The following is a conversation with Michael Mynor. He's a professor at Harvard doing research on infectious disease and immunology. The most defining characteristic of his approach to science and biology is that of a first principles thinker and engineer focused not just on defining the problem, but finding the solution. In that spirit, we talk about cheap, rapid home testing, which is a solution to covid-19. That, to me, has become one of the most obvious, powerful and doable solutions that frankly should have been done months ago and still should be done now as we talk about its accuracy is high for detecting actual contagiousness and hundreds of millions can be manufactured quickly and relatively cheaply.

In general, I love engineering solutions like these. Even if government bureaucracies often don't respect science and data, it respects our freedom, respects our intelligence and basic common sense. Quick mention of his sponsor, followed by some thoughts related to the episode, thank you to brave, a fast browser that feels like Chrome but has more privacy, preserving features, athletic greens, that only one drink that I start every day with to cover all my nutritional bases, express leupen, the VPN I've used for many years to protect my privacy on the Internet and catch up the app.

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Apple also donate ten dollars to an organization that is helping to advance robotics and stem education for young people around the world. And now here's my conversation with Michael Mynor. What is the most beautiful, mysterious or surprising idea in the biology of humans or viruses that you ever come across in your work? Sorry for the overly philosophical question.

Wow. Well, that's a great question. You know, I love the pathogenesis of viruses and. One of the things that I've worked on a lot is trying to understand how viruses interact with each other and so pretty all this covid stuff, I was I was really, really dedicated to understanding how how viruses impact other pathogens. So how if somebody gets an infection with one thing or a vaccine, does it either benefit or harm you from other things that appear to be unrelated to in the eye to most people?

And so one. One system which is highly detrimental to humans, but what I think is just immensely fascinating is measles and measles gets into a kid's body. The immune system picks it up and essentially grabs the virus and does exactly what it's supposed to do, which is to take this virus and bring it into the immune system so that the immune system can learn from it, can develop an immune response to it. But instead, measles plays a trick and gets into the immune system, serves almost as a Trojan horse.

And instead of getting eaten by these by these cells, it just takes them over and it ends up proliferating in the very cells that were supposed to kill it. And it just distributes throughout the entire body gets into the bone marrow, kills off children's immune memories. And so it essentially what I've found and what my research has found is that this one virus was responsible for as much as half of all of the infectious disease deaths in kids before we started vaccinating against it, because it was just wiping out children's immune memories to all different pathogens, which, as you know, I think just astounding.

It's just amazing to watch it spread throughout the body as we've done the studies in monkeys. And you can watch it just destroy and obliterate people's immune memorised in the same way that, you know, some parasite might destroy somebody's brain. And, you know, it.

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

I think in that sense, it's just coincidence. It probably is a it's a good way for measles to, uh, it's a good way for measles to essentially be able to survive long enough to replicate in the body. It just replicates in the cells that are meant to destroy it. So it's it's utilizing our immune cells for its own replication. But in so doing, it's destroying the memories of all of the other the other immunological memories. But there are other viruses.

So different system is influenza and flu predisposes to severe bacterial infections.

And that, I think, is another coincidence. But I but I also think that there are that there are some evolutionary benefits that bacteria may hijack and sort of piggyback on viral infections, viruses. Can they just grow so much quicker than bacteria? They replicate faster. And so there's the system with viruses, with flu and bacteria, where the influenza has these proteins that cleave certain receptors. And the bacteria want to cleave those same receptors, I want to believe the same molecules that give entrance to those receptors.

So instead the bacteria found out like, hey, you know, we could just piggyback on these viruses. They'll do at one hundred or a thousand times faster than we can. And so then they just piggyback on and they flew kleve, all these sialic acids and then the bacteria just glom on in the wake of it. So there's all different interactions between pathogens that are just remarkable.

So there's this whole system of viruses that interact with each other and so damn good at getting inside our bodies. Does that fascinate you or terrify you?

Very much a scientist. And so it fascinates me much more than it terrifies me. But knowing enough, I know just how well, you know, we get the wrong virus in our population, whether it's through some random mutation or whether it's the same covid-19 virus. And it you know, these things are tricky. They're able to mutate quickly. They're able to find new hosts and rearrange in the case of influenza. So what terrifies me is just how easily this particular pandemic could have been so much worse.

This could have been a virus that is much worse than it is. Same thing with H1N1 back in 2009. That terrifies me. If a virus like that was much more detrimental, uh, you know, that would be it could be much more devastating, although it's hard to say, you know, the human species were worth.

Well, I hesitate to say that we're good at responding to things because there are some aspects that were or this particular virus, sars-cov-2 and covid-19 has found a sweet spot where where it's not quite serious enough on an individual level that humans just don't. We haven't seen much of a useful response by many humans. They a lot of people even think it's a hoax. And so it's led us down this path of. It's not quite serious enough to get everyone to respond immediately and with the most urgency, but it's enough it's bad enough that, you know, it's caused our economies to shut down and collapse.

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

It's fascinating to think that covid-19 is, as a result of a virus evolving together, would like Twitter, like figuring out how we can sneak past the defenses of the humans. So it's not bad enough. And then the misinformation, all that kind of stuff together is operating in such a way that the virus can spread effectively. I wonder I mean, obviously a virus is not intelligent, but there's a there's a rhyme and rhythm to the way this whole evolutionary process works and create these fascinating things that spread throughout the entire civilization.

Absolutely.

It's. Yeah, I'm I'm completely fascinated by this idea of. Social media in particular, how it replicates, how it grows, you know, I've been how it how it actually starts interacting with the biology of the virus masks who is going to get vaccinated. Politics like these seem so external to virus biology, but it's become so intertwined. And and it's it's interesting. And I actually think we could find out that the virus actually becomes obviously not intentionally.

But, you know, we could find that choosing people, choosing not to wear masks, usually choosing not to counter this virus in a regimented and sort of organized way, effectively gives the virus more opportunity to escape. We can look at. Vaccines, you know, we're about to we're about to have one of the most aggressive vaccination programs the world has ever seen, but we are unfortunately doing it right at the peak of viral transmission when millions and millions of people are still getting infected.

And when we do that, that just gives this virus so many more opportunities, I mean, orders of magnitude, more opportunity to mutate around our immune system. Now, if we were to vaccinate everyone when there's not a lot of virus. Then there's just not a lot of virus, and so there's not going to be as many, you know, I don't even know how many zeros are at the end of however many viral particles there are in the world right now.

You know, more than quadrillions, million. And so you assume that at any given time, somebody might have trillions of virus in them, at any given individual. So then, you know, multiply trillions by millions and, you know, you get a lot of viruses out there. And and if you start applying pressure, ecological pressure to this virus at that, you know, when it's not abundant, had the opportunity for a virus to sneak around immunity, especially when all the vaccines are identical.

Essentially, it takes is one to mutate and then jumps, takes one, takes one in the whole world.

And we have to we have to not forget that this particular virus was one it was one opportunity. And it has spread across the globe. And there's no reason that can't happen tomorrow. I know.

You know, it's scary. I have a million other questions in this direction, but I'd love to talk about one of the most exciting aspects of your work, which is testing or rapid testing. You wrote a great article in Time on November 17th. So this is like a month ago about rapid testing titled How We Can Stop the Spread of covid-19 by Christmas. Let's jot down the fact that this is a month ago. So maybe your timeline would be different.

But let's say in a month, you've talked about this powerful idea for quite a while throughout the covid-19 pandemic. How do we stop the spread of covid-19 in a month? Well, we we use tests like this, you know, so so the only reason the virus continues spreading is because people spread it to each other. This isn't this isn't magic. Yes. And so there's a few ways to stop the virus from spreading to each other. And that is you either can vaccinate everyone and vaccinating everyone is a way to immunologically prevent the virus from growing inside of somebody and therefore spreading.

We don't know yet, actually, if this vaccine, if any of these vaccines are going to prevent onward transmission. So so that may or may not serve to be one opportunity. Certainly, I think it will decrease transmission. But the other idea that we have at our disposal now, we had it in May. We had it in June, July, August, September, October, November, and now it's December. We still have it. We still choose not to use it in this country and in much of the world.

And that's rapid testing that is giving. It's empowering people to know that they are infected and giving them the opportunity to not spread it to their loved ones and their friends and neighbors and whoever else. We could have done this. We still can today. We could start we have millions of these tests. These tests are simple paper strep tests. They are inside of this thing is just a little piece of paper now, and I can actually open it up here.

There we go. So this this is how we do it right here. We have this little paper strep test. This is enough to let you know if you're infectious with somewhere around the order of 99 percent sensitivity, 99 percent specificity, you can know if you have infectious virus in you. If we can get these out to everyone's homes, buildings make 10 million, 20 million, 30 million of them a day. You know, we make more bottles of Dasani water every day.

We can make this little paper strip tests. And if we do that and we get these into people's homes so that they can use them twice a week, then we can know if we're infectious, you know, is it perfect? Absolutely not. But is it near perfect? Absolutely. You know, and so if we can say, hey, the the transmission of this is, you know, for every hundred people that get infected right now, they go on to infect maybe one hundred and thirty additional people.

And that's exponential growth. So 100 becomes one hundred and thirty. A couple of days later, that 130 becomes another. Another hundred and sixty five people have now been infected and, you know, go over three weeks and 100 people become 500 people infected. Now, it doesn't take much to have those hundred people not infect 130, but infect 90. All we have to do is remove, say, 30, 40 percent of new infections from continuing their spread.

And then instead of exponential growth, you have exponential decay. So this doesn't need to be perfect. We don't have to go from 100 to zero. We just have to go and have those hundred people, in fact, 90 and those 90 people, in fact, you know, 80 to whatever it might be. And you do that for a few weeks and boom, you have now gone instead of 100 to 500, you've gone from 120. Yes.

It's not very hard. And so the way to do that is to let people know. That they're infectious. I mean, I we're a perfect example right now, I this morning I use these tests to make sure that I wasn't infectious. Is it perfect? No, but it reduced my odds. Ninety nine percent. I already was an extremely low odds because I spend my life quarantining these days. Well, the interesting thing with this test, with the testing in general, which is why I love what you've been espousing, it's really confusing to me that this is not been taken on as it's one an actual solution.

There's those available for a long time. There's there doesn't seem to have been solutions proposed at a large scale and a solution that it seems like a lot of people would be able to get behind. There's some. Politicization or fear of other solutions that people have proposed, which is like lockdown and there's a worry, you know, especially in the American spirit of freedom, like you can't tell me what to do. The thing about tests is it like empowers you with information?

Essentially, yes. So, like you, it's it gives you more information about your like your role in this pandemic.

And then you could do whatever the hell you want, like it's all up to your ethics and so on. So like and it's obvious that with that information, people would be able to protect their loved ones and also do do their sort of quote unquote duty for their country. Right. Is protect the rest of the country. That's exactly right. I mean, it's just it's empowerment. But, you know, this is a problem. We have not put these into action in large part because we have a medical industry that doesn't want to see them be used.

