. You're being empowered to make your
Michael Mina (1:22:02.880)
own decision. You're not being told you need to isolate for 10 days and you're sitting there
Michael Mina (1:22:06.880)
thinking, oh, I feel fine. I don't know. There's a lot of asymptomatic spread. But if you see the
Michael Mina (1:22:11.760)
two lines every day, then you actually get to, you're doing a little experiment for yourself to
Michael Mina (1:22:18.000)
prove to yourself, today I'm still infectious. Let's hope it's tomorrow. Come on immune system.
Michael Mina (1:22:23.200)
You can do this. And then you get to day four and boom, you start being negative.
Michael Mina (1:22:28.160)
That's a much more tolerable thing because you are being able to make that decision based on
Michael Mina (1:22:34.640)
true data that is empowering you. And it really does change, changes everything,
Lex Fridman (1:22:40.320)
because it's all fear and empowerment and these are empowering devices.
Michael Mina (1:22:46.560)
Well, I wanted to have this conversation with you because obviously it's a great solution.
Lex Fridman (1:22:50.800)
Let's keep talking about it. People who will listen to this should,
Michael Mina (1:22:55.120)
I guess, pressure local politicians, federal, national politicians.
Michael Mina (1:23:01.200)
Write articles with the title like, Dear POTUS, please designate these as public health tools.
Michael Mina (1:23:08.160)
Or just start talking about it in the media. Talk about it on social media, anywhere.
Michael Mina (1:23:12.080)
Testing is a public health good. Testing is a public health good. It should not be considered
Michael Mina (1:23:18.640)
a medical device. I shouldn't have to pay to keep you safe. Testing should generally be free
Michael Mina (1:23:26.320)
for that matter, subsidized by the government. These tools exist. We should all... And I think
Michael Mina (1:23:32.160)
the more people that generate noise to just say, a public health test is a public health tool.
Lex Fridman (1:23:40.160)
Period. You can't even argue with it. That's just true.
Michael Mina (1:23:43.600)
Yeah. I think if you talk about it enough, then certain people that have even a bigger platform,
Michael Mina (1:23:49.600)
like Elon Musk, Sunder Prachai, those folks that have power to really do large scale manufacturing,
Michael Mina (1:23:58.640)
also influence governments, will pay attention. And that's the hope. Enough people talk about it.
Michael Mina (1:24:04.960)
I think business leaders, like business leaders, obviously have so much power here.
Michael Mina (1:24:09.440)
Yeah. They pay the lobbyists who make things
Michael Mina (1:24:13.600)
happen. Let's be honest. There's people who pull levers that are not the politicians themselves.
Lex Fridman (1:24:17.600)
And I do think business leaders have so much to gain from these tools to keep their businesses
Michael Mina (1:24:23.120)
safe, to not have to quarantine and lockdown. And I hope that all of them hear this message to say,
Michael Mina (1:24:29.360)
let's ask the president or the people around the president to designate these as public
Michael Mina (1:24:34.480)
health tools. Change the system. And if you can't change every aspect of the system,
Michael Mina (1:24:39.680)
then figure out how to change the system enough so that you're doing everything
Lex Fridman (1:24:43.840)
in a safe way that is not endangering anyone, but it is only protective.
Michael Mina (1:24:48.560)
Yeah. You mentioned last time that you spent time as a Buddhist monk.
Michael Mina (1:24:54.960)
We didn't spend much time talking about it. I just would love to talk to you about it a
Michael Mina (1:25:00.160)
little bit more. Maybe by way of advice, how do you recommend people can integrate
Lex Fridman (1:25:08.000)
meditation into their lives? Or how does one meditate?
Michael Mina (1:25:14.720)
I think for me, meditation was really an active effort, which sounds weird because most people
Michael Mina (1:25:26.000)
think of meditation as the absence of activity. But just like anything, meditation requires
Michael Mina (1:25:35.200)
exercise. In this case, it requires exercise and quieting your mind. And the whole... Well,
Michael Mina (1:25:42.800)
there's a lot of different reasons people meditate. Most people watching this podcast or this show,
Lex Fridman (1:25:49.440)
what is this called? I don't know.
Lex Fridman (1:25:50.960)
Is this an interview? I'm not even recording. This is
Michael Mina (1:25:53.360)
just you and I talking. It is. Most people are meditating to bring
Michael Mina (1:26:01.680)
some balance and bring some sanity to their life and just be able to control their feelings and
Michael Mina (1:26:06.720)
emotions a little bit more. And for that purpose, I think the best way to... What meditation is,
Michael Mina (1:26:14.560)
if you can call it what you will, it's just getting some alone time, some time to think
Michael Mina (1:26:18.800)
or not think. Whatever looks different for each person. For me, it was a very active effort to
Michael Mina (1:26:26.560)
try to quiet my mind with the explicit intent to detach from things, from lots of things.
Lex Fridman (1:26:34.800)
And it's actually... It sounds weird in our culture here to talk about detachment as a goal.
Michael Mina (1:26:41.840)
Detachment from loved ones, detachment from objects is easy to reconcile. People understand
Michael Mina (1:26:47.760)
that, yeah, I don't want to be too attached to my car or whatever. But detachment from
Michael Mina (1:26:52.320)
a loved one is a very hard thing because we want to do the opposite usually. We want to love a loved
Michael Mina (1:26:56.720)
one. But in a lot of Buddhist thought, it is those attachments that keep people in this cycle of
Michael Mina (1:27:05.920)
rebirth. Now, I don't personally believe in rebirth in a Buddhist sense in that you actually get
Michael Mina (1:27:18.240)
born multiple times. I think my personal feeling is we die and we're vanished. That's just me.
Lex Fridman (1:27:25.680)
But I still really found meditation to be extraordinarily powerful to feel control over
Michael Mina (1:27:36.480)
a whole different part of my body that I never thought that it could be controlled, your mind.
Michael Mina (1:27:42.640)
You close your eyes and most of us immediately start seeing blotches and we start thinking about
Michael Mina (1:27:50.640)
things. And it's an amazing feeling to start getting to the point where you can actually
Michael Mina (1:27:59.440)
quiet your mind and close your mind down so that you can just have peace, silence of your mind
Michael Mina (1:28:08.400)
for a long period of time. And I loved it. But it's kind of a dangerous slope because you can
Michael Mina (1:28:14.800)
kind of get caught up in it and really start going from, okay, I'm trying to quiet my mind
Michael Mina (1:28:19.840)
to almost being addicted to quieting your mind. And it was a very active exercise every day,
Michael Mina (1:28:25.200)
15 hours a day to just practice quieting my mind. And eventually I could. And in Buddhism,
Michael Mina (1:28:33.840)
there's a whole lot of stages that you go through too. Once you hit that point where you can quiet
Michael Mina (1:28:38.400)
your mind, then there's other psychological things that happen. And eventually the end goal for a
Michael Mina (1:28:47.600)
Buddhist monk who's spending their life meditating in the forest is to achieve nirvana, is to have
Michael Mina (1:28:54.160)
an absence of any attachment to the point where you're not even attached to your own foot or your
Michael Mina (1:29:00.080)
own leg. You can cut it off. So you don't even have an attachment to self, to ego? Do you feel
Michael Mina (1:29:09.520)
like a conscious being or no? Well, I never attained it, but I didn't really. So the goal
Michael Mina (1:29:16.560)
is you have to first look at it through the eyes of samsara, which is the cycle of rebirth,
Michael Mina (1:29:22.880)
which is suffering. It's a cycle of suffering is how it's viewed. And the idea is like,
Michael Mina (1:29:27.600)
if I really love this hat and then the hat gets lost, I'm sad. So that makes me suffer.
Lex Fridman (1:29:34.320)
And if I hate this hat and I see it, then it makes me sad or mad. And that is an emotion.
