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

TL;DR

Cheap and accessible at-home rapid testing, such as paper strip tests, could have been implemented months ago and can still be a powerful solution to curb the spread of COVID-19.

Key Insights

• 🔬 The key insight is that rapid at-home testing is an effective solution for controlling the spread of COVID-19. It is highly accurate in detecting contagiousness and can be manufactured quickly and affordably in large quantities.
• 🌍 Michael Mina emphasizes the importance of engineering solutions like rapid testing that respect science, data, freedom, intelligence, and common sense.
• 💪 The main barriers to widespread implementation of rapid testing are the resistance from medical and regulatory industries, who prefer more complex and expensive solutions.
• ⚖️ There is a need to shift the focus from criticizing solutions to applauding the efforts of those trying to solve the problem, as Teddy Roosevelt stated in his "The Man in the Arena" speech.
• 🦠 Measles is a highly detrimental virus that tricks the immune system and destroys immune memories of other pathogens, making it responsible for a significant number of infectious disease deaths in children.
• 💡 Influenza can predispose individuals to severe bacterial infections, and bacteria can "piggyback" on the rapid replication of viruses, leading to a mutually beneficial relationship.
• 😨 Michael Mina recognizes the potential of viruses to spread rapidly and cause devastating impacts on human populations, highlighting the need for proactive measures to control pandemics like COVID-19.
• 🏥 The medical industry's focus on perfection and the complexity of regulations hinder the utilization of simple and affordable rapid tests, which could be more effective in preventing viral spread.
• 💰 Rapid testing can be produced at a low cost, with some tests costing less than a dollar to manufacture. They can be a cost-effective solution compared to expensive lab-based PCR tests.

Transcript

the following is a conversation with michael minna 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 c... Read More

Questions & Answers

Q: Why have cheap rabbit at-home tests not been widely implemented?

The adoption of cheap at-home tests has been hindered by a paternalistic approach, lack of funding, and the medical industry's preference for more expensive diagnostic tests.

Q: How do rapid antigen tests work?

Rapid antigen tests, such as paper strip tests, detect the presence of viral proteins (antigens) to determine if a person is currently infectious.

Q: Why is it important to differentiate between diagnostic sensitivity and contagiousness sensitivity in testing?

Diagnostic sensitivity focuses on detecting any trace of the virus, even in individuals who are no longer infectious, whereas contagiousness sensitivity specifically detects individuals who are currently infectious. This distinction is crucial for effective public health interventions.

Q: What is the role of the FDA in the implementation of cheap rabbit at-home testing?

The FDA plays a regulatory role in authorizing and classifying tests. However, the current regulatory landscape is focused on medical diagnostic standards rather than public health needs, causing delays in the adoption of cheap at-home tests.

Summary

This conversation with Michael Mina, a professor at Harvard researching infectious disease and immunology, focuses on his approach to finding solutions to the COVID-19 pandemic. They discuss the importance of rapid testing as a tool to stop the spread of the virus, the different types of tests available, the cost of testing, and the barriers preventing widespread use of rapid tests.

Questions & Answers

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

Michael Mina finds the pathogenesis of viruses and their interaction with other pathogens fascinating. He explains how measles, in particular, tricks the immune system by entering immune cells and using them to its advantage. Measles ends up destroying immune memories and can be responsible for half of all infectious disease deaths in children before vaccination. This interactivity between pathogens is likely coincidence, but there are evolutionary benefits to some interactions, such as influenza predisposing to severe bacterial infections.

Q: Does the vast interactivity between viruses and their ability to get inside our bodies fascinate or terrify you?

As a scientist, Michael Mina finds the interactivity between viruses fascinating rather than terrifying. However, he acknowledges the potential for a virus to cause more damage than we have seen with COVID-19. He emphasizes the importance of understanding virus biology to better respond to future threats.

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

Mina believes that rapid testing is a key solution to stopping the spread of COVID-19. By empowering individuals to know if they are infectious, they can take actions to prevent the virus from spreading to their loved ones and the community. He suggests producing and distributing tens of millions of rapid tests every day, which would be cost-effective and efficient in controlling the spread of the virus.