We have a political and a regulatory industry that doesn't want to see them be used. That sounds crazy. Why wouldn't they want them to be used with a very paternalistic approach to everything in this country, you know, despite this country kind of being founded on this individualistic ideal, play yourself up from your bootstraps, all that stuff. When it comes to public health, we have a bunch of. Ivory tower academics who want data, they know they want to see perfection, and we have this issue of letting perfection get in the way of actually doing something at all, you know, doing something effective.

And so we keep comparing these tests, for example, to the laboratory based PCR test. And sure, this isn't a PCR test, but this doesn't cost one hundred dollars and it doesn't take five days to get back, which means in every single scenario, this is the more effective test. And we have, unfortunately, a system that's not about public health. We have. Entirely eroded any ideals of public health in our country for the biomedical complex, the medical industrial complex, which overrides everything, and that's why, you know, I'm just.

And I swear on this party, just so fucking pissed that these tests don't exist, meanwhile, and everyone says, you know, how we couldn't make these, you know, that we could never do it, that would be such a hard a difficult problem. Meanwhile, the vaccine gets we've we have at the same time that we could have gotten these stupid little paper strep tests out to every household. We have developed a brand new vaccine. We've gone through phase one, phase two, phase three trials.

We've scaled up its production. And now we have UPS and FedEx and all the logistics in the world getting freezers out to where they need to be. We have this immense we see with when it comes to sort of medicine, you know, something you're injecting into somebody. Then all of a sudden people say, oh, yes, we can. Yeah, but you say, oh, no, that's that's too simple a solution to cheaper solution. No way could we possibly do that.

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

You know, and I mean a difficult no, because this is part of your work from before the covid. It does seem that I saw a statistic currently is that 40 percent would not be taken of. Americans would not be taking the vaccine some some number like this. So you also have to acknowledge that all the money that's been invested, like there doesn't appear to be a solution to deal with, like the fear and distrust that people have. I bet I don't know if you know this number, but for taking a step like rapid test like this, I bet you people would say that the percentage of people that wouldn't take it is in the single digits.

Probably.

I completely think so. And, you know, there's a lot of people who don't want to get a test today, and that's because it gets sent to a lab, it gets reported, it has all the stuff. And we're a country which teaches people from the time they're babies, you know, to keep their medical data close to them. We have HEPA, we have all these we have immense rules and regulations to ensure the privacy of people's medical data.

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

And so for so many reasons, that approach is failing, not to even mention the delays in testing and things like that. And so this is a whole different approach, but it's an approach that empowers people and takes the power a bit away from the people in charge, you know, and that's what's that's what's really grating on UN, I think public health officials who say, no, we need the data. So they're effectively saying, if I can't have the data, I don't want the individuals.

I don't want the public to have their own data either. Yeah. Which is a terrible approach to a pandemic where we can't solve a public health crisis without actively engaging the public. It just doesn't work and, you know, and that's what we're trying to do right now, which is a terrible approach. So first of all, there's you have a really nice, informative website, rapid test, drug information on the I still can't believe this is not more popular.

It's ridiculous. OK, but ah, are one of the fake news you have. Is a rapid test too expensive.

So can, can cost be brought down. Like I pay. I take a weekly PCR test and I think I pay one hundred sixty one hundred seventy bucks a week.

No I mean it's criminal. Absolutely. We can get cost. This, this thing right here cost less than a dollar to make with everything combined. Plus the swabs, you know, maybe it costs a dollar fifty could be sold for frankly it could be sold for three dollars and still make a profit if they want to sell it for five. This one here. This is a slightly more complicated one, but you can see it's just got the exact same paper strip inside and this is really it doesn't look like much, but it's kind of the cream of the crop in terms of these rapid tests.

This is the one that the U.S. government part and it is doing an amazing job. It has a ninety nine point nine percent sensitivity and specificity. So it's really it's really good. And so essentially, the way it works is you just use a swab. You put the once you you can use the swab in yourself, you put the swab into these little holes here. I put some puffer on and you close it and and a line will show up if it's positive and the line won't show up.

If it's negative, it takes five, 10 minutes. This whole thing, the this this can be made so cheap that the US government was able to buy them by one hundred and fifty million of them from Abbott for five dollars apiece. You know, so anyone who says that these are expensive, we have the proof is right here, this one. And it's you know, it was Abbott did not lose money on this deal. You know, they got seven hundred and fifty million dollars for for selling one hundred and fifty million of these at five bucks apiece.

All of these tests can do the same. So anyone who says that this should be you know, unfortunately, what's happening, though, is the FDA is only authorizing all of these tests as medical devices. So what happens when you if I'm a medical company, if I'm if I'm a test production company and I want to make this test and I go through and the FDA at the end of my authorization, the FDA says, OK, you know, you now have a medical device, not a public health tool, but a medical device.

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

Why would I ever, as a you know, in our capitalistic economy and and sort of infrastructure, why would I ever not sell this for 30 dollars when insurance will pay pay for it or one hundred dollars, you know, might only cost me 50 cents to make. But but by pushing all of these tests through a medical pathway at the FDA, they want what extrudes out. The other side is an expensive medical device that's erroneously expensive. It doesn't need to be inflated in cost.

But the companies say, well, I'd rather make fewer of them and just sell them off for 30 dollars apiece, then make tens of millions of them, which I could do, and sell them at a at a dollar marginal profit, you know. And so. It's a problem with our with our whole medical industry that we see it tests only as medical devices. And you know, what I would like to see is for the government in the same way that they bought one hundred and fifty million of these from Abbott, they should be buying, you know, all of these tests that they should be buying 20 million a day and getting them out to people's homes.

This virus has cost trillions of dollars to the American people. It's closed down restaurants and stores. And, you know, obviously the main streets across America have shut down, have shuttered. It's killing people. It's killing our economy. It's killing lifestyles. And and it wasn't obvious to me this is exciting.

This is like this is a solution I wish to like in April or something like that to launch like the larger scale manufacturing deployment of tests. Doesn't matter what test they are. It's obviously the capitalist system would create cheaper and cheaper tests that would be hopefully driving down to one dollar. So what are we talking about in America? There's, I don't know, three hundred plus million people. So that means you want to be testing regularly, right? Mm hmm.

So how many do you think is possible to manufacture will be the ultimate goal to manufacture per month.

Yeah. So if we want to slow this virus and actually stop it from transmitting, achieve what I call herd effects like vaccine herd immunity, uh, herd effects are when you get that R value below one through preventing onward transmission.

If we want to do that with these tests, we need about 20 million to 40 million of them every day, which is not a lot in the United States, in the United States. So we could do it. There's other ways you can have two people in a household swab each other in a swab themselves, rather, and then mix, you know, put the swabs into the same tube and onto one test so you can pool so you can get a two or three X gain in efficiency through pooling in the household.

Could do that in schools or offices to wherever and just use a swab of those two people. I mean, even if it's just standing in line at a public testing site or something, you know, you could just say, OK, these two are the last people. The tests are a swab themselves. They go into one one thing and if it comes back positive, then you just do each person and, you know, it's rapid. So you can just say to the people, one of you is positive, let's test you again.

So there's ways to get the efficiency gains much better. But let's say I think that that the optimal number right now that matches sort of what we can produce more or less today if we wanted is 20 million a day right now. One company that I don't have their test here, but one company is already producing five million tests themselves and shipping them overseas. It's an American company based in California called Enova, and they are giving five million tests to the UK every day.

Not to the you know, and this is just because there's no the federal government hasn't authorized these tests without the support of the government. So, yeah, so essentially, if the government just put some support behind it, then then. Yeah, you can get 20 million, probably easy.

Oh yeah. This I mean, just here I have three different companies. These, they all look similar. Well it's close, but these are three different companies right here. This is a fourth. But now this is a fifth. This is a sixth. These two are a little bit different.

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

Yeah, let's let's do it. We can. We can. We can. Absolutely.

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

So there's a few different classes of tests that I just have here. And there's more test. There's many more different tests out in the world, too. These are these are one class of tests. These are rapid antigen tests that are just the most barebones paper strep tests. These are this is the type that I want to see produced in the tens of millions every day. It's so simple. You know, you don't even need the plastic cartridge. You can just you can just make make the paper strip and you could have a little a little tube like this that, you know, you just dunk the paper strip and you don't actually need the plastic, which I'd actually prefer, because if we start making tens of millions of these, this becomes a lot of waste.

So I'd rather not see this kind of waste be out there. And there's a few companies. Dell is making a test called The Quick View, which is just just this. It's a they've gotten rid of all the all the plastic.

So people who are just listening to this, we're looking at some very small tests that fit into the palm of your hand. And they're basically paper strips fit into different containers. And that's hence the comment about the plastic containers. These are just injection molded, I think. And they're you know, they can build them at high numbers, but then they have to, like, place them in there appropriately and all this stuff. So it is a it is a bottleneck or some somewhat of a bottleneck in manufacturing.

The actual bottleneck, which the government, I think should use the Defense Production Act to build up is the there's a nitrocellulose membrane, laminate membrane on this that allows the material, the the the buffer with the swab mixture to flow across it. So the way these work, they're called lateral flow tests. And you take a swab, you swab the the front of your nose, you dunk that swab into some buffer, and then you put a couple of drops of that buffer onto the lateral flow.

And just like paper, if you dip a piece of paper into a cup of water, though, the paper will pull the water up there. Capillary action. This actually works very similarly. It flows through through some sort of capillary action through this nitrocellulose membrane. And there's little antibodies on there. There's little proteins that are very specific in this case for antigens or proteins of the virus. So these are antibodies similar to how to the antibodies that our body makes from our immune system.

But they're just printed on these lateral flow tests and they're printed just like a little line. So then you you slice these all up into individual ones. And if there's any virus on that buffer as it flows across the antibodies, grab that virus and it creates a little reaction with some colloids in here that cause it to turn dark just like a pregnancy test. One line means negative, means a control strep worked and two lines mean positive means, you know, if you get two lines just means your virus there, you're very, very likely to virus there.

And so so there are super simple this is it is the exact same technologies, pregnancy tests. It's the technology, this particular one from Abbott. This has been used for other infectious diseases like malaria. And and actually a number of these companies have made malaria tests that do the exact same thing. So they just co-opted they're the same form factor and and just change the antibodies. So picks up sars-cov-2 instead of other infections. They're also the Abbott one.

Is it also strep? Yep. Yeah. This about one here is there there's the in this case instead of being put in a plastic sheath that's just put in a cardboard thing and literally glued on, I mean it's it looks like nothing, you know, it's just, uh, it looks like a like.

I mean, this is the simplest thing you can you could imagine exterior packaging looks very apple like this. It does, yeah. Yeah, yeah. So it's nice.

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

If we could just pause for a second if it's OK.