Lex Fridman (1:29:40.080)
But if I'm completely ambivalent about that hat, I don't care if it's there,
Michael Mina (1:29:45.360)
I don't care if it gets lost, if it's shredded, then that invokes no emotional rise out of me,
Michael Mina (1:29:52.080)
good or bad. And so the idea is to find the balance there where you are so detached from
Michael Mina (1:29:57.520)
everything that you're not getting a rise, negative or positive. And this is really,
Michael Mina (1:30:03.840)
it's really such a distinct thing in a relative to our normal lives here in America where we live
Michael Mina (1:30:13.840)
for rises. You want happiness and joy. And then you also, nobody wants sadness, but when you come
Michael Mina (1:30:20.400)
out of sadness, you feel happy. Either way it averages out. And if it doesn't average out,
Michael Mina (1:30:26.080)
then you're in a bad spot. That would be things like major depressive disorder where you're
Michael Mina (1:30:31.760)
truly not averaging out. But if you're living a pretty happy life, that's why there's no right
Michael Mina (1:30:36.080)
or wrong. You can go up and down and you average out or you can just go that straight line.
Lex Fridman (1:30:40.400)
So this is not necessarily the Buddhist ideal is somehow obviously the ideal you should strive for,
Lex Fridman (1:30:49.600)
but the actual exercise of meditation that the Buddhist monks use seems like a
Michael Mina (1:30:58.880)
great tool for becoming aware of your own mind. And that seems to be important for
Lex Fridman (1:31:06.560)
appreciating life. There's some kind of experiencing life on a deeper level.
Michael Mina (1:31:15.440)
I think so. I mean, that's my personal opinion is yes. And that I think it,
Lex Fridman (1:31:22.800)
I don't meditate anymore.
Michael Mina (1:31:25.680)
Back in the capitalist Western world where there's meetings.
Lex Fridman (1:31:30.640)
That's right. I mean, I stopped after I was a monk and then the tsunami hit
Lex Fridman (1:31:34.720)
and I lived in a refugee camp and that was the Indian Ocean tsunami in 2004. And it just really,
Lex Fridman (1:31:44.640)
it was really interesting in Sri Lanka. They wanted me, I asked, well, what can I do to help?
Michael Mina (1:31:49.600)
It was a horrible, horrible hell on earth experience in many ways. But when I said,
Lex Fridman (1:31:57.280)
what can I do to help? The answer was, well, you could meditate. That's how, keep doing what you're
Michael Mina (1:32:04.160)
doing. That's how we can get good karma. And to me, coming from Western roots, I just couldn't
Michael Mina (1:32:11.280)
deal with that. I just said that it doesn't make sense to me. Why would I just sit and meditate
Michael Mina (1:32:16.400)
when there's so much devastation happening here? And so I kind of stopped meditating then and then
Michael Mina (1:32:22.000)
never really recovered from that time in the refugee camp. But I do feel like I understand
Michael Mina (1:32:29.200)
or like I am aware of a part of me that most people never get the privilege to be aware of.
Lex Fridman (1:32:35.040)
And that is a pretty profound feeling, I think, or just awareness to say, if I ever need to go
Michael Mina (1:32:45.520)
back to that, I have the capacity to do that. And I do use it. I mean, I don't use it a lot,
Lex Fridman (1:32:51.440)
but I use it when I really need to, to try to settle myself, to actually calm myself, whether
Michael Mina (1:33:01.840)
it's pain, physical or emotional pain. It is possible to make those things go away, but just
Michael Mina (1:33:09.120)
like anything, it takes training. If you take yourself back to that place you were, Sam Harris
Michael Mina (1:33:18.080)
talks about that through his meditation practice, he's able to escape the sense of free will
Lex Fridman (1:33:25.280)
and the sense of agency. You can get away from that. Do you ever think about consciousness and
Michael Mina (1:33:33.200)
free will when you were meditating? Like, did you get some deep insight about the nature
Lex Fridman (1:33:40.640)
of consciousness that you were somehow able to escape it through meditation or no?
Michael Mina (1:33:46.240)
I looked at it in a much more utilitarian way, I think.
Michael Mina (1:33:52.400)
The sensation, like minimizing amount of thoughts in your mind and then beginning to really
Michael Mina (1:33:56.960)
appreciate the sensation. You weren't writing a book on free will.
Michael Mina (1:34:01.920)
Right. I mean, maybe if I kept at it, there's a good chance that if the tsunami didn't happen,
Michael Mina (1:34:08.160)
I might still be sitting there on the top of that mountain.
Michael Mina (1:34:10.960)
If there's tsunamis, you see pain, you see, especially if you see cruelty and you're
Michael Mina (1:34:17.920)
supposed to meditate through that, there's something in the human spirit that pushes us
Michael Mina (1:34:24.320)
to want to help. If you see somebody who's suffering, to react to that seems like to help
Michael Mina (1:34:30.000)
them as opposed to care less through meditation. Don't become attached to the suffering of others.
Michael Mina (1:34:36.960)
Exactly. I mean, that's, I do think that that's, you know, and they're two totally valid ways to
Michael Mina (1:34:43.440)
live life. They are, generally, I think they're ingrained in us pretty early in society.
Lex Fridman (1:34:50.320)
Right. And it's hard to escape.
Michael Mina (1:34:52.000)
Yeah.
Lex Fridman (1:34:52.640)
What about just in general, becoming detached from possessions, like minimalism in not having
Michael Mina (1:35:00.320)
many things. So, the capitalist world kind of pushes you towards having possessions and
Michael Mina (1:35:09.040)
deriving joy from more and more and better possessions. Have you returned back to the
Lex Fridman (1:35:15.760)
joys of that world or do you find yourself enjoying the minimalist life?
Michael Mina (1:35:21.360)
A little of both. I think I really don't like, I find things to be a burden, to be a massive
Michael Mina (1:35:30.320)
burden. And to me, when you have a burden like that, you know, even if it's just knowing that
Michael Mina (1:35:37.440)
there's like boxes in your basement of stuff, you know, whatever it might be, it makes it hard to
Michael Mina (1:35:43.520)
focus. And so, I personally like, I mean, my ideal, like if I had a, my house, for example,
Michael Mina (1:35:52.800)
would be to have like nothing on anything. And that to me is like peaceful. Some people find
Michael Mina (1:36:01.200)
that to be not peaceful. For me, it's like, I love to have the idea that if needed, I could like
Michael Mina (1:36:10.800)
pack up and move and not worry about anything. Do I actually have that in reality? No. We're
Michael Mina (1:36:19.440)
about to have a baby, you know, but it's like, I already see it, it's like stressful. There's
Michael Mina (1:36:24.640)
like boxes of stuff showing up at the house, like bottles and clothes and all these little
Michael Mina (1:36:30.720)
hats and whatnot. And I do have to like sometimes go into my meditation to just say like, this is
Michael Mina (1:36:39.360)
okay. You know, like it's okay to have all of this stuff. It's not permanent, you know. And, but I do
Michael Mina (1:36:49.040)
think that it's easy to get lost in it all. And it's important to remember given all that, like
Michael Mina (1:36:54.160)
people who buy houses, you know, buy a home and buy a house and make a home out of it. And you
Michael Mina (1:37:00.160)
start a family. It's easy to forget that even though you have all these responsibilities,
Michael Mina (1:37:05.840)
you're still free. And like freedom takes work and it takes remembering, it takes
Michael Mina (1:37:12.640)
meditation on it, but you're free. You're born free, you live free. I mean, depends of course
Michael Mina (1:37:18.880)
which country, but in the United States, even with all the possessions, even with all the burdens
Michael Mina (1:37:25.280)
of sort of credit and owing money and all those kinds of things, you can scale everything down
Lex Fridman (1:37:33.600)
and you're free. But ultimately the people you love, you love each other, it doesn't take much
Michael Mina (1:37:40.160)
money to be happy together. And for me, I personally value that freedom of having the freedom to
Michael Mina (1:37:47.600)
always pursue your happiness as opposed to being burdened by material possessions that, you know,
Michael Mina (1:37:55.360)
yeah, that basically limit your ability to be happy because you're always paying off stuff.
Michael Mina (1:37:59.840)
You always catch, you know, trying to match the neighbors that are always a little bit richer,
Michael Mina (1:38:04.320)
that kind of pursuit. I think that pursuit is wonderful for innovation and for building
Michael Mina (1:38:09.520)
cooler, better things. But on an individual level, I think you have to remember that,
Michael Mina (1:38:15.200)
first of all, life is finite. And second of all, like your goal is not to get a bigger house.
Lex Fridman (1:38:20.000)
Your goal is to be just content and happy in the moment.