Q: Why has rapid testing not been widely adopted?

Mina explains that the medical industry, political and regulatory systems, and paternalistic approach to public health prevent the widespread adoption of rapid testing. The medical industry prefers costly and longer tests, and regulatory bodies classify rapid tests as medical devices instead of public health tools. This cost and regulatory framework inhibits the availability and affordability of rapid tests.

Q: Can the cost of rapid tests be reduced?

Rapid antigen tests, such as the ones Mina discusses, could reduce costs significantly. He states that these tests can be manufactured for less than a dollar each and sold for as low as three to five dollars while still turning a profit. However, the medical industry inflates the costs due to the medical device classification and insurance reimbursement practices. Mina suggests that the government should support the production and distribution of these tests.

Q: How many rapid tests would be necessary in the United States?

To effectively slow and stop the transmission of the virus, Mina estimates that the United States would need 20 to 40 million rapid tests every day. This high number takes into account individual testing as well as pooling strategies, where multiple individuals' samples are combined and tested together to improve efficiency.

Q: Is there a difference in accuracy between rapid antigen tests and PCR tests?

Mina explains that rapid antigen tests primarily detect contagiousness rather than residual viral RNA. While PCR tests are highly sensitive at detecting viral RNA, they often continue detecting the RNA even after a person is no longer contagious. This discrepancy in detection has led to criticisms of rapid antigen tests when compared to PCR tests. However, Mina argues that for public health purposes, the accuracy of detecting contagiousness is more important than detecting residual RNA.

Q: Can rapid tests be used as public health tools?

According to Mina, the evaluation and classification of tests as medical devices rather than public health tools hinder their use for controlling the spread of the virus. He emphasizes that public health requires looking forward to prevent onward transmission, while the medical perspective tends to focus on diagnostic confirmation. The medical industrial complex and the prioritization of medical diagnostics over public health measures contribute to the lack of adoption of rapid tests.

Q: What are the different types of COVID-19 tests available?

Mina explains that there are three major classes of tests: PCR tests, antigen tests, and serology tests. PCR tests detect the genetic code (RNA) of the virus, while antigen tests detect specific proteins (antigens) of the virus. Serology tests detect an individual's immune response to the virus by looking for antibodies. The tests discussed in the conversation belong to the antigen test category.

Q: What are the advantages and disadvantages of antigen tests compared to PCR tests?

Antigen tests have the advantage of being rapid, cost-effective, and can detect contagiousness more accurately. In contrast, PCR tests are more sensitive at detecting viral RNA but often continue to detect RNA even after a person is no longer contagious. The prolonged positivity of PCR tests can cause confusion and lead to unnecessary isolation or quarantine.

Q: How can rapid testing be used to manage future pandemics?

Mina believes that the lessons learned from the COVID-19 pandemic should prioritize public health tools, such as rapid testing, for controlling the spread of future pandemics. He highlights the need to invest in public health infrastructure, change regulatory frameworks, and shift the focus from medical diagnostics to public health measures. By doing so, future pandemics can be managed more effectively by empowering individuals and preventing widespread transmission.

Takeaways

The conversation with Michael Mina underscores the importance of rapid testing in controlling the spread of COVID-19. Rapid antigen tests have the potential to empower individuals, detect contagiousness accurately, and prevent onward transmission. However, barriers such as the medical industrial complex, regulatory frameworks, and cost issues limit the widespread adoption of rapid tests. To address future pandemics effectively, a shift towards prioritizing public health tools and investing in public health infrastructure is necessary.

Summary & Key Takeaways

• Michael Minna advocates for cheap rabbit at-home testing as a solution to COVID-19.

• Rapid antigen tests, like paper strip tests, can accurately detect contagiousness and are cost-effective to manufacture.

• Government bureaucracies and the medical industry have hindered the implementation of these tests despite their potential to empower individuals and halt the spread of the virus.