And could you just briefly say what is an antigen test and what other tests are out there, like categories of tests which are just really quick? So the testing landscape is a little bit complicated, but it's but I'll break it down. There's really just three major classes of tests. We'll start with the first two. The the first two tests are just looking for the virus or looking for antibodies against the virus. So we've heard about serology tests or maybe some people have heard about it.

Those are a different kind of test they're looking to see. Has somebody in the past, does somebody have an immune response against the virus which would indicate that they were infected or exposed to it? So we're not talking about the antibody tests. I'll just leave it at that. Those they actually can look very similar to this or they can be done in a laboratory. Those are usually done from blood and they're looking for an immune response to the virus.

So that's one. Everything I'm talking about here is looking for the virus itself, not the immune response to the virus. And so there's two ways to look for the virus. You can either look for the genetic code of the virus, like the RNA, just like the DNA of some of these human cells. Or you can look for the proteins themselves, the antigens of the of the virus. So I like to differentiate them. If you are a PCR test that looks for RNA in let's say let's say if we made it against humans, it would be looking for the DNA inside of our cells that would be actually looking for our genetic code.

The equivalent to an antigen test is sort of a test that actually is looking for our eyes or our nose or physical features of our body that would delineate, OK, this is this is Michael, for example. And so so you're either looking for a sequence or you're looking for a structure. The PCR test that a lot of people have gotten now and they're done in labs usually are looking for the sequence of the virus, which is RNA. This test here by a company called Detect, this is one of Jonathan Rothberg companies.

He's the guy who helped create modern day sequencing and all kinds of other things. So this Ditech device, that's the name of the company, this is actually a rapid RNA detection device. So it's almost like a PCR like test. And we could even do it here. It's really it's it's a beautiful test. My opinion works exceedingly well. It's going to be a little bit more expensive. So I think it could confirm could be used as a confirmatory test for this.

Is there a greater accuracy to it? Um, yes. I would say that there is a greater accuracy. There's also a downfall, though, of PCR and tests that look for RNA. They can sometimes detect somebody who is no longer infectious. So you have the RNA test and then you have these antigen tests. The antigen tests look for structures, but they're generally only going to turn positive if people have actively replicating virus in them. And so what happens after an infection dissipates?

You have you've just gone from having sort of a spike. So if you get infected maybe three days later, the virus gets into exponential growth and it can replicate to trillions of viruses inside the body. Your immune system then kind of tackles it and beats it down to nothing. But what what ends up in the wake of that? You just had a battle. You had this massive battle that just took place inside your upper respiratory tract. And because of that, you've had trillions and trillions of viruses go to zero, essentially.

But the irony is still there. It's just these remnants in the same way that if you go to a crime scene and blood was was was sort of spread all over the crime scene, you're going to find a lot of DNA. There's tons of DNA. There's no people anymore, but there's a lot of DNA there. Same thing happens here. And so what's happening with PCR testing is when people go and use these exceedingly high sensitivity PCR tests, people will stay positive for weeks or months after their infection has subsided, which is causing a lot of problems in my opinion.

It's problems that the CDC and the FDA and doctors don't want to deal with. But I've tried to publish on it. I've tried to, you know, suggest that this is an issue both to New York Times and others. And now it's unfortunately kind of taken on a life of its own of conspiracy theorists think, you know, they call it a case to make. They say, oh, you know, pictures. It's detecting people who are no longer who are false positive.

They're not false positives. They're they're late positives, no longer transmissible. I think the way you like what I saw in Rapid Tests Dog, I really like the distinction between diagnostic sensitivity and contagiousness sensitivity. That's so that Web site is so obvious. That is painful because it's like, yeah, that's what we should be talking about, is how accurately the test able to detect your contagiousness. And you have different plots that show that actually there's, you know, that antigen test.

The test we're looking at today, like rapid tests, actually really good at detecting contagiousness. Absolutely.

It all mixes back with this whole idea that of the medical industrial complex. You know, in this country and in most countries, we have almost entirely defunded and devalued public health period.

You know, we just we just have and and what that means is that we don't even we don't have a language for it. We don't have a lexicon for it. We don't have a regulatory landscape for it.

And so the only window we have to look at a test today is as a medical diagnostic test. And and that becomes very problematic when we're trying to tackle a public health threat and a public health emergency by definition. And this is a public health emergency that we're in. And yet we keep evaluating tests as though the diagnostic benchmark is the gold standard, where if I'm a physician, I am a physician. So I'll put on that physician hat for a moment.

And if I have a if I have a patient who comes to me and wants to know if their symptoms are a result of them having covid, then I want every shred of evidence that I can get to see. Does this person currently or did they recently have this infection inside of them? And so in that sense, the PCR test is the perfect test. It's really sensitive. It will find the RNA if it's there at all. So that I could say, you know, yeah, you have a low amount of RNA left.

You might have been you said your symptoms started two weeks ago. You probably were infectious two weeks ago and you have lingering symptoms from it. But that's that's a medical diagnosis. It's kind of like a detective recreating a crime scene. They want to go back there and recreate, create the pieces so that they can assign blame or whatever it might be.

But that's not public health and public health. We need to only look forward. We don't want to go back and say, well, was this person are there symptoms because they had an infection two weeks ago in public health, we just want to stop the virus from spreading to the next person. And so that's where we don't care if somebody was infected two weeks ago. We only care about finding the people who are infectious today. And unfortunately, our regulatory landscape fails to apply that knowledge to evaluate these tests as public health tools, they're only evaluating the tests as medical tools.

And therefore we get all kinds of complaints that say this test, which detects ninety nine plus ninety nine point eight percent of of current infectious people by the FDA's rubric, they'll say, no, no, that's it's only 50 percent sensitive. And that's because when you go out into the world and you just compare this against PCR positivity, most people who are PCR positive in the world right now at any given time are post infectious. They're no longer infectious because you might only be infectious for five days, but then you'll remain PCR positive for three or four or five weeks.

And so when you go and just evaluate these tests and you say, OK, this person's PCR positive, does the rapid antigen test detect that? More often than not, it's no, but that's because those people don't need isolation. You know, they they're post infectious. And this is a it's become much more of a problem then I think even the FDA themselves is recognizing because they are unwilling at this point to.

To look at this as a public health problem requiring public health tools, we'll talk about this a little bit more, because the concern I have is that like a bigger pandemic comes along, what are the lessons we draw from this and how we move forward? Let's talk about that in a bit. But sort of can we can we discuss further delay of the land here, of the different tests before us?

Absolutely. So I talked about PCR tests and those are done in the lab or they're done essentially with a rapid test like this, the detect. And we can even try this in a moment. It goes into a little heater. So you might have one of these in a household or one of these in a nursing home or something like that, or in an airport, or you could have one that has 100 different outlets. This is just to keep the tube up.

These are the rapid tests. They are super simple, no frills. You just swab your nose and you put the swab into a buffer and you put the buffer on the test. So we can use this right now if you want and we can try it.

And all the tests we're talking about, they usually swabbing the nose like that's the that's still that mean. Yeah, there are some saliva tests coming about and these can all work potentially with saliva. They just have to be recalibrated. But these these swabs are really not bad. This isn't the the deep swab that goes way back into your nose or anything. This is just the just a swab that you do yourself like right in the front of your nose.

So if you want to do it, do you mind for sure? Yeah. Yeah. Why don't we start with this one? Because this is this is the Abitibi Next Now test. And it's really it's pretty simple.

This is this the swab from the ABA test? That's correct. That's the swab from the ABA test. So what I'm going to do to start is I'm going to take this buffer here, which is this is just the buffer that goes onto this test. So it's a brand new one. I just opened this test out. Um, uh, I'm going to just take six drops of this buffer and put it right onto this test here. Two, three, four, six, OK, and now you're going to take that swab, open it up.

Yeah, and now just wipe it around inside the into the front of your nose. Do a few circles on each nostril. Alex can. This always makes me want to sneeze. Yeah. OK, now I'm going to have you do it yourself. I'm getting emotional.

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

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

So one line will be positive and two lines will be negative. It's very cool.

There's this purple thing creeping up. Onto the control line. That's perfect, that's what you want to be seeing. So you want to see that? So right now, you essentially want to see that that blue line turns pink or purply color. There's a blue line that's already there printed. It should turn sort of a purple pink color. And ideally, there will be no additional line for the sample. And if there is that's the ninety nine point whatever percent accuracy on I mean, they have I'm contagious, that would mean that you're likely contagious or you likely have infectious virus in you.

What we can do, because one of the things that that my plan calls for is because sometimes these tests can get false positive results. It's rare, maybe one percent or in the case of this bionics, now it's about test point one percent. So one in a thousand one in five hundred, something like that can be false positive. What I recommend is that when somebody is positive on one of these, you turn around and you immediately test on a different test.

You can either do it on the same, but for for good measure, you want to use a separate test that is somewhat orthogonal, meaning that it shouldn't turn false positive for the same reason this particular test here, this detect test, because it is looking for the RNA and not the antigen. This is an amazingly accurate test and it's sort of a perfect gold standard or a confirmatory test for any of these antigen tests. So one of the recommendations that I've had, especially if people start using antigen test before you get onto a plane or as what I call entrance screening, if somebody is positive, you don't immediately tell them you're positive.

Go isolate for 10 days. You tell them let's confirm on one of these on a detect test. That is a because it's completely orthogonal. It's looking for the RNA instead of the antigen. There is no reason, no biological reason that both of these should be falsely positive. So if one's false positive and the other one is negative, especially because this one's more sensitive, then I would trust this as a confirmatory test. If this one's negative than the antigen test, you know, would be considered false positive.

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

It says wait 15 minutes to see both lines. But in general, if somebody is really going to be positive, that line starts showing up within a minute or two.

So you want to keep the whole we'll keep watching it for the whole 15 minutes as it's sitting there. But I would say you're knowing that you've had PCR tests recently and all that.

You know, the odds are pretty good.

Odds are very good packaging, very ifone. Like I'm digging the sexy packs here. I'm a sucker for good packaging.

OK, so then there's this there's this test here, which is, you know, this is another you know, it's funny this let me to open this up and show you this is a really nice test. It's another antigen test, works the exact same way as this, essentially. But what you can see is it's got like lights in it and a power button and stuff. This is called an ILLUM test, which is, you know, fine.

And it's a really nice test, to be honest. But it. But it has to pair with an iPhone, and so it's good as I think that this is going to become this is there's a lot of use for this from a medical perspective. You know, where you want good reporting. This can because it pairs of an iPhone, it can immediately send send the report to a Department of Health, whereas these paper strip test that they're just paper, they don't report anything unless you want to report it.

So I'm going to just pick it up, pick it apart. And so you can see is there's like flourescent readers and little lasers and LEDs and stuff in there. You can actually see the lights going off and there's a paper strip test right inside there. But you can see that there's like a whole circuit board and and all this stuff.