Michael Mina (1:38:24.560)
I completely, completely agree with that. So in looking at our failure at scale
Michael Mina (1:38:32.880)
to engineer, to manufacture, to deploy tests, how do you feel about our prospect as a human
Michael Mina (1:38:42.080)
civilization? Are you optimistic? So this pandemic, it is what it is. It hurt a lot of people,
Michael Mina (1:38:51.840)
both it took lives, but it also hurt a lot of businesses and a lot of people economically.
Lex Fridman (1:39:00.400)
But there's very likely to be a much worse pandemic down the line. There might be other
Lex Fridman (1:39:05.600)
threats to human civilization. Are you nevertheless optimistic?
Michael Mina (1:39:10.800)
Oh, I don't think I'm optimistic about it at all, I think.
Lex Fridman (1:39:14.320)
What are you most worried about?
Michael Mina (1:39:15.440)
It's one of those things, it's so existential that I don't worry about it. But I do think,
Michael Mina (1:39:23.520)
I mean, in the United States, for example, so you asked about the human civilization,
Lex Fridman (1:39:27.840)
but let's talk about like American society for a moment. I do think that we're probably seeing
Lex Fridman (1:39:35.920)
the end of a really interesting experiment, like the American experiment,
Lex Fridman (1:39:39.680)
and we're seeing its limitations. We're probably going to become another blip,
Lex Fridman (1:39:44.080)
like another power that's in the history books that like rose and collapsed.
Michael Mina (1:39:48.800)
Probably that's where we'll go. In terms of civilization, I think we're demonstrating a
Michael Mina (1:39:55.600)
pretty significant inability to recognize the danger, whether that's the pandemic or whether
Michael Mina (1:40:03.280)
that's climate change. I think it's extraordinary that we are not taking these things seriously.
Lex Fridman (1:40:12.800)
Yeah.
Lex Fridman (1:40:13.680)
And we're not acting with the urgency. And I mean, in some ways, climate change
Michael Mina (1:40:20.240)
truly makes like this pandemic look like child's play in terms of like the destruction it has the
Michael Mina (1:40:26.560)
potential to wreak. I tend to think if you just look at the progress of human history,
Michael Mina (1:40:32.480)
that the people who do good in the world outpower the people that do bad in the world.
Lex Fridman (1:40:41.840)
So there's something about our minds that likes to focus on the negative, like on the destructive,
Michael Mina (1:40:49.120)
because we're afraid of it. It's also, for some reason, more fun to watch destruction.
Lex Fridman (1:40:56.640)
But it seems like the people who build, who create solutions, who innovate, and who just put
Michael Mina (1:41:06.160)
like both on the emotional level, so love out there and like on the actual engineering level,
Michael Mina (1:41:12.880)
tools that make for higher quality of life. I think those win out if you look at human history.
Lex Fridman (1:41:19.120)
But the question is whether the negative stuff can sometimes peak to the level where everybody's
Michael Mina (1:41:24.400)
just destroyed. But as long as that doesn't happen, I tend to believe that there'll be like
Michael Mina (1:41:30.640)
a gradual, with some noise, a gradual improvement of quality of life in human civilization.
Michael Mina (1:41:37.360)
I do think so, to a certain extent. But it's that what you said, like unless there's like some
Michael Mina (1:41:43.440)
significant peak of bad, you know, the problem with bad is that it can happen like that, you know,
Michael Mina (1:41:50.640)
good. You can't build a society overnight, but you sure can kill one. Like I just think about
Michael Mina (1:41:58.000)
food crises and instability and just, I don't know. But I do hope that, I mean, I completely agree. I
Michael Mina (1:42:03.840)
think we can engineer our way to a healthier, better world. Like I truly do. My concern is that
Michael Mina (1:42:14.160)
the people who are doing that until very recently don't generally rule the world. Now, of course,
Michael Mina (1:42:21.040)
we're seeing non elected leaders and, you know, people who run massive corporations essentially
Michael Mina (1:42:31.040)
having as much or really more power than elected leaders, or than kings and queens and such. So how
Michael Mina (1:42:37.680)
they choose to wield that power, you know, is an interesting choice. And I do hope that you're
Michael Mina (1:42:42.640)
right in that over time, fear will drive companies to produce a better product or whatever, you know,
Michael Mina (1:42:52.640)
something like over time, it's just like predator prey models. You get so bad or so everything like
Michael Mina (1:42:59.120)
it's so revved up that all of a sudden, something cracks and they say, okay, I do want an electric
Michael Mina (1:43:04.080)
car or whatever. And that takes some combination of innovation, letting people know that you're
Michael Mina (1:43:10.800)
an innovation, letting people know that these electric cars exist. It's kind of rapid test too.
Michael Mina (1:43:15.440)
Like you get to finally feel it and see it, have an electric car. And then all of a sudden things
Michael Mina (1:43:20.960)
change and everyone says, oh, this is so bad. And actually I'm doing good for the world, relatively
Michael Mina (1:43:25.200)
speaking. And, you know, I guess the paradigm shift, it becomes a, for lack of a better word,
Lex Fridman (1:43:32.320)
viral positivity does. And I mean, I believe that ultimately that wins out
Michael Mina (1:43:39.120)
out because I think there's much more power to be gained. So I think most people want to do good.
Lex Fridman (1:43:46.160)
And if you want to wield power, you want to channel people's desire to do good.
Lex Fridman (1:43:54.160)
And I think over time that's exactly what people will do. But yeah, this, I mean, both on the
Michael Mina (1:44:01.200)
natural side, the pandemic, you know, there's still biology at play. There's still viruses
Michael Mina (1:44:05.520)
out there trying to kill us. There's accidents. There's nuclear weapons. There's unintended
Michael Mina (1:44:10.720)
consequences of tools, whether it's on the nanotechnology side or the artificial intelligence
Michael Mina (1:44:16.000)
side. Then there's the natural things like meteors and all that kind of stuff and the climate change,
Michael Mina (1:44:23.920)
all of that. But I tend to think we humans are a clever bunch. And when there's a deadline,
Michael Mina (1:44:30.000)
a real deadline or a real threat before us, we kind of step up. I don't know, but maybe you have
Lex Fridman (1:44:37.120)
to believe that until the very end. Otherwise life's not as fun.
Michael Mina (1:44:43.600)
Yeah, that's right. I mean, we'll have to see, I guess. Well, ideally we won't be alive to see that.
Michael Mina (1:44:50.800)
Well, no, Michael, I'm glad we talk again because this has been such a difficult time
Michael Mina (1:45:00.800)
that feels like there's no solutions. And it's so refreshing to hear that there's a solution
Michael Mina (1:45:08.960)
to COVID. And there's an engineering solution on the individual level, something people can do.
Michael Mina (1:45:14.720)
On the government level, it's something people can do. On the global level, something people can do.
Michael Mina (1:45:19.920)
We should be doing rapid testing at scale. It's obvious. It's amazing that you still
Michael Mina (1:45:27.360)
are telling that story, pushing that message bravely, boldly. I really,
Michael Mina (1:45:34.000)
really appreciate the work you're doing. And I will do in my small way the same to try to help out
Lex Fridman (1:45:41.680)
and everybody else should too until we get hundreds of millions of tests in people's hands.
Michael Mina (1:45:47.040)
It's an obvious solution. We should have had it a long time ago. And I like solutions, not problems.
Lex Fridman (1:45:56.400)
And this is obviously a solution. So thank you for presenting it to the world and thank you for
Michael Mina (1:46:00.880)
talking about it. It's something that I can't not do. If it saves one person's life, then it was
Michael Mina (1:46:07.360)
worth the two years of lobbying for this. And so let's hope we see a change. Thanks for talking today.
Lex Fridman (1:46:15.360)
Absolutely.
Michael Mina (1:46:17.680)
Thanks for listening to this conversation with Michael Mina. To support this podcast,
Michael Mina (1:46:21.840)
please check out our sponsors in the description. And now, let me leave you with some words from
Michael Mina (1:46:27.280)
Lord Byron. Always laugh when you can. It is cheap medicine. Thank you for listening and hope to see
Lex Fridman (1:46:35.840)
you next time.
Michael Mina (20:01.520)
I think what the real reason is the FDA has one job around these tests and it is to authorize
Michael Mina (20:08.880)
them as medical devices. They haven't been charged with doing anything else. So in their eyes,
Michael Mina (20:14.800)
they're doing exactly what they're supposed to do. They're evaluating these tests as medical
Michael Mina (20:20.880)
devices and they're telling company after company after company, sorry, you don't make the cut.
Lex Fridman (20:26.560)
And the only way to make the cut is really to kind of skew your clinical trials to favor
Michael Mina (20:31.600)
the rapid test being positive, which isn't really good practice. We shouldn't be trying to
Michael Mina (20:36.080)
skew clinical trials. But that's kind of what's happened. It's been forced upon the companies to
Michael Mina (20:43.200)
do that. And so I think the FDA truly believes from the bottom of their heart that they are
Michael Mina (20:48.560)
doing the right thing here. And I would argue that to an extent they are. I've been pretty
Michael Mina (20:53.680)
hard on the FDA, but maybe the issue is a higher level issue. Like the in vitro diagnostics
Michael Mina (21:00.400)
division is they get applications and they evaluate them and the applications are for
Michael Mina (21:04.800)
medical claims. That's however, because there's been a misunderstanding of these tests and
Michael Mina (21:10.960)
the companies only know to apply for these as medical claims because there's nothing else in
Michael Mina (21:18.080)
this country to apply for except the medical claim. So we don't have a public health pathway
Michael Mina (21:24.800)
to evaluate a test and authorize a test. It doesn't exist. We have defunded and devalued
Michael Mina (21:30.720)
public health for so long that we literally don't have a language for it. We don't have laws,
Lex Fridman (21:36.000)
a language, words. Is it called a public health test? Is it called something else?
Michael Mina (21:40.960)
I call it a public health test because I'm trying to create a new definition here,
Lex Fridman (21:45.760)
but that's why nobody's acted because everyone says, well, there's no other pathway. So the FDA
Michael Mina (21:53.040)
in vitro medical diagnostics division is the only pathway. So what I am trying to do is to say, look,
Michael Mina (22:01.200)
the FDA very clearly states that they do not authorize or review public health tools
Lex Fridman (22:09.120)
and they don't authorize or review public health tests for COVID. So what I want the president of
Michael Mina (22:17.280)
the United States to do is to utilize executive powers and take an executive action that can
Michael Mina (22:24.000)
simply state like one line. One line could potentially change all of this. And it's a pretty
Michael Mina (22:31.200)
obvious and simple line. And it is that any tools used for public health testing during this public
Michael Mina (22:39.840)
health emergency will be designated as public health tools. Like it's obvious, like it's public
Michael Mina (22:47.120)
health emergency. It's a tool used for public health that should be designated as a public health
Michael Mina (22:51.040)
tool. If we can do that, if we can get that language out there so that that's the president's
Michael Mina (22:57.760)
decision, then all of a sudden the FDA is off the hook. They're not trying to cram a square peg
Michael Mina (23:05.120)
through a round hole. They can say, look, the antigen tests are not on us anymore. At least if
Michael Mina (23:11.680)
they're going to be used for public health, like when you test a thousand people at a time or test
Michael Mina (23:16.800)
a school classroom if they've been exposed, this is public health. And so then the CDC could take
Michael Mina (23:23.120)
it over. The CDC could say, okay, what are the metrics we are interested in? And they could say,
Michael Mina (23:30.080)
we're interested in a test that can catch you if you're infectious. So you want high viral load
Michael Mina (23:34.160)
detection. That's fast, that's scalable. And hey, if your test has been used in Europe for months
Lex Fridman (23:40.880)
and has performed extremely well, then we'll give you a certificate by right immediately. And that
Michael Mina (23:47.920)
could actually get hundreds of millions of additional tests into the United States tomorrow.
Lex Fridman (23:54.480)
So you need some kind of classification from an FDA or from somebody to call it a public health
Michael Mina (23:59.200)
tool in order for it to be manufactured. Is it possible to just go around all of this and just
Michael Mina (24:04.400)
for somebody to manufacture at scale tests? Well, if you did that and you just called them,
Michael Mina (24:11.920)
you put a claim on them that called them public health tools, the FDA has a very
Lex Fridman (24:19.120)
weird view of this and they will tell you that it's illegal, that it's a crime.
Lex Fridman (24:24.800)
Is there a way to say like Elon Musk did with the flamethrower, it's not a flamethrower?
Michael Mina (24:29.520)
Yeah. Believe me, I've tried to think of all the different approaches. There's major
Michael Mina (24:38.480)
inconsistencies here. So it's not like we don't have a precedent for a public health test even
Michael Mina (24:42.720)
during this pandemic. There is a very strong precedent. Pooled testing, we have companies
Michael Mina (24:50.000)
like Ginkgo based out here in Cambridge that are working with 100 different labs around the country.
Lex Fridman (24:57.920)
So that might mean like not a ton of quality control over those labs. I don't want to say
Michael Mina (25:04.480)
that they don't, I'm just saying the reality is if you're working with that many labs,
Michael Mina (25:07.840)
it's hard to say, they're running pooled testing of millions and millions and millions of kids.
Lex Fridman (25:15.040)
So here you have a company that's testing in each pool five to 25 kids at a time,
Michael Mina (25:22.880)
millions of kids in a pretty distributed way across the country in all these different labs
Lex Fridman (25:28.480)
and the FDA doesn't care at all. You don't need an EUA. It doesn't need a regulatory authority.
Michael Mina (25:33.520)
It's collection on site. It's getting shipped to a lab. There's no oversight of it. So why does
Michael Mina (25:40.720)
that have no oversight but a rapid test for the exact same purpose? You're just giving people
Michael Mina (25:47.280)
immediate results instead of two day delayed pooled PCR results. So it's a much more effective tool.
Lex Fridman (25:53.680)
Why is the rapid test used for the same purpose, not designated as a public health tool, but
Michael Mina (25:58.960)
requiring FDA authorization? It's a ridiculous reason and it's because the FDA says that if
Michael Mina (26:07.520)
a test, and this is actually CMS that says this and the FDA adopts it, if a test alters your
Michael Mina (26:17.120)
behavior, if you get a single result and it's going to alter your behavior, then that is a
Michael Mina (26:22.400)
medical device. But the thing that I find ridiculous is like, okay, but you can give a
Michael Mina (26:29.520)
pooled test that alters 25 people's behavior at once and that's not falling, like that's more
Michael Mina (26:35.680)
risky. One person turns positive in the pool and 25 people have to be quarantined.
Lex Fridman (26:42.720)
And how do they evaluate the accuracy? So for people who don't know, pooled test
Michael Mina (26:47.040)
is you're testing a small fraction of the people. And if one of them is positive,
Lex Fridman (26:54.240)
then you basically say, we have to retest everybody in the pool.
Michael Mina (26:57.680)
Yeah. So you take, let's say you have a school and each classroom you might have 20 kids each swab
Michael Mina (27:03.760)
their nose in a classroom and all those swabs go into a single tube. And then you rinse that tube
Michael Mina (27:09.440)
out with some saline and you run a PCR test on that tube of 25 samples, 20 samples. And so if
Michael Mina (27:16.240)
that tube turns positive in the PCR test, then all 20 or 25 of those students are now having
Michael Mina (27:23.840)
to quarantine. And if there's no positive, then all 20 or 25 students are interpreting that their
Michael Mina (27:31.280)
result is negative. So it really is ridiculous decision by the FDA to say that if the test itself
Michael Mina (27:40.080)
only tests one sample at a time, it's medicine because it will tell you one person at a time,
Michael Mina (27:44.960)
if you're positive or if you're negative. But if you do it as a pool and you tell 25 people that
Michael Mina (27:51.600)
your pool was negative, then that's somehow different. That's public health, not medicine.