Mm hmm. Right. And so. This is the kind of thing that, you know, the FDA is looking for for like home use and things like that, because it's kind of foolproof, like you can't go wrong with it it with an iPhone. So you need Bluetooth. So it's going to be more limited. It's a great test. Don't get me wrong, it's as good as any of these. But, you know, when you compare this thing with a battery and a circuit board and all the stuff, it's got its purpose.

But, you know, it's not a public health tool. I don't want to see this made in the tens of millions a day and thrown away. Just likes that kind of stuff.

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

The flashing lights is this. It's got batteries. It's got a Bluetooth thing. It's a great test. But, you know, it's to be honest, it's not any better than than this one. Yeah. And so, you know, I want this one. Um, it's nice. And all the form factor is nice, but and it's really nice that it goes to Bluetooth, but it goes against the principle of just 20 million a day. The easy solution.

Everybody has it. You can manufacture it. Probably you could have probably scale this up in a couple of weeks.

Oh, absolutely. These companies, I mean, the rest of the world has these they can be scaled up. They already exist. You know, Steve Biosensors, one company is making tens of millions a day, not coming to the United States, but going all over Europe, going all over Southeast Asia and East Asia.

So they exist. The US is just you know, we can't get out of our own way.

I wonder or somebody I don't know if you're paying attention, but somebody like Elon Musk type character. So he was really into doing something like obvious engineering solution like this at home. Rapid test seems like a very Elon Musk thing to do. I don't know if you saw, but I had a little Twitter conversation with Elon Musk.

Does he not like what is it? Do you know what his thoughts on rapid testing?

Well, he was using a slightly different one, one of these. But that requires an instrument called the Beedie Verita. And he got a false positive or no, I shouldn't say he didn't necessarily get a false positive. He got discrepant results. He did this test four times. He got two positives, two negatives, but then he got a PCR test and it was a very low positive result. So I think what happened is he just tested himself at the tail end of and this was actually right before he was about to send us.

It was the day of essentially that he was sending the astronauts up to the space station the other day. So he is he was using these rapid tests because he wanted to make sure that he was good to go in and he got discrepant results. Ultimately, they were correct. But, you know, two or negative two are positive. But what what really happened once he got as he shared his PCR results and they were very low positive. So really what was happening is my guess is he found himself right at the edge of his positivity, of his infectiousness.

And so, you know, the test worked out was supposed to work. It probably had he used it two days earlier, it would have been screaming positive. You know, he wouldn't have gotten discrepant results, but he found himself right at the edge by the time you use the test. So the PCR would always pick it up because it's still because that will still stay positive then for weeks potentially. But the rapid antigen test was starting to to falter, not in a bad way, but just he probably was really no longer particularly infectious.

And so it was kind of when it gets to be a very low viral load, it becomes stochastic as fascinating, this duality.

So one you could think from an individual's individual perspective, it's unclear when you take four and half are positive or negative, like what are you supposed to do? But from a societal perspective, it seems like if just one of them is positive, just stay home for for a couple of days, for for a while. So when you're CEO of a company, you're launching astronauts to space. You may not want to rely absolutely. On the antigen test as a as a thing by which you steer your decisions of like ten thousand plus people, companies.

But as individuals just living in the world, if you can if it comes up positive, then you make decisions based on that. And then that scales really nicely to an entire society of hundreds of millions of people. And that's how you get that virus to stop spreading.

That's exactly right.

You don't have to catch every single one. And and the nice thing is that these will these will catch the people who are most infectious. So at Elon Musk, it is generally that test. We don't have the counterfactual. We don't have his results from three days earlier when he was probably most infectious. But my guess is the fact that it was catching two out of the four, even when he was down at the city of really, really very, very low viral load on the PCR test suggests that it was doing its job.

And you just want to in. The nice thing is because these can be produced at such scale, getting a. Getting one positive doesn't immediately have to mean 10 days of isolation. That's the CDC's more conservative stance to say if you're positive on any test, stay home for 10 days and isolate. But here, people would just have more tests. So the recommendation should be test daily. If you turn positive test daily until you've been negative for 24 or 48 hours and then go back to work.

And the nice thing there is right now, people just aren't testing because they don't want to take 10 days off. They're not getting paid for it, so they can't take 10 days off.

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

Well, to be honest, I've been trying to get in touch with them again. I think take somebody like Elon Musk what the engineering prowess within his ranks, you know, to. Easily, easily build these at the tens of millions a day, he could build the machines from scratch. You know, a lot of the companies, they buy the machines from South Korea or Taiwan, I believe we don't have to like we can build these machines. They're simple to build.

Put somebody like Elon Musk on it, you know, take some of his best engineers and say, look, the US needs a solution in two weeks to build these machines. You know, figure it out. He'll do it. He could do it. This is a guy who who is literally he has started multiple entirely new industries. He has the capital to do it without the US government if he wanted to, and you know what it would the Return on Investment Act for him would be huge.

But frankly, the return on investment in the country would be hundreds of billions of dollars because it means we could get society open. So I know that he his first experience with these rapid tests was confusing, which is how I ended up having this Twitter kind of conversation with him very briefly. But I think that if if he understood sort of a little bit more and I think he does, I really love to talk to him about it because I think he could totally change the course of this pandemic in the United States single handedly.

You know, he loves grand things.

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

I love that you say the engineering solution. So this is something I've been really trying to I'm an engineer. You know, my my previous history was all engineering, and that's really how I think I then went into medicine and Ph.D. world.

But but but I I think that the world, like one of the major catastrophes or one of the major problems is that we have physicians making the decisions about public health. And in a pandemic when really we need engineers, this is an engineering problem. And so what I've been trying to do, I actually really want to, you know, start a whole new new field called public health engineering, you know, and so I've been I love that. Eventually I want to try to bring it to MIT and get an MIT.

I want to start a new department or something.

This is a doubly awesome idea that this is really OK. I love this. I love every aspect.

I love everything you're talking about. A lot of people believe because vaccines start being deployed currently, that, you know, we are no longer in need of a solution.

We're no longer in need of slowing the spread of the virus to me, as I understand it seems like this is the most important time to have something like a rapid testing solution. Can you kind of break that apart? What's the role of rapid testing in the next? You know, what is it, three, four months, maybe even more?

This the vaccine rollout isn't going to be as easy as everyone is hoping. You know, and I hate to be the Debbie Downer here, but there's a lot of unknowns with this vaccine. You've already mentioned one, which is there's a lot of people who just don't want to get the vaccine. And I hope that that might change as things move forward and people see their neighbors getting it and their family getting it. And it's safe. And we don't know how effective the vaccine is going to be after two or three months.

We've only measured it in the first two or three months, which is a massive problem, which we can go into biologically because there's reasons to very good reasons to believe that the efficacy could fall way down after two or three months. We don't know if it's going to stop transmission and if it doesn't stop transmission, then we're not. Then there's, you know, herd immunity is much, much more difficult to get because that's all based on transmission. Blockheaded.

And and frankly, we don't know how easily we're going to be able to roll it out, some of the vaccines need really significant cold chains, have very short half lives outside of that cold chain. We need to organize massive numbers of people to be able to distribute these. Most hospitals today are saying that they're not equipped to hire the right people, to be even administering enough of these vaccines. And then a lot of the hospitals are frustrated because they're getting much smaller allocations than they were expecting.

So I think right now, like you say, right now is the best time. You know, besides three or four or five or six months ago, right now is the best time to get these rapid tests out. And we need to I mean, the country has the capacity to build them. We have or shipping them overseas right now. We just need to flip a switch, get the FDA to recognize that there's more important things than diagnostic medicine, which is the effectiveness of the public health program.

When we're dealing with a pandemic, they need to authorize uses public health tools or, you know, frankly, the president could you know, there's a lot of other ways to get this test to not have to go through the normal FDA authorization program, but maybe have the NIH and the CDC give a stamp of approval. And if we could, we could get these out tomorrow.

And that's where that article came from. You know how we can stop the spread of this virus by Christmas? We could you know, now it's getting late. And so we have to keep updating that time frame, maybe putting Christmas in the title, as it should have said, how we can stop the spread of this virus in a month.

Yeah, it would be a little bit more timeless, but but we could do it, you know, we really could do it.

And that's the most frustrating part here, is that we're just choosing not to as a country, we're choosing to bankrupt our society because some people at the FDA and other places just can't seem to get their head around the fact that this is a public health problem, not a bunch of medical problems.

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

What would what do you what are the ideas here?

I think it's a little both. I, I think it's political on the one hand. And I've certainly been talking to Congress a lot, talking to senators. Are they receptive? Oh, yeah. I mean, that's the crazy thing, everyone. But the FDA is receptive. I mean, it's it's astounding. I mean, I advise, you know, informally, I advise the president and the president elect's teams. I talk to Congress. I talk to senators, governors.

You know, and then all the way down to, you know, mayors of towns and things, and I mean, months ago I held a roundtable discussion with Mayor Garcetti, who's the mayor of L.A. And I brought all the all the companies who make these things. This is in like July or August. And they brought all the companies to the table and said, OK, how can we get these out? And unfortunately, it went nowhere because the FDA won't authorize them as public health tools.

The nice thing is that this is one of the nice and frustrating things. This is one of the few bipartisan things that I know of.

And like you said, it's it's a real solution. Yeah, lockdown's aren't a solution. They're they're a kind of emergency Band-Aid to a catastrophe that's currently happening. They're not a solution and they're definitely not a public health solution. If we're taking a more holistic view of public health, which includes people's well-being, includes their psychological well-being, their financial well-being, you know, just stopping a virus, if it means that all those other things get thrown under the bus, is not a public health solution.

It's a it's a it's a myopic or very tunnel vision approach to a viral virus that's spreading. This is. A simple solution with essentially no downfall, you know, there is no nothing bad about this, it's just giving people a result and it's bipartisan, you know, the most conservative and the most liberal people. Everyone just wants to know their status. You know, nobody wants to have to wait in line for four hours to find out their status on Monday, a week later on Saturday.

You know, it just doesn't make any sense. It's a useless test at that point and everyone recognizes that.

So why why do you think, like the mayor of L.A., why do you think politicians are going for these? From my perspective, like kind of half assed lockdown's, which is not so, I have seen good evidence that like a complete lockdown can work, but in theory, like communism in theory can work.

Yeah, like theoretically speaking. But it just doesn't at least in this country we don't. I think it's just impossible to have complete lockdown. And still politicians are going for these kind of lockdowns that everybody hates. Hmm. That's really, really hurting small businesses. Like why are they going big businesses and. Yeah, all businesses, but like, basically not just hurting, they're destroying small businesses. Right. Which is going to have potentially. I mean, last year I've been reading as I don't shut up about the rise and fall of the Third Reich and, you know, there's economic effects that take a decade to, you know, there's going to be long lasting effects that may may be destructive to the very fabric of this nation.

So why are they doing it and why they're not using the solution? Is there is there an intuition? I mean, you've said the FDA has a stranglehold, I guess, on this whole public health problem. Is that is that all it is?