Lex Fridman (27:58.240)
There's no logic there. Was it just personalities and
Michael Mina (28:00.880)
accidents of history or something like that? For example, you talk about the public health
Michael Mina (28:06.240)
tools and CDC, you look at masks. So masks were decided to somehow be an effective tool
Michael Mina (28:12.880)
to help with the pandemic. So I'm sure the evidence that was used there was probably not
Michael Mina (28:20.080)
as strong as the evidence supporting antigen rapid tests. I was very much reading a lot of research
Michael Mina (28:26.000)
on masks. It's tricky. It's really tricky to show how well they stop the transmission of a virus,
Michael Mina (28:31.920)
especially when you don't fully understand how the virus is transmitted or the viral load required,
Michael Mina (28:36.720)
all that kind of stuff. But then the CDC pretty quickly decided masks or whatever,
Michael Mina (28:41.440)
there's some oscillations back and forth, but then they quickly decided, everybody decided
Michael Mina (28:47.360)
masks is a good tool. So masks being decided a good tool and then rapid antigen tests,
Michael Mina (28:53.760)
not a good tool. Is that just like certain personalities who didn't speak up in a meeting
Michael Mina (28:58.880)
or who did speak up in a meeting? Is this just like a weird roll of the dice or is there a
Michael Mina (29:03.120)
better explanation? I think it's somewhat of a roll of the dice, but I also think it's that testing.
Lex Fridman (29:09.760)
So doctors don't pretend to really understand much about fluid dynamics and how well masks are
Michael Mina (29:20.960)
working. That's way out of their realm. Doctors do believe that they understand all aspects of
Michael Mina (29:28.400)
the tests. And so the greatest barriers to rapid tests being brought to market or being rolled out
Michael Mina (29:39.680)
heavily and supported as public health tools, the greatest barriers came from physicians saying,
Michael Mina (29:47.600)
hell no, we can't use a test that's not as sensitive as a PCR.
Lex Fridman (29:51.120)
And look at what happens if you use this antigen test and not a PCR test. You get people who are
Michael Mina (29:58.800)
showing a positive on a PCR and negative on an antigen. And they just assume that that was a
Michael Mina (30:05.520)
false negative on the antigen. For public health, I would call it a false positive on the PCR test.
Lex Fridman (30:12.000)
But this type of thinking literally does not exist in medicine. And I think the biggest problem here
Michael Mina (30:18.960)
is that we placed physicians in decision making power. When this pandemic hit, everyone called up
Michael Mina (30:28.320)
clinical laboratory folks and microbiologists and physicians to ask, well, what kind of test should
Michael Mina (30:34.640)
we use, that kind of thing. And there is no training in medical school for this kind of
Michael Mina (30:40.960)
public health work. You have to optimize on the right qualities of a test that have nothing to
Michael Mina (30:47.760)
do with medicine. And then sometimes, if not frequently, they're actually at odds. And I'll
Michael Mina (30:54.000)
give an example why the physicians, you could see why the physicians would have been against it from
Michael Mina (30:59.440)
their perspective. And they say, if a physician is a TSA agent at the airport, you know, a TSA agent,
Michael Mina (31:08.720)
their role at any given time, and the role they think that the instruments need to play is I want
Michael Mina (31:14.720)
you to scan the bag as well as possible. This is the only bag that I'm interested in at the moment.
Lex Fridman (31:20.640)
And this is my lane, this is my bag. I want to make sure that my instrument's doing, I don't want
Michael Mina (31:26.560)
the crappy instrument in my lane, I want to make sure that I'm doing everything I can. But what
Michael Mina (31:32.000)
those TSA agents don't have to worry about is, well, how many other instruments are there in this
Michael Mina (31:36.720)
airport? Is anyone getting through the lines here without going through security? The average TSA
Michael Mina (31:42.000)
agent doesn't have to worry about that. They literally have one job to do, and it's pay
Michael Mina (31:45.600)
attention to this lane. If there's a big gap in the security line and people are flowing through
Michael Mina (31:52.160)
without going through security, that's not on the TSA agent. That's not a big systematic problem of
Michael Mina (31:56.800)
that of the system. And we can't expect that TSA agent to have ever even thought about that. Like,
Michael Mina (32:04.480)
that's not on them. They were trained to look at the bag. And that's kind of like physicians.
Michael Mina (32:09.760)
That's kind of like physicians. And probably some physicians will hear this and feel like I'm
Michael Mina (32:15.280)
insulting it. I don't mean to be likening the two professions or anything like that. But the point
Michael Mina (32:20.560)
is that a physician has one duty. Do no harm to this patient. Time is an of the essence. Scale,
Lex Fridman (32:28.960)
how many tests can my hospital perform in a day? How many tests can my county or country perform
Michael Mina (32:35.440)
in a day? That's not a physician's training to think like that at all. And so what has happened
Michael Mina (32:42.720)
is doctors got on board early and said, oh, hell no. We've seen these antigen tests before. They're
Michael Mina (32:47.680)
not particularly sensitive compared to PCR. And early in the pandemic, there was like pissing
Michael Mina (32:52.560)
matches between labs who had the most sensitive PCR. And it just distracted everything. I was
Michael Mina (33:00.720)
trying to say pretty early, like, we don't need sensitivity. We just need frequency. We just need
Michael Mina (33:06.560)
scale. We need to think differently because our only goal if we're doing frequent routine testing
Michael Mina (33:12.000)
of asymptomatic people is not medicine. It's to say, do you need to isolate now? And if you have
Michael Mina (33:17.360)
a PCR test that's taking three days to return and you're like, if I was currently spreading virus
Michael Mina (33:23.200)
before I walked in here and you handed me, this actually happened to me today when I walked into
Michael Mina (33:27.920)
Harvard. Today was my first day back into Harvard since February of 2020. I go in, I scan my badge
Lex Fridman (33:35.040)
and they hand me a PCR tube and they say like, return this by noon or something before your work
Michael Mina (33:42.560)
day is done. And I'm looking at it. I'm like, what is this going to do? Like, what if I'm super
Michael Mina (33:48.480)
spreader right now? You're giving me free reign to walk around and infect everyone in the school
Lex Fridman (33:52.960)
and you're going to give me my result to tell me I did that in two days from now? It doesn't really
Michael Mina (33:58.960)
make sense. So who is supposed to be, so it's understandable that doctors kind of feel that way,
Michael Mina (34:04.720)
just like you said, do no harm. Who's supposed to care about public health? Is it the FDA? Is there
Michael Mina (34:12.960)
some other organization yet to be created? Is it like, just like with the military, the reason we
Michael Mina (34:19.040)
have civilian leadership when you talk about war, is it the president that's supposed to do like
Michael Mina (34:25.520)
override FDA, override doctors, override and basically politicians in representing the people
Michael Mina (34:32.080)
in the state of emergency make big public health decisions? Like who is supposed to do it? Besides
Michael Mina (34:37.920)
you on Twitter. It's like most people really thinking about solutions to COVID will mention
Michael Mina (34:45.360)
you or will mention this idea of rapid at home testing. And it's, you watch that happening,
Michael Mina (34:53.440)
this discussion that this is an obvious part of the solution and the solution is not happening.
Lex Fridman (34:57.920)
So who is supposed to implement this idea? I think the CDC that it should start there.
Michael Mina (35:04.080)
Override the FDA? Well, I don't even think it needs to override it. And that's why I think
Michael Mina (35:08.880)
these should just be designated as a different tool so that the company is, it's not overriding.
Michael Mina (35:14.400)
It's just saying, look, this isn't even, this isn't in your jurisdiction to the FDA. This is
Michael Mina (35:19.200)
just a public health tool. But the problem is the centers for Medicaid, Medicare services
Michael Mina (35:25.280)
designates any tool, just like FDA, they designate these as medical devices purely because they could
Michael Mina (35:31.200)
change somebody's behavior based on the result of one test. So to change that at this point,
Michael Mina (35:37.360)
unless you can get CMS buy in, you know, we don't have, there is no designation as a public health
Michael Mina (35:42.320)
tool, but the president can just say, these are public health tools. These are not to be
Lex Fridman (35:50.960)
regulated as medical devices if their goal is not medicine, but public health.
Lex Fridman (35:55.520)
And if he does it, he does have the authority to do that as president and to say, I'm tasking the CDC
Michael Mina (36:03.440)
to certify these tests or, or authorize them for use in the United States. And, you know,
Michael Mina (36:08.880)
he has to say something like that. He can't come out and say, these are public health tools, have
Michael Mina (36:14.080)
free reign, just, you know, any company start, start shipping them in the US because that would
Michael Mina (36:19.200)
create pandemonium and we'd have a lot of bad tests. But there's a lot of really good tests
Michael Mina (36:25.120)
out there. We just are taking like six to 12 months to run trials. They're failing because
Michael Mina (36:30.960)
they can't keep up with PCR. And if the president were to do this, then the CDC could take it over
Lex Fridman (36:37.920)
and they could say, okay, it's on us. We're going to decide. The UK actually did this. They,
Michael Mina (36:44.320)
early on, they said, okay, they laid out a very clear regimen. They said, this is how we are going
Michael Mina (36:49.680)
to evaluate rapid antigen tests because they're public health tools. They did it in a, in a domain
Michael Mina (36:56.080)
that was outside of their normal medical diagnostic regulatory agencies. And they, they literally just
Michael Mina (37:02.000)
had a very fast screening to say, what are the best tests? They went through a huge number of
Michael Mina (37:08.720)
different tests and they said, okay, these are the, this is the rank order of which tests are good,
Michael Mina (37:12.480)
which are bad, which are scalable, which are not. And they were able to start deploying them in
Michael Mina (37:18.320)
weeks, not years. So I think the CDC really needs to take charge. The problem is when it comes to
Michael Mina (37:24.080)
like law, if everyone currently perceives this as like fully within the domain of the FDA and they've
Michael Mina (37:31.440)
never heard of such enough public health test idea enabling, but the, but the FDA itself has created
Michael Mina (37:39.040)
the idea by saying we don't regulate public health tools. So the word is out there. The FDA has said,
Michael Mina (37:45.360)
we don't regulate them. So that gives the president an opportunity to say, okay, these are
Michael Mina (37:51.200)
those, you know, these are public health tools by definition. And, and I do think that this is a kind
Michael Mina (37:57.440)
of a crisis and it's a crisis of testing, but it's also a crisis of like, really, we're going to go
Michael Mina (38:02.480)
through this whole pandemic and never figure this thing out. That's just really sad. You know, if we
Michael Mina (38:08.080)
get through this and don't figure out how to evaluate a rapid test. So how do vaccines
Michael Mina (38:15.200)
play with this? So one of the things that when people discuss solutions to COVID, there's a
Michael Mina (38:22.000)
sense that once you have a vaccine COVID is solved. So how does that interplay? Like, why do we still
Michael Mina (38:29.680)
need tests if we have vaccines? Yeah, I actually wrote an op ed in New York times or Wall Street
Michael Mina (38:36.880)
Journal or something that was titled why we still need rapid tests with vaccines. And the real reason
Michael Mina (38:44.880)
is because we have evaluated our vaccines based on their ability to stop disease. In fact, most of
Michael Mina (38:51.520)
the trials didn't evaluate them based on their ability to stop transmission. They didn't even
Michael Mina (38:57.120)
evaluate that at all, no less put it as one of the metrics for authorization. And with a virus like
Michael Mina (39:04.960)
this, it would be a bit naive to think that it's really going to stop transmission well.
Michael Mina (39:12.240)
I think a lot of excitement happened right after the first clinical trials. And I'm sure we were
Michael Mina (39:17.120)
talking about it when I was last here, I would imagine given the timing. But those first clinical
Michael Mina (39:22.000)
trials came out and everyone jumped for joy that these things were going to be the end to this
Michael Mina (39:27.440)
pandemic. But we had really short sighted vision there by not recognizing two main features. One is
Michael Mina (39:35.680)
that they might not stop transmission. Another, I guess three, another is that new variants might
Michael Mina (39:41.600)
come around that will break through the vaccine protective immunity. And the third is that we were
Michael Mina (39:48.640)
measuring the efficacy of these vaccines during the peak of their performance in the first few
Michael Mina (39:54.160)
months after people got vaccinated. And that gives a skewed view of just how effective these are going
Michael Mina (39:59.200)
to be long term. So what happened with the vaccines is that everyone got very comfortable,
Michael Mina (40:05.600)
including the CDC saying, if you've been vaccinated, this is the end of the pandemic for
Michael Mina (40:10.880)
you. And let's keep it up. But then Delta comes along and waning immunity comes along. And both
Michael Mina (40:17.280)
of these things compound exactly as anticipated to get breakthrough cases. And unfortunately,
Lex Fridman (40:24.880)
what we're seeing now is the CDC and the administration went so all in on saying that
Michael Mina (40:30.720)
breakthrough cases are rare, that transmission doesn't really happen if you're vaccinated
Michael Mina (40:35.360)
without great data, especially with Delta, that once people started seeing breakthrough cases,
Michael Mina (40:41.600)
they started interpreting that as a failure of the vaccine. The vaccines are still working to
Michael Mina (40:46.560)
keep people out of the hospital for the most part, but they're not working to stop transmission.
Lex Fridman (40:53.360)
And if our goal is to stop transmission, which until we decide as a society that we have different
Michael Mina (41:00.560)
goals, like we're okay with people getting ill and letting transmission go because we don't want
Michael Mina (41:06.560)
to worry about it anymore. We're not there yet. So until we decide that we're not going to stop
Michael Mina (41:10.880)
transmission, we need other avenues besides the vaccine because it's not doing it. It also means
Michael Mina (41:16.960)
that herd immunity isn't going to happen. And unfortunately, as long as we keep letting spread
Michael Mina (41:21.840)
happen in the context of vaccinated people, we're kind of giving this virus a bootcamp
Michael Mina (41:27.520)
of exactly what it needs to do and mutate to get around our vaccine derived antibodies.
Lex Fridman (41:33.840)
And that makes me very nervous. So the more we can do to stop spread
Michael Mina (41:38.240)
in the unvaccinated, in the elderly vaccinated, and in other people,
Michael Mina (41:43.200)
the better. We just should be focusing on that. So in your eyes, the solution would look like this.
Lex Fridman (41:49.360)
You would make enough tests where every single person will get tested every single day?
Michael Mina (41:53.600)
I think that that would be... I don't want to do that actually. I want to do a variation on that.
Michael Mina (42:00.240)
I think what we should do is have a dynamical testing program. It doesn't have to be
Michael Mina (42:06.880)
complicated. Every household has a box of tests in their cupboard. And if you haven't seen any
Michael Mina (42:14.080)
cases in your community for a long time, stop testing. Do wastewater testing to see if there's
Michael Mina (42:19.680)
any RNA coming back. If you start to see RNA in the wastewater that represents the virus,
Lex Fridman (42:25.360)
and you're still wanting to stop outbreaks, you say, hey, you know those tests that are in your
Michael Mina (42:30.160)
cupboards, households in this county, why doesn't each household or each person in each household
Michael Mina (42:35.360)
use one test per week? Can you start to just pause on that idea? That's really cool, the wastewater
Michael Mina (42:44.160)
testing. That's the thing? So you can get a sense of how prevalent the virus is in a particular
Michael Mina (42:49.920)
community by testing the wastewater? That's exactly right. And so the viral load associated,
Michael Mina (42:56.160)
the viral load that you can find in the community represents the prevalence of the virus in the
Michael Mina (43:02.400)
community, which is really quite nice. That's a nice way to paint like a map of the intensity
Michael Mina (43:08.800)
of the virus. Okay, so when it goes above a certain level, you can start doing much higher
Michael Mina (43:17.600)
frequency testing in each household. That's right. So I don't want people to be in testing purgatory,
Michael Mina (43:23.680)
like that's not what I want. I just want us to get through this damn pandemic. And so we can
Michael Mina (43:29.280)
monitor the wastewater or any other methods. We can monitor the hospitals and the clinics. And
Michael Mina (43:34.880)
if somebody does come in with COVID like symptoms, and then a few other people come in,
Michael Mina (43:38.320)
you realize, okay, we got spread happening in our community. Send out a text message,
Michael Mina (43:43.120)
put it on the news, put in the newspaper, whatever you need to do, tell people, tell families,
Michael Mina (43:48.080)
use your test. And if the cases get worse, because you're just doing it once a week,
Michael Mina (43:53.120)
that's not going to stop transmission, but it's going to enable you to identify where outbreaks
Michael Mina (43:58.320)
are happening. If you start to find outbreaks in pockets, then the rule is simply, okay,
Michael Mina (44:03.840)
let's squash the outbreak real fast. So everyone in that area in certain zip code or whatever it
Michael Mina (44:08.400)
might be, test every two days for seven days or every day for seven days, and you'll get rid of
Michael Mina (44:15.440)
the outbreak. We can do that. And if you've now gone, again, a week or two with no cases
Michael Mina (44:23.120)
identified, stop the testing again. That's the nice thing that everything changes when people
Michael Mina (44:28.960)
have the tests in their home. It becomes dynamic. It can become easy. You send a text message,
Michael Mina (44:35.120)
take your test today. If some people don't do it, that's fine. The only goal is to get R below one,
Lex Fridman (44:41.280)
and you stop the outbreak. People think it has to be near perfect. I always hear people say,
Michael Mina (44:48.080)
oh, what if somebody doesn't use it? Or what if somebody lies? Well, you have 98% of people
Michael Mina (44:54.240)
testing or even 50%. That's a whole lot better. And another big difference that people, I think,
Michael Mina (45:00.160)
oftentimes have a problem wrapping their head around, especially to an extent physicians who
Michael Mina (45:07.360)
are used to different kinds of metrics, is that all we have to do to completely stop an outbreak
Michael Mina (45:14.720)
from spreading in a community is to get, for every 100 infected people, to get them to go on
Lex Fridman (45:21.840)
and infect 95. Most people would say, oh my God, that's a horrible program. You're still letting
Michael Mina (45:29.200)
100 people go and infect 95 people. But for a virus like this, that's a massive public health
Michael Mina (45:36.400)
win. If you can get 100 people to infect 90, most people, doctors, I would say, like a lot of people
Michael Mina (45:42.080)
would say, that sounds like a failure, to be honest. But if you do that for multiple days in
Michael Mina (45:47.360)
a row, then in a couple of weeks, you've gone from a big outbreak to a very, very small outbreak.