That's honestly it's pretty much all it is the companies. So the somebody like Mayor Garcetti or Governor Baker, Cuomo, Newsom, any of the DeWine and I've talked to I've talked to a lot of governors in this country at this point.

And and, of course, the federal government, including including the president's own teams, you know, and and the heads of the NIH, the heads of the CDC about this.

The problem is the tests don't exist in this country at the level that we need them to right now. To make that kind of policy, to make that kind of program, they could, but they don't. And so what that means is that when Mayor Garcetti says, OK, what are my actual options today? Despite this sounding like a great idea, he looks around and he says, well, they're not authorized, you know, they don't exist right now for at home use.

And from his perspective, he's not about to pick that fight with the FDA. And it turns out nobody is.

Why are people afraid of it? Seems like an easy fight. It's like, well, it's not. So they don't see it as a fight. They think that the FDA is the end all. Be all. Everyone thinks the FDA is the end all be all. And and so they just everyone is deferential, including the heads of all the other government agencies, because that is their role. But what everyone is failing to see is that the FDA doesn't even have a mandate or a remit to evaluate these tests as public health tool.

So they're just falling in this weird gray zone.

Where the FDA is saying, look, we evaluate medical products, that's the only thing that I meant, like Tim Stenzel, head of in vitro diagnostics at the FDA, he's doing what he is, what his job is, which is to evaluate public, which is to evaluate medical tools. Unfortunately, this is where I think the CDC has really blundered, they haven't made the right distinction to say, look, OK, the FDA is evaluating these for doctors to use and all that.

But you know, where the CDC and where the public health agency of this country and we recognize that these tools require a different authorization pathway and a different use not just to medical devices and public health.

And I guess FDA is not designed for this public health, especially in emergency situations.

And they they actually explicitly say that. I mean, when I go and talk to him, you know, he's a very reasonable guy. But when I talk to him, he says, look. We don't we just do not evaluate a public health tool. You're telling me this is a public health tool. Great. Go and use it. And and so I say, OK, great, we'll go and use it. And then the comment is, but, you know, does it give a result back to somebody?

I say, well, yes, of course it gives a result back to somebody. It's being done in their home. So well then it's defined as a medical tool. Can't use it. So it's stuck in this gray zone where we unfortunately, there's this weird definition that any tool, any any test that gives a result back to an individual is defined by CMS, the Centers for Medicare Medicaid Services, as a medical device requiring medical authorization. But then you go and ask gets crazier because then you go and ask Sima Verma, the head of CMS, you know, OK, can these be authorized as as public health tools and not fall under your definition of a medical device?

So then the FDA doesn't have to be the ones authorizing it as a public health tool. And Seema Verma says, oh, well, we don't we don't have any jurisdiction over over point of care and and sort of rapid devices like this. We only have jurisdiction over lab devices. So it's like nobody has ownership over it, which means that they just keep they stay in this purgatory of of not being approved. And so this is where I think, frankly, it needs a president.

It needs a presidential order to just unlock them to say this is more important than. You know, having a prescription and in fact, I mean, really what's happening now, because there is this sense that tests are public health tools, even if they're not being defined as such. The FDA now is pretty much not only are they not authorizing these public health tools, what they're doing by by authorizing what are effectively public health tools as medical devices, they're just diluting down the practice of medicine.

Right. I mean, his answer right now, unfortunately, is, well, I don't know why you you want these to be sort of available to everyone without a prescription. We've already said that a doctor can write a whole prescription for for a whole college campus. It's like, well, if you're going in that direction, then and that's no longer medicine. Having a doctor write a prescription for a college campus for everyone on the campus to have repeat testing.

Now now we're just in the territory of of eroding medicine and eroding all of the legal rules and reasons that we have prescriptions in the first place. So it's just everything about it is just destructive instead of just making a simple solution, a solution which is. These are OK as public health tools, as long as they meet X and Y metrics go and CDC can put their stamp of approval on them.

What do you think? Sorry if I'm stuck on this. Your mention of mighty and public health engineering, right?

Mm hmm. I mean, it has a sense of I talk to competition biology folks. It's always exciting to see computer scientists start entering the space of biology. And there's actually a lot of exciting things that happen because of that, trying to understand the fundamentals of biology.

So from the engineering approach to public health, what kind of problems do you think can be tackled?

What kind of disciplines are involved? Like do you have ideas on this in the space? Oh, yeah. I mean, I can speak to to one of the major activities that I want to do. So what I normally do in my research lab is develop technologies that can take a drop of somebody's blood or some saliva and profile for hundreds of thousands of different antibodies against every single pathogen that somebody could be possibly exposed to. So this is all new technology that we've been developing more from a from a bioengineering perspective.

But then I use a lot of the mathematics tools to interpret that. But what I really want to do, for example, to kind of kick off this new field of what I consider public health engineering is to create maybe it's a little ambitious, but create, uh, a weather system for viruses. I want us to be able to open up our iPhones, plug in our zip code and get a better sense, get a probability of why my kid has a runny nose today.

Is it covid? Is it a rhinovirus and adenoviruses or is it flu? And, you know, we can do that. We can start building the rules of virus spread across the globe, both for pandemic preparedness, but also for, uh, just everyday use in the same way that people used to think that predicting the weather was going to be impossible.

Of course, we know that's not impossible. Now, is it always perfect? No. But does it offer does it completely change the way that we go about our days? Absolutely. Uh, you know, I envision, for example, right now we open up our iPhone, we plug in a zip code. And if it tells us it's going to rain today, we bring an umbrella. So, you know, in the future, it tells us, hey, you know, there's a lot of sars-cov-2 in your community.

Instead of grabbing your umbrella, you grab your mask. You know, we don't have to have masks all the time. But if we know the rules of the game that these viruses play by, we can start preparing for those.

And, you know, every year we go into every flu season blindfolded with our hands tied behind our back. Just saying I hope this isn't a bad flu season this year. I don't I mean, this is you know, we're in the 21st century. You know, it's becoming you know, I mean, we have the tools at our disposal now to not have that attitude. This isn't like 1920s. You know, we can we we can just say, hey, this is going to be a bad flu season this year.

Let's act accordingly. And with a targeted approach. Now, we don't, uh, for example, we don't just use our umbrellas all day long, every single day in case it might rain. We don't board up our homes every single day in case there's a hurricane. We we wait. And if we know that there's one coming, then we act for a small period of time accordingly. And then we go back and we've prepared ourselves in like these little bursts to not have it ruin our days.

I can't tell you how exciting that vision of the future is. I think that's incredible. And it seems like it should be within our reach. The just needs like weather maps of viruses floating about the Earth. And it seems obvious it's one of those things where right now it seems like maybe impossible. And then looking back like twenty years from now will wonder, like, why the hell this hasn't been done well earlier. The one difference in weather, I don't know if you have interesting ideas in the space.

The difference between weather and viruses is it includes the collection of the data, includes the human body potentially. And that means that there is some as with the contact tracing question, there's some concern about privacy. This seems to be this dance that's really complicated, you know, with Facebook getting a lot of flack for basically misusing people's data or, you know, just whether it's perception or reality, there's certainly a lot of reality to it, to whether or not good stewards of our private data.

So there's this weird place where it's like obvious that if we do. We collect a lot of data about human beings and maintain privacy and maintain all the basic respect for that data, just like, honestly common sense, respect to the data, that we can do a lot of amazing things for the world, like a weather map for viruses. Is there a way forward to gain trust of people or to do this, to do this? Well, to have ideas here?

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

And we process them because taking the it's taking like one of the basically the biology and chemistry and converting them to numbers. That's exactly right.

So what we're doing, for example, there's a lot of people who go to the hospital every day, a lot of people who donate blood, people to donate plasma. So one of the projects that I have I'll get to the privacy question in a moment. But this so what I want to do is the name that I've given. This is global, a global immunological observatory. There's no reason not to have that good name. I've said, you know, instead of saying, well, how do we possibly get enough people on board to send in samples all the time?

Well, just go to the source, you know, so there's a company in Massachusetts that makes 80 percent of all the instruments that are used globally to collect plasma from plasma donors. So I went to this company in genetics and said, you know, is there a way you have 80 percent of the global market on plasma donations? Can we start getting plasma samples from healthy people that use your machines? So that hooked me up with this company called OCTA Pharma, an active pharma as a huge reach and sat in offices all over the country where they're just collecting people's plasma.

They actually pay people for their plasma and then that gets distributed to hospitals and all that stuff as anonymous plasma. So I've just been collecting anonymous samples and we're processing them in this case for covid antibodies to watch. From January up through December, we're able to watch how the virus entered into the United States and how it how it's transmitting every day, you know, across the US. So we're we're getting those results organized now. And we're going to start putting them publicly online soon to start making at least a very rough map of covid.

But that's the type of thinking that I have in terms of like how do you actually capture huge numbers of specimens? You can't ask everyone to participate on sort of a I mean, you maybe could if you have the right tools and you can offer individuals something in return, like twenty three and me does, you know, that's a great way to get people to give specimens and they get results back. So with these technologies that I've been building, along with some collaborators at Harvard, we can come up with tools that people might actually want.

So I can offer you your immunological history. I can say give me a drop of your blood on a filter paper, mail it in and I will be able to tell you every infectious disease you've ever encountered. And maybe even when you encountered it roughly, I could tell you. Do you have covid antibodies right now? Do you have Lyme disease antibodies right now, flu, Tripoli and all these different viruses. Also peanut allergies, you know, milk allergies, anything.

You know, if it if your immune system makes a response to it, we can detect that response.

So all of a sudden, we have this very valuable technology that on the one hand gives people maybe information they might want to know about themselves, but on the other hand, becomes this amazingly rich source of big data, you know, to to enter into this global immunological observatory sort of mathematical framework to start building these maps, these epidemiological tools. But you ask for privacy and absolutely, that's essential to keep in mind first and foremost. So privacy can be you can keep these samples 100 percent anonymous.

They are just when I get them, they show up with nothing. They're literally just tubes. I know a date that they were collected in a zip code that they're collected from or, um, or even just sort of a county level ID with an urban with ethical approval and with the people's consent, we can maybe collect more data, but that would require consent. But then there's this other approach which I'm really excited about, which is certainly going to gain some scrutiny, I think.

But we'll have to figure out where where it comes into play. But I've been recognizing that we can take some of these immunological profile and we can make a biological fingerprint out of it. And it's actually stable enough so that I could take your blood.

Let's say I don't know who you are. But you sent me a drop of blood a year ago, and then you sent me a drop of blood today. I don't know that those two blood spots are coming from the same person. They're just showing up in my lab. But I can run the our technology over that. And it just gives me your immunological history. But your immunological history is so unique to you. And the way that your body responds to these pathogens is so unique to you that I can use that to tether your two samples.

I don't know who you are. I know nothing about you. I only know when those samples were came out of a person. But I can say, oh, these two samples a year apart actually belong to the same person.