Lex Fridman (45:53.360)
And on the other hand, if you don't do that, if you allow 100 people to just infect 140 people,
Michael Mina (45:59.200)
because you're not doing the testing, then instead of having 20 people at the end of
Michael Mina (46:03.680)
those four weeks with the testing, you literally would have 600. Massive differences here.
Michael Mina (46:10.960)
The only goal then is to get R below one, have 100 people infect less than 100, and you stop the
Lex Fridman (46:16.080)
outbreaks and everyone stays safe. From everything you've seen, how cheap can these things get?
Michael Mina (46:21.040)
From like in the past year, in terms of the developments you've seen with the various test
Michael Mina (46:26.080)
manufacturers, how cheap can it be to make a test, to manufacture a test? So there's the
Michael Mina (46:32.320)
manufacturing process that could be 50 cents, maybe less. It's hard to really have eyeballs
Michael Mina (46:38.880)
inside these companies in terms of where they're producing them in China and Taiwan, a number of
Michael Mina (46:43.600)
other places. Some of them are produced here in the United States too, but 50 cents, say,
Michael Mina (46:49.360)
was a very, very reasonable, generous number for how much it costs per test.
Michael Mina (46:54.800)
You look at a place with high market competition that has actually authorized a lot of these tests
Michael Mina (46:59.280)
like Germany. Germany has 60, 70 some odd different companies of high quality rapid tests
Michael Mina (47:04.640)
authorized. You can go there and buy it for 80 cents, and they're still making a profit.
Lex Fridman (47:10.080)
And so it's extremely cheap. Market competition can drive these tests way down in terms of cost.
Michael Mina (47:19.040)
I think one of the most important features of a rapid test program is what do you do with the
Michael Mina (47:25.680)
result? Is it going to be used for you to gain entry to school or work? Is it going to be reported
Michael Mina (47:33.280)
to the public health agencies? All of these, the primary mode should be just get people tests,
Lex Fridman (47:38.880)
but really if you're going to be using it for a workplace thing, like what Biden is now saying,
Michael Mina (47:42.560)
vaccinate or test, which is going to lead to a crisis if we don't fix this soon because we're
Michael Mina (47:46.960)
going to have massive demand for testing in the next couple of weeks. But when he says that,
Michael Mina (47:52.160)
that's essentially saying, okay, companies need to make sure that their people are testing.
Lex Fridman (47:56.880)
So are you going to base it on the honor system? I would say you probably would not base
Michael Mina (48:02.960)
testing on the honor system if it's like to take somebody who would otherwise be quarantined from
Michael Mina (48:08.800)
work in school. And so you can go to school as long as your test is negative. So test to stay
Michael Mina (48:13.360)
program is a big thing that I've been pushing for and others have. Businesses bringing people into
Michael Mina (48:19.040)
work who need to test, they need to have verification, but they don't want to set up
Michael Mina (48:24.960)
nursing stations in their lobbies or in the school parking lot or whatever. Everyone's tired of that.
Michael Mina (48:30.080)
We need to bring the tests into the home, but that means we need the technology to enable it.
Lex Fridman (48:34.800)
And so I was at a conference recently. Do you know Mike Milken? Milken Institute. He's a very
Michael Mina (48:42.240)
wealthy billionaire, but he's done a lot of philanthropy and he has a conference to raise
Michael Mina (48:46.720)
money for prostate cancer research. I was at this conference recently, Francis Collins,
Michael Mina (48:52.480)
a number of other people were there. And every morning we all had to test in the morning,
Michael Mina (48:58.640)
which I thought was a great idea obviously before we walked into that conference. But you didn't
Michael Mina (49:05.040)
have to test there and they didn't base it on the honor system. Every morning I scanned a QR code on
Michael Mina (49:11.200)
the box and eMed, which is a service that provides test verification, popped up with a proctor right
Michael Mina (49:19.200)
on my phone or on my computer and said, okay, let's go through your tests. And they watch you,
Michael Mina (49:25.440)
they videotape you using the test. So it's all recorded. It's all a reportable type of test.
Lex Fridman (49:30.960)
And at the end of it, just from your home, you don't actually see the proctor,
Michael Mina (49:35.440)
you know, but they're just verifying that you actually do it. They verify the test,
Michael Mina (49:39.520)
they verify the test results with you. And at the end of it, you've then gotten
Michael Mina (49:45.360)
from your couch or from your car, wherever you are, an actual verified laboratory report that
Michael Mina (49:51.200)
can be considered proof that you yourself use the test and you yourself got a negative.
Lex Fridman (49:56.640)
So the tools are out here if we want to use them at scale. And in fact, the CDC uses eMed now to
Michael Mina (50:03.840)
enable people to come back into the United States through an antigen test. So before you get on your
Michael Mina (50:08.880)
flight, you're sitting in the airport in Heathrow or wherever you are, you can get on your computer,
Michael Mina (50:13.920)
use your eMed test, and you get the negative and CDC will accept that, TSA will accept you to come
Michael Mina (50:19.760)
back into the US with a rapid antigen test that you did without anyone else watching,
Michael Mina (50:24.240)
except for this proctor on your phone. Super simple.
Lex Fridman (50:27.840)
How much private information is being collected? So like this, you know, people have in the United
Michael Mina (50:33.760)
States, the American way, they have a hesitancy on the overreach of government in things like
Michael Mina (50:41.120)
vaccine passports, like using any mechanism of verification that's controlled by government
Michael Mina (50:50.720)
can lead to overreach by said government. So there's a concern of that. Do you see there a way
Lex Fridman (50:58.160)
of achieving testing that's verified but does not violate people's privacy or sense of freedom?
Michael Mina (51:06.000)
Absolutely. I think so. The way that right now in the United States, they're requesting that
Michael Mina (51:13.760)
these tests get, that the results get delivered to public health agencies. But I've long held that
Michael Mina (51:20.560)
while that's ideal, it should never be the thing that holds up somebody being allowed to know their
Michael Mina (51:25.520)
own status. But if you are going to work and you have to let your boss or your manager, whomever,
Michael Mina (51:32.960)
know that you were negative that day, or if you're going to school, I think it's going to be hard to
Michael Mina (51:38.000)
maintain complete privacy in that situation because they need to know your name. But sure, I mean,
Michael Mina (51:46.080)
could you cut off the public health reporting? Yes, you could. But I worry, I mean, can you opt
Michael Mina (51:51.920)
out? Maybe you could opt out. That should be a feature. I want to opt out of the public health
Michael Mina (51:56.560)
reporting because for whatever reason, otherwise I'm not going to do the test. But that means that,
Michael Mina (52:03.520)
okay, then you're not going to go to work. So right now there's this serious tension and
Michael Mina (52:08.000)
I am very uncomfortable with the idea that we force anyone to do anything. But there is a tension
Lex Fridman (52:14.960)
between these two things for sure. And how do you balance that during a public health emergency?