So there's sufficient information that immunological history to match the samples or from a privacy perspective, I think that generally holds for humans. So you're saying there's enough uniqueness to match because it's very stochastic, even twins.

So this I believe, you know, we haven't published this yet. We will soon. You have a twin to me. I do have a twin. I have an identical twin brother interested in us. He looks very much like me that works.

And, you know, DNA can't really tell us apart. But this tool is one of the only tools in the world that can tell twins apart from each other could still be accurate enough to say this blood. You know, it's like ninety nine point nine nine nine percent accurate to to say that these two blood samples came from the same individual. And it's because it's a combination, both of your immunological history, but also how your unique body responds to a pathogen which is random.

The way that we make antibodies, as is by and large, it's got an element of randomness to it, how the cells, when they make an antibody, they chop up the genetic code to say, OK, this is the antibody that I'm going to form for this pathogen and you might farm. If you get a coronavirus, for example, you might form hundreds of different antibodies, not just one antibody against the spike protein, but hundreds of different antibodies against all different parts of the virus.

So that gives this really rich resolution of information that when I then do the same thing across hundreds of different pathogens, some of which you've seen, some of which you have, and it gives you an exceedingly unique fingerprint that that is sufficiently stable over years and years and years to essentially give you a barcode. You know, and I don't have to know who you are, but I can know that these two specimens came from the same person somewhere out in the world.

So fascinating that there's this trace your life story in the space of viruses, in the space of pathogens like. Like these, you know, because there's this entire universe of these organisms that are trying to destroy each other and then your little trajectory through that space leaves a trace. And then you can look at that trace that's fascinating. And that I mean, there's that data period is just fascinating. And the vision of making that data universally connected to where you can make, like, infer things.

And just like what the weather is, is really fascinating in this probably artificial intelligence applications, there's started making predictions that are finding patterns.

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

Oh, really? The ones that need it. Why do you need it? And of course, now, you know, I mean, I wrote in 2015 about this why we would why this would be useful.

And of course, now we're seeing why it would be useful had we had this up and running and two thousand nineteen had we had it going. We were drawing blood from, you know, are getting blood samples from hospitals and clinics and blood donors from New York City. Let's just say no, that could have we didn't run the first PCR test for coronavirus until probably a month and a half or two months after the virus started transmitting in New York City.

So it's like with the rain, we didn't start wearing umbrella or taking out umbrellas. Exactly. For two months, getting wet, but different than the rain, we couldn't actually see that it was spreading right now. And so Andrew Cuomo had no choice but to leave the city open. You know, there were hints that maybe the virus was spreading in New York City, but, you know, he didn't have any data to back it up, no data.

And so it was just week on, week and week. And he didn't have any information to really go by to allow him to have the firepower to say we're closing down the city. This is an emergency. We have to stop spread before it starts. And so they waited until the first PCR tests were coming about, and then the moment they were in a PCR test to find out it's everywhere, you know. And so that was a disaster because, of course, New York City, you know, it was just hit so bad because nobody was you know, we were blind to it.

We didn't have to be blind to it. The nice thing about this technology is we wouldn't have with the exact same technology we had in twenty seventeen, we could have detected this novel coronavirus spreading in New York City in 2020, not because we changed, not because we are actually actively looking for this novel coronavirus, but because we would see we would have seen patterns in people's immune responses using A.I. or just frankly using our just the raw data itself. We could have said, hey, it looks like there's something that looks like known coronavirus is spreading in New York.

But there's gaps. You know, there's for some reason people aren't developing an immune response to this coronavirus that seems to be spreading to these normal things that, you know, it just looks the profile looks different.

And we could have seen that and immediately, especially since we had an idea that there was a novel coronavirus circulating in the world, we could have very quickly and easily seen, hey, clearly we're seeing a spike of something that looks like a known coronavirus, but people are responding weirdly to it. Ah, I algorithm's would have picked it up. And just our basic hack you could put you could have put it in an Excel spreadsheet. We would have seen it.

Yeah.

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

So to me, the fascinating question, everything we've talked about, the both the huge collection of data at scale, just super exciting. And then the kind of obvious. At scale solution to the current virus and future ones is the rapid testing, can we talk about the future of viruses that might be threatening the our very existence? So do you think like a future natural virus can have an order of magnitude greater effect on human civilization than anything we've ever seen?

So something that either kills all humans or kills. I don't know, 60, 70 percent of humans or some like something something we can't even imagine, is that is that something that you think is possible? Because it seems to have not have happened yet.

So maybe like the entirety whoever whoever the programmer is of the simulation that sort of launched the evolution from the Big Bang seems to not want to destroy us humans. Or maybe that's the natural side effect of the evolutionary process that humans are useful. But do you think it's possible that the evolution process will produce a virus that will kill all humans?

I think it could. I don't think it's likely. And the reason I don't think it's likely is.

Well, on the one hand, it hasn't happened yet, in part because mobility is is is a recent phenomenon. People weren't particularly mobile until, uh, fairly recently. Now, of course, now that we have people flying back and forth across the globe all the time. The chances of global pandemics has escalated exponentially, of course, and so on the one hand, that's part of why it hasn't happened yet. We can look at things like Ebola and Ebola.

We don't we haven't generally had major Ebola epidemics in the past, not because Ebola wasn't transmitting and infecting humans, but because they were it was largely affecting and infecting humans in disconnected communities. So you see in rural parts of Africa, for example, in Western Africa, you might end up having isolated Ebola outbreaks. But there weren't connections that were fast enough that would allow people to then spread it into the cities. Of course, we saw back in 2014 15 massive Ebola outbreak.

That wasn't because it was a new strain of Ebola, but it was because there's new inroads and connections between the communities and people got it to the city. And so we saw it start to spread. So that should be a little bit for, you know, foreshadowing of what's to come. And now we have this pandemic. We had 2009. We have this there is a benefit or there is sort of a natural check. And this is kind of latke, Voltaire, predator prey, dynamic kind of systems, ecological systems and mathematics that if you have something that's so deadly, people will respond more, maybe with a greater panic, a greater sense of panic, which alone could, you know, destroy humanity.

But at the same time, like, we now know that we can lock down.

We know that that's possible, and so if this was a worse virus that was actually killing 60 percent of people is infecting, we would lock down very quickly. My biggest fear, though, is let's say that was happening. You need serious lockdowns if you're going to keep things going, so the only reason we were able to keep things going during our lockdowns is because it wasn't so bad that we were still able to have people work in the in the in the grocery stores, still have people work in the shipping to get the food onto the shelves.

So on the one hand, we could probably figure out how to stop the virus. But can we stop the virus without starving? You know, I'm not sure that that if this was another acute respiratory virus, that they had a slightly say it transmitted the same way, but say it actually did worse damage to your heart. But it was like a month later that people started having heart attacks in mass. You know, it's like not not just one offs, but but really severe.

Well, that could be a serious problem for humanity.

Um. So so in some ways, I think that there are lots of ways that we could end up dying at the hand of a virus. I mean, we're already seeing it just I mean, my fear still, I think coronaviruses have demonstrated a keen ability to destroy or to to create outbreaks that can potentially be deadly to large numbers of people. Flu strains, though, are still. By and large, my concern. So you think the battle might come from the flu, the influenza?

Yeah, the replication cycle, they're able to genetically recombine in a way that coronaviruses aren't. They have segmented genomes, which means that they can just swap out whole parts of their genomes, no problem, repackage them and and then, boom, you have a whole antigenic shift, not a drift. What that means is that any on any occasion, any day of the year, you can have, boom, a new whole new virus that didn't exist yesterday.

And now with farming and industrial livestock and we're seeing animals and humans come into contact much more, just the the the opportunities for an influenza strain that is unique and deadly to humans increases. All the while, treant transmission and mobility has increased. It's just a matter of time, in my opinion. What about from immunology perspective of the idea of engineering a virus so not just the virus leaking from a lab or something, but actually being able to understand the protein like the everything about what makes a virus enough to be able to figure out ways to.

Maybe targeted are on targeted attack by the community. Yeah, yeah, is there is that something obviously that's somewhere in the list of concerns, but is there anywhere close of the like the top 10 highlights along with nuclear weapons and so on, that we should be worried about? Or is the natural pandemic really the one that much greater concern?

I would say that the former that man made viruses and genetically engineered viruses should be right up there with the greatest concerns for humanity right now.

You know, we know that the tools, for better or worse, the tools for creating a virus are there, you know. Yeah, we can do it. I mean, heck, you know, the human the human species is no longer vaccinated against smallpox. I didn't get a smallpox vaccine. You didn't get a smallpox vaccine, at least I don't think. And, you know, so if somebody wanted to make smallpox and and distribute it to the world in some way, it could be exceedingly deadly and and and detrimental to humans.

And that's not even that's not even sort of using your imagination to create a new virus. That's one that we already have. Unlike the past, when smallpox would circulate, you had large fractions of the community that was already immune to it. And so it wouldn't spread or would spread a little bit slower, but now we have essentially in a few years we'll have a whole global population that is susceptible. Let's look at measles. We have an entire I mean, measles.

I have you know, there are some researchers in the world right now which for various reasons, are working on creating a measles strain that evades immunity. It's not for bioterrorism. At least that's not the expectation. It's for using measles as an oncolytic virus to kill cancer. And the only way you can really do that is if your immune system doesn't, you know, if you if you take a measles virus and there's we don't have to go into the details of why it would work, but it could work.

Measles likes to target potentially cancerous cells. But to get your immune system not to kill off the virus, if you're trying to use the virus to target it, you may want to make it blind to the immune system. But now imagine we took some virus like measles, which has an aunt of 18 transmits extremely quickly. And now we have essentially, let's say we had a whole human race that is susceptible to measles. And this is a virus that spreads.

Orders of magnitude easier than this current virus. Imagine if you were to plug something toxic or detrimental into that virus and release it to the world.

So it's possible to be both accidental and intentional. Absolutely, yeah.

An accident. So Mark Lip-Synch is a good colleague of mine at Harvard. We're both in the he's the director of the Center for Communicable Disease Dynamics from a faculty member. He's spoken very, very forcefully. And and he's very outspoken about the dangers of gain of function testing, where in the lab we are intentionally creating viruses that are exceedingly deadly under the auspices of trying to learn about them, so that if the idea is that if we kind of accelerate evolution and make these really deadly viruses in the lab, we can be prepared for if that virus ever comes about naturally or through a natural means.

The concern, though, is, OK, that that's one thing. But what if that virus got out on somebody's shoe? Just what if, you know, if the if the debt if the effects of an accident are potential potentially catastrophic, is it worth taking the chances just to be prepared a little bit for something that may or may not ever actually develop? And so it's a serious ethical quandary where and how to both be prepared, but also not.

Cause a catastrophic mistake. As a small tangent, there's recent really exciting breakthrough of Alpha two of alpha fold to solving protein folding or achieving steadily our performance on protein folding.

And then I thought proteins have a lot to do with viruses.

It seems like being able to use machine learning to design proteins that achieve certain kinds of functions will naturally allow you to use maybe down the line, not yet, but allow you to use machine learning to design basically viruses, maybe like measles, like forgood, which is like to attack cancer cells, but also for bad. Is that is that is that a crazy. Thought or is this a natural place where this technology may go, I suppose is all technologies can, which is for good and for bad?

Mm hmm. Do you think about the role machine learning in this?

Oh, yeah, absolutely. I mean, uh, Alpha Fold is amazing. You know, it's an amazing algorithm. Series of algorithms, and it does demonstrate. To me, it demonstrates just just how powerful, you know, everything in the world has rules, we just don't know the rules, you know, we often don't know them. But, you know, our brain has rules. How it works, everything is plus and minus. There's nothing in the world that's really not at its most basic level, positive, negative.

You know, it's all obviously it's all just charge and and that means everything. You can figure it out with enough computational power and enough in this case. I mean, machine learning and AI is just one way to learn rules. It's an empirical way to learn rules. And it's but it's a profoundly powerful way.

And certainly now now that we are getting to a point where we can take a protein and know how it folds.

Given its sequence, we can reverse engineer, then we can say, OK, we want a protein to fall this way, what is the sequence need to be? We haven't done that yet so much, but it's just the next iteration of all of this. So let's say somebody wants to develop a virus. It's going to start with somebody wanting to develop a virus to to defeat cancer, something good, you know. And so it would start with a lot of money from the federal government, you know, for all the positives that would come out of it.

But we have to be really careful, because that will come about, there's no doubt in my mind that we will develop. We're already doing it. We engineer molecules all the time for specific uses. Oftentimes we take them from nature and then tweak them. But now we can supercharge it. We can accelerate the pace of discovery to not have it, just be discovery. We have it be true. Ground up engineering. Let's say you're trying to make a new molecule to stabilize somebody with some retinal disease.

Right. So we come up with some molecule that can improve the stability of somebody with retinal degeneration. You know, just a small tweak to that to, say, make a virus that causes the human race to become blind. You know, I mean, it sounds really conspiracy theory, but, uh, but it's not you know, it's we're learning so much about biology and there's always nefarious reasons. I mean, heck, look at how I and, you know, just Google searches.

Those can be you know, they are every single day being leveraged by nefarious actors to take advantage of people, to steal money, to do whatever it might be, uh, eventually probably to create wars or already to create wars. And I mean, I don't think there's any question at this point behind disinformation campaigns. And so it's being leveraged, this thing that could be wholly good.

You know, it's always going to be leverage for bad. And so how do you balance that as a species?

I'm not quite sure when the hope is, as you mentioned previously, that there's some that we're able to also develop defense mechanisms.

And there's something about the human species that seems to keep coming up with like ways to just just like I'm the deadline just at the last moment, figuring out how to avoid destruction.

I think I'm, like, eternally optimistic about the human race not destroying ourselves.

But you could do a lot of things that will be very painful. Yes.

Well, we're doing it already. You know, just I mean, we are seeing how our regulation today. Right? We did this thing. It started as a good thing, regulation of medical products. But now it is, uh, you know, unwillingly and unintentionally harming us. Our regulatory landscape, which was developed totally for good in our country, is getting in the way of us deploying a tool that could stop our economies from having to be sort of sputtering like closed, that could stop deaths from happening at the rate that they are.

And it's you know, I think we will come to a solution. Of course, now we're going to get the vaccine and it's going to make people lose track of, like, why we even bother testing, which is a bad idea. But, um, but we're already seeing that we have this amazing capacity to to both do damage when we don't intend to do damage and and then also to pull up when we need to pull up and, you know, stop complete catastrophe.

And so it's we are an interesting species in that way, that's for sure.

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

It's hard.

I struggle a little bit sometimes to give advice because the advice that I get from my own personal experience is necessarily distinct from the advice that would make other people successful. I have. Unending ambitions to make things better. I was and I don't see I don't see barricades where other people sometimes see barricades and even just little things like when this virus started. I'm a medical director at Brigham and Women's Hospital. And so I oversee or helped oversee molecular virology diagnostics.

So when this fire started wearing my epidemiology hat and wearing my sort of viral outbreak hat, I recognize that this is going to be a big virus that was important at a global level. Even if the CDC weren't ready to admit that it was a pandemic, it was obvious in January that it was a pandemic. So I started trying to get a test built at the Brigham, which is one of Harvard's teaching hospitals. You know, the first encounters I had with the upper administration at the hospital were pretty much know why would we do that?

That's silly. Who are you?

You know? And I said, well, OK, don't believe me. Sure. But I kept pushing on it. And then eventually I got them to agree. It was really only a couple of weeks before the Biogen conference happened, we started building the test. I think they sort of looking abroad and saying, OK, this is happening. Sure. Like maybe he was right. But then I went a step further and I said we're not going to have enough tests at the hospital.

And so so my ambition was to get a better testing program started. And and so I figured what better place to scale up testing than the Broad Institute for Institutes is amazing in a very high throughput, high efficiency research institute that does genomic sequencing, things like that. So I went to the road and I said, hey, you know, there's this coronavirus that's obviously going to impact our society greatly. Can we start modifying your high efficiency instruments and robots for coronavirus testing?

Everyone in my in my orbit in the hospital world just said that's ridiculous. You know, how could you possibly plan to do that? It's impossible. You know, and to me, it was like the most dead simple thing to do, right? It didn't. But the higher ups and the people who think about, you know, I think one of the most important things is to recognize that most people in the world don't see solutions. They just see problems.

And it's because it's an easy thing to do. Thinking of problems and how things will go wrong is really easy.

Because you're not coming up with a brand new solution. This, to me was just a super simple solution. Hey, let's get the brand to help build test. Every single hospital director, you know, told me no, like it's impossible. My own superiors, the ones I report to in the hospital, said, you know, Mike, you know, you're a new faculty member. Your ideas, you know, probably well, would be right, but you're too naive and young to to know that it's impossible.

You know, obviously now the Broadus is the highest throughput laboratory in the country and.

Yes, you know, and so I think my recommendation to people is as much as possible get out of the mode of thinking about things as problems. Sometimes you piss people off. I could probably use a better filter sometimes to try to be not so up front with certain things, but but it's just so crucial to always just see to just bring it like think think about things in new ways that that other people haven't. Because usually there's something else out there.

And one of the things that has been most beneficial to me, which is that my my education was really broad. It was engineering and physics and. Well, and then I became a Buddhist monk for a while. And so that gives me a different perspective. But then it was medicine and immunology and and now I've brought all of it together from a mathematics and biology and medicine perspective and policy and public health. And I think that, you know, I'm not the best in any one of these things.

I recognize that there are going to be geniuses out there who are just worlds better than me at any one of these things that I try to work on. But my superpower is bringing them all together, you know, and just thinking. And that's, I think, how you can really change the world. You know, I don't know that I'll ever change the world in the way that I hope. But that's how you can have a chance. Yeah, that's how you can have a chance.

Exactly. And and I think it's also what you know, this to me, this rapid testing program like. This is the most dead simple solution in the world, and this literally could change the world. It could change the world. It could change. And it is, you know, those countries that are doing it now, the U.S. isn't. But I've been advising many countries on it. And and I would say that, you know, some of the early papers that we put out earlier on, a lot of the things actually are changing.

You don't know unless you really look hard. You don't know where you're actually having an effect. Sometimes it's more overt than in other times. In April, I published a paper that was saying, hey, with the PCR values from these tests, we need to really focus on the CT values, the actual quantitative values of these lab based PCR tests. At the time, all the physicians and laboratory directors told me that was stupid, you know, why would you do that?

They're not accurate enough. And and of course, now it's headline news that, you know, Florida, they just mandated reporting out the CT values of these tests because there's a real utility of them. You can understand public health from that.

You can understand better clinical management. You know, that was a simple solution to a pretty difficult problem.

And it is changing the way that we approach all of the lab testing in this country is starting to it's taken a few months, but it's starting to change because of that. And, you know, that was just me saying, hey, this is something we should be focusing on, got some other people involved and other people. And and now people recognize, hey, there's actual value in this number that comes out of these lab based PCR tests. So sometimes it does grow fairly quickly.

But I think the real answer, if my only my only answer, I don't know what you know, I recognize that everyone some people are going to be really focused on and have one small but deep skill set. I go the opposite direction. I try to bring bring things together. And but the biggest thing I think is just don't see don't don't see barriers like just see like there's always a solution to a barrier. If there's a barrier that literally means a solution to it.

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

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

If you think big and you communicate that vision with the world, all the most brilliant and passionate people, just like you'll attract them and they'll come to you. And then it makes your life actually really exciting that people I've met at like Tesla and NewLink, I mean, there's just like this fire in their eyes. There's just love life. And it's amazing, I think, to to be around those people.

I have to ask you about what was the philosophy, the journey that took you to becoming a Buddhist monk and what. What were what did you learn about life? What did you take away from that experience? How did you return back to Harvard and the world? That's unlike that experience, I imagine. Yeah, well, I was at Dartmouth at the time. Uh, well, I went to Sri Lanka.

I was already pretty interested in developing countries and sort of under-resourced areas. And I was doing a lot of engineering work and I went there. But I was also starting to think maybe health was something of interest. Um. And so I went to Sri Lanka because I had a long interest in Buddhism as well, just kind of interested in it as a thing, which aspects of the philosophy attracted you?

I would say that the thing that interested me most was, um, was really this idea of kind of a butterfly effect of like, uh, you know, what you do now. Has ripple effects that extend out beyond what you can possibly imagine? Um, both in your own life and in other people's lives and in some ways, Buddhism has not in some ways in a pretty deep way. Buddhism has that as part of its underlying philosophy in terms of rebirth and sort of your actions today propagate to others, but also propagate to to sort of what might happen in your circle of what's called samsara and rebirth.

And, um, I don't I don't know that I subscribe fully to this idea that we are reborn, which always was a little bit of a of a debate internally, I suppose, when I was a monk.

Um. But but it has always been it was that and then it was also meditation at the time I was a fairly elite rower. I was, you know, rowing at the national level and and rowing to me was very meditative. It was, um. You know, just there is even if you're on a boat with other people, it's I mean, on the one hand, it's like the extreme of like a team sport, but it's also.

The extreme sort of focus and concentration that requires that's required of it, and so I was always really into just meditative type of things, is doing a lot of pottery, too, which was also very meditative. And and so Buddhism just kind of really, really there are a lot of things about meditating that just appealed. And so I moved to Sri Lanka, planning to only be there for a couple of months. But then I was shadowing in this medical clinic and there was this physician who was just really I mean, it's just kind of a horrible situation, frankly.

This guy was trained decades earlier. He was an older physician and he was still just practicing like these fairly barbaric approaches to medicine because he had, you know, as a rural town and he just didn't have a lot of.