Michael Mina (52:21.200)
I think first and foremost, let people, everyone has a right to know their status.
Lex Fridman (52:25.520)
Right. The fact that we have made it hard for people
Michael Mina (52:28.720)
to know their status on their terms, I think is a travesty. I mean, it's just so
Michael Mina (52:34.400)
terrible that we have prioritized us knowing at the expense of you. Essentially what public health
Michael Mina (52:42.640)
has long said during this pandemic is, if I'm public health, if I can't know, then you can't
Michael Mina (52:48.160)
know your status. That's not the right way to look at public health. We need to engage the public.
Lex Fridman (52:54.240)
And if some of them don't want to participate in the public health part, but want to know
Michael Mina (52:58.240)
their status, by default, they are participating in public health, whether they know it or not,
Michael Mina (53:03.200)
because they're not going to go get their mom sick by mistake. At least most people wouldn't.
Lex Fridman (53:07.520)
And then also you can create systems where you can, individuals can form
Michael Mina (53:14.720)
relationships based on their status without ever reporting it to a centralized place.
Lex Fridman (53:21.280)
So you can go to, I don't know, a local business owner might require that you show
Michael Mina (53:28.560)
that you're negative, but that doesn't require reporting it. You can, like there might be
Michael Mina (53:35.280)
basically like an ID that's only in possession, you are the only person in possession of that.
Lex Fridman (53:42.160)
So you literally show it, here's a test I took, it's negative and nobody else knows about that test.
Lex Fridman (53:48.080)
So that could very well be done, even through a company like eMed. I think, and I might be wrong
Michael Mina (53:53.840)
here, I believe that they take the test result, and because they are considered a CLIA waived
Michael Mina (54:00.320)
laboratory, like a digital laboratory, they report their results by law out to the public health
Michael Mina (54:07.360)
agencies. But let's say there was something a little different. Let's say you were verifying
Michael Mina (54:11.360)
an over the counter test, and it doesn't have to be a CLIA waive because it's over the counter,
Michael Mina (54:15.520)
then you're not bound by CLIA rules. And you could create the same service, but that just doesn't
Michael Mina (54:21.920)
report out to the public health agencies. It gives people the option to opt in or out of public
Michael Mina (54:27.120)
health reporting. And I know that public health people get a little queasy when I talk about this,
Lex Fridman (54:34.880)
but as a public health person myself, I guess of course I would prefer that the data be available
Michael Mina (54:41.040)
to evaluate to know where the cases are. But first and foremost, I want to make sure that the people
Michael Mina (54:45.920)
using the test are going to use the test. And if that means that they're not reporting, and if
Michael Mina (54:52.960)
that's the only way that they will use it is if it's not reported, then that's better than no test.
Michael Mina (54:58.240)
Especially given that the central to the vaccine hesitancy is a distrust of authority and the
Michael Mina (55:05.280)
distrust of government. So you're asking people to get tested and report their status
Michael Mina (55:17.120)
to a centralized authority when they clearly do not trust that authority. It doesn't make any
Michael Mina (55:22.240)
sense. It seems like a perfect solution to let people who are hesitant on the vaccine
Lex Fridman (55:28.640)
to get their own status and have full control of that information and opt in,
Michael Mina (55:33.760)
provide that information if they wish to, but they have the full control of it and have the
Michael Mina (55:37.840)
freedom to do that information what they want. I fully agree with that. I really do. I think
Michael Mina (55:43.040)
we can have the verified services and we could have the privacy if you want it. If you need to
Michael Mina (55:48.640)
go into a restaurant and there's a rule that you have to be a negative test, have it on your phone
Lex Fridman (55:53.680)
and only your phone. And it's okay. Like emails you the lab report, you have it. You can say,
Michael Mina (55:59.040)
look, that's my name. I used it this morning. Negative. And in that case, you'd want something
Michael Mina (56:04.400)
that just is there and is not going anywhere else. And I think that those services, I think they can
Michael Mina (56:10.560)
exist. And it's a struggle because for those companies, they don't want to fall out of favor
Michael Mina (56:17.120)
with the CDC or with the FDA. And so this is a big problem in our marketplace in general by having
Michael Mina (56:24.400)
private companies who want to be the public health agents of this pandemic. We lose a lot of control
Michael Mina (56:33.680)
because the companies ultimately have to do what's going to make them money so they survive and keep
Michael Mina (56:38.240)
performing the service. It's really just such a hard problem. And this is why last time I was here,
Michael Mina (56:45.040)
I'm guessing I was probably really pushing for the government to be producing these tests. I think I
Michael Mina (56:52.640)
would have still been pushing for that. At this point, I've decided, okay, the government's clearly
Michael Mina (56:56.320)
not going to do that. I've been thinking, I really want Elon Musk to produce the tests. I really am
Michael Mina (57:03.440)
sort of serious that these tests are simple to make, but we've been using machines to make them
Michael Mina (57:09.280)
that have been around for a long time. Scale is an issue right now, kind of. Really, it's the EUA
Michael Mina (57:15.520)
process and getting the companies to be allowed to market in the US that's the issue. But let's
Michael Mina (57:19.680)
just say scale is the issue. And one company wants to make 20 million tests a day. These aren't that
Michael Mina (57:26.240)
hard. We should be able to do that. We just need a faster machine, a better machine, and a quicker
Michael Mina (57:31.360)
one. And there's a few folks, like you mentioned, know how to solve that problem. I've had a lot of
Michael Mina (57:36.000)
discussion with Tesla folks and know with people that used to work at Tesla, like Jim Keller,
Michael Mina (57:41.360)
about how to make stuff much cheaper, much better. That's basically what Tesla is world class at.
Michael Mina (57:46.240)
It's like, okay, does this thing have to cost $1,000? No, it can cost $10. And let's figure out
Lex Fridman (57:53.440)
how to manufacture it. Those folks are like the best in the world at doing that. Okay, but what
Michael Mina (58:00.320)
about this Biden action plan? So it sounds like the guy agrees with you, vaccinate or test. So
Michael Mina (58:10.000)
I think given that choice, a lot of people go test in America because there's like a division,
Michael Mina (58:15.920)
it seems like. So is this just politics? Is this just words? Or do you think this is actually
Lex Fridman (58:22.400)
going to lead to something? And maybe can you explain what the action plan is?
Michael Mina (58:27.040)
Sure. So there's a number of pillars to the action plan. The two that I've been most focused on,
Michael Mina (58:34.400)
I mean, some of them are we want to get everyone vaccinated. We want to get everyone vaccinated.
Michael Mina (58:37.520)
All these things. And one pillar is saying any company in the United States that has
Michael Mina (58:45.200)
more than 100 employees is now required to ensure that any unvaccinated individuals in their workforce
Michael Mina (58:55.680)
test weekly. Another pillar is that the president's going to reduce the cost of PCR tests.
Michael Mina (59:04.400)
By 35%, which is pretty moderate reduction. And is going to reduce the cost of antigen tests
Lex Fridman (59:14.080)
and scale them up and make 280 million tests and put $2 billion into it.
Lex Fridman (59:22.400)
So those are the two that I found most intriguing for the kind of mission that I've been on, which
Michael Mina (59:26.320)
is to just educate people around, hey, we have really, really powerful products that we can
Michael Mina (59:31.200)
educate people around. Hey, we have really, really powerful public health tools we have yet to deploy.
Michael Mina (59:39.520)
The issue at hand though, is that now that the president has said vaccinate or test,
Michael Mina (59:47.360)
there's a problem inherent in that. It's essentially to coerce people around vaccinated
Michael Mina (59:52.400)
to get vaccinated. Because vaccinate or test doesn't make sense when the vaccinated people
Michael Mina (59:56.320)
can transmit the virus just fine. It should be vaccinate and test.
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