He didn't have any updated training, frankly, and so, you know, I just remember this girl came in with, like shrapnel in her hand and his solution was to, like, air it out. And so he was like without even numbing her hand, he was like cutting it open market with this idea that, like, the more oxygen and stuff, you know, and it just I think there was something about all of this. And I was already talking to these monks at the time.

I would be in this clinic in the morning and I'd go and my idea was to teach English to these monks in the evening. Turned out I'm a really bad English teacher.

So they just thought they allowed me just to sit with them and meditate. And they were teaching me more about Buddhism than I could have possibly taught them about English or being an American or something. And and and so I just slowly I just couldn't take I couldn't handle being in that clinic. So more and more, I just started moving to spending more and more time at this monastery. And then after about two months, I was supposed to come back to the States and I decided I'd want to.

So I moved to this monastery in the mountains, primarily because I didn't have the money to, like, just keep living. So I was living in a monastery is free. Yeah. And so I moved there and just started meditating more and more. And then months went by and and I.

It just really gravitated I gravitated to the whole to the whole notion of it, I mean, it became. It sounds strange, but, you know, meditating almost just like anything that you've put your mind to. Became exciting, you know, it became like there weren't enough hours in the day to meditate and I would do it for, you know, 18 hours a day, 15 hours a day, just sit there and you and like I mean, I hate sleeping anyway, but I wouldn't want to go to sleep because I felt like I didn't accomplish what I needed to accomplish in meditation that day, which is so strange because there is no end, you know.

But it was always. But there are these. There are these steps that happen during meditation that are very prescribed in a way Buddha talked about them, you know, and these are ancient writings which exist. I mean, the writings are real. They're thousands of years old now. And, um, you know, so whether it was Buddha writing them or whoever, you know, then there are lots of different people have contributed to the to these writings over the years.

And but they're very prescribed and they they tell you what you're going to go through. And I didn't really focus too much on them. Uh, I read a little bit about them. But your mind really does when you actually start meditating at that level, like not an hour here and there, but like truly just spending your days meditating. It becomes kind of like this other world where it becomes exciting and and you're actively working. You're actively meditating, not just kind of trying to quiet things.

That's sort of just the first stage of trying to get your mind to focus. Most people never get past that first stage, especially in our culture.

Could you briefly summarize what's waiting beyond the stage of just quieting the mind is? Yeah, it's hard for me to imagine that there's something that could be described as exciting. On there, yeah, it's it's an interesting question, so I would say. So the first thing, the first step is truly just to be able to close your eyes, focus on your breath and not have other thoughts, enter into your mind, that alone is just so hard to do.

Like, I couldn't do it now if I wanted what I could then and. But once you get past that stage, you start entering into like all these other you go through the kind I went to, it's like pretty trippy stage, which is a little bit euphoric, um, where you just kind of start not hallucinating. I mean, it wasn't like some crazy thing that happened in a movie where but definitely just weird. You start getting to the stage where you're able to quiet your mind for so long, for hours at a time that like for me, I started getting really excited about this idea of mindfulness, which is part of Buddhism in general, but it's part of Turbit and Buddhism in particular for this in this way, which was, uh, you take, uh, you start focusing on your daily activities, whether that's sipping a cup of tea or walking or, you know, sweeping around.

Uh, I lived in on this mountainside in this cottage thing is built into the rock. And, you know, so every morning I would wake up early and sweep around it and stuff because that's just what we did. And you start to you meditate on all those activities. And one of the things that was so exciting, which sounds completely ridiculous now, was just, um, almost learning about your daily activities in ways that you never would have thought about before.

So what isn't what what's what's involved with, like, picking up this glass of water? You know, if I said, OK, I'm just going to pick I'm going to take a drink of water to me right now, it's a single activity.

But, um, during during meditation, it's not a single activity.

It's a whole series of activities of, like, little engineering feats, um, and feelings. And it's it's gripping the water and it's feeling that the glass is cold and it's lifting and it's moving and dragging and dragging. And you start to learn a whole new language of life. And that to me was like this really exhilarating thing, that it was an exhilarating component of meditation, that there was never enough time. Uh, it's kind of like learning a new computer language, like it gets really exciting when you start coding and all these new things you can do.

You learn how to watch, to experience life in a much richer way. And so you never run out of ways to go deeper and deeper and deeper in the way you experience you and just the drinking of the glass of water. That's exactly right. And what becomes kind of exhilarating as you start to be able to predict things that you never are?

I don't even have predictions, right word. But I always think of the Matrix, you know, or, um, I forget who it was. Somebody was shooting at Neil and he, like, leans backwards and he dodges the bullets. Um, you know, in some ways when you start breaking every little action that your hands do or that your feet do or that your body does, down into all these little actions that make up one, what we normally think of as an action, all of a sudden you can start to see things almost in slow motion.

I like to think of it very much like language. The first time somebody hears a foreign language, uh, it sounds really fast. Usually you don't hear the spaces between words and, um. And it just sounds like just like a stream of consciousness and it just sounds like a stream of noises if you've never heard the language before. And as you learn the language, you hear clear breaks between words and it starts to gain context. And and all of a sudden like that, what once sounded very fast slows down.

And it has meaning that's our whole life. There's this whole language happening that we don't speak generally. But if you start to speak it and if you start to learn it and you start to say, hey, I'm picking up this glass is actually eighteen little movements, then all of a sudden it becomes extremely exciting and exhilarating to just just breathe, you know, breathing alone and the rise and fall of your abdomen or the way the air pushes in and out of your nose becomes almost interesting.

Um, and what's really neat is, is the world just starts slowing down. And I'll never forget that feeling. And it's if there was one euphoric feeling for meditation, I want to gain back, but I don't think I could without really meditating like that again, and I don't think I will. Was this like slow motion of the world? It was. Finding the spaces between all the movements in the same way that the spaces between all the words happened and then it almost gives you this new appreciation for everything, you know.

So it was really amazing. And so I think it came to an abrupt end when the tsunami hit. I was there in the Indian Ocean tsunami hit in 2004. And it was like this dichotomy of being a monk and, you know, just meditating in this extraordinary place, and then the tsunami hits and kills forty thousand people in a few minutes on the coast of this really small little country in Sri Lanka.

And, you know, then I. It like my whole world of being a man, came crashing down when I go to the coast and I mean, that was just a devastating. Visual sight and emotional sight, but the strangest thing happened, which was that everyone just wanted me to stay as a monk and have people in their culture they wanted to.

The monks largely fled from the coastlines of those, you know, and and so then there I was and people wanted me to be a monk. They wanted me to stay on the coast but be a monk and not help, like not help in the in the way that I considered helping. They wanted me just to keep meditating so that they could bring me down like offerings and get and have their sort of karmic responsibilities attended to as well. And so that was really bizarre to me.

It was like, how could I possibly just sit around while all these people, half of everyone's family just died? And so in any case, I stopped being a monk and I moved to this refugee camp and lived there for another six months or so and just. Stayed there not as a monk, but tried to raise some money from the US and tried to like I didn't know what I was doing. Frankly, I was 22 and. And I don't think I appreciated at the time how much of a role I was having in the in that community's life, but it's taken me a lot, many years to process all of this since then.

But I would say it's what put me into the public health world, living in that refugee camp and that difference that happened, you know, from being a monk to being in this devastating environment just really changed my whole view of what sort of why I was existing, I suppose.

Well. So there's this. Richness of life in in a single drink of water, the experience, and then there's this power of nature that's capable to take the lives of thousands of people. So given all that, the absurdity of that. Let me ask you and the fact that you study things that could kill the entirety of human civilization, what do you think is the meaning of this or what do you think is the meaning of life, this whole orchestra we've got going on?

Does it have a meaning and maybe from another perspective as well? How does one live a meaningful life if such as possible?

Well, you know, from what I've seen, I don't think there's a single answer to that by any stretch. One of the most interesting things about Buddhism to me is that the human existence is part of suffering. Which is very different from. Judeo Christian existence, which is that human existence is. Something to be is a very different you know, it's something to it's there's a richness to it in Buddhism, it's just another one of your lives. And but it's your opportunity to attain nirvana and become a monk, for example, and meditate to attain nirvana, or else you kind of just go back into the samsara, the cycle of of suffering.

And so, you know.

When I look at I mean, in some ways the notion of life and what the purpose of life is, you know, they're kind of completely distinct, this sort of Western view of life, which is that this life is the most precious thing in the world, versus this is just another opportunity to try to get out of life. I mean, the whole notion of Nirvana and in Buddhism, it getting out of this sort of cycle of suffering is to vanish.

You know, if you could if you could attain nirvana, you know, throughout this life, the idea is that you don't get reborn. And so when I look at these two, you know, on the one hand you have. Christian, Christian faith and other things that want to go to heaven and live forever in heaven, then you have this other whole half of humans who want nothing more than to get out of the cycle of rebirth and just poof, you know, not exist anymore.

The cycle of suffering. Yeah. And so how do you reconcile those two? And I guess do you have both of them? And you do you basically oscillate back and forth? I don't think I think I just I look at us and I think we're just a bunch of proteins that we form. And we they work in this really amazing way. And they might work on a bigger scale, like there might be some connections that we're not really clear about, but they're still biological.

I believe that they're biological.

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

Well, I think I don't have an answer to that, but I. I really do believe I would. It's just, you know, this is just an evolution of. Uh, consciousness, I don't I don't personally think is my feeling is that we're a bunch of pluses and minuses that have just gotten so complex that they're able to make rich feelings, rich emotions. And and I do believe, though, you know, on the one hand, I sometimes wake up, some days my fiance doesn't always love it.

But, you know, I kind of think, well, this bunch of robots with, like, pretty complicated algorithms that we deal with. Yeah. And, you know, in that sense, like, OK, if the world just blew up tomorrow and no, nothing was, you know, nothing existed the day after that. It's just another blip in the universe, you know, but at the same time, I don't know. So that's kind of probably my most basic feeling about life.

It's like we're just a blip and we may as well make the most of it while we're here blipping it.

But it's one hell of a blip, though. It is. It's it's an amazing in a blink of of of an eye in time. Michael, this is you're one of the most interesting people I've met, one of the most interesting conversations, important ones. Now, I'm going to publish it very soon. I really appreciate taking the time. I know how busy you are is really fun. Thanks for talking. Well, thanks so much. As was a lot of fun.

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If you enjoy this thing, subscribe on YouTube review starting up a podcast, follow on Spotify, supporta on Patrón or connect with me on Twitter, Elex Friedman. And now let me leave you with some words from Teddy Roosevelt. It is not the critic who counts. Not the man who points out how the strong man stumbles or where the doer of D could have done them better. The credit belongs to the man who actually is in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who cares who comes short again and again because there is no effort without error and shortcoming.

But who does actually strive to do the deeds? Who knows great enthusiasms, the great devotions? Who spends himself in a worthy cause? Who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly so that his place shall never be with those cold and timid souls who neither know victory or defeat. Thank you for listening and hope to see you next time.