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

1. 0:00 – 2:32

   Introduction

   1. LFLex Fridman0:00

      The following is a conversation with Michael Mina. He's a professor at Harvard doing research on infectious disease and immunology. The most defining characteristic of his approach to science and biology is that of a first principles thinker and engineer, focused not just on defining the problem but finding the solution. In that spirit, we talk about cheap rapid at-home testing, which is a solution to COVID-19 that, to me, has become one of the most obvious powerful and doable solutions that, frankly, should have been done months ago and still should be done now. As we talk about, its accuracy is high for detecting actual contagiousness, and hundreds of millions can be manufactured quickly and relatively cheaply. In general, I love engineering solutions like these, even if government bureaucracies often don't. It respects science and data. It respects our freedom. It respects our intelligence and basic common sense. Quick mention of each sponsor followed by some thoughts related to the episode. Thank you to Brave, a fast browser that feels like Chrome but has more privacy-preserving features. Athletic Greens, the all-in-one drink that I start every day with to cover all my nutritional bases. ExpressVPN, the VPN I've used for many years to protect my privacy on the internet. And Cash App, the app I use to send money to friends. Please check out these sponsors in the description to get a discount and to support this podcast. As a side note, let me say that I've always been solution-oriented, not problem-oriented. It saddens me to see that public discourse disproportionately focuses on the mistakes of those who dare to build solutions rather than applaud their attempt to do so. Teddy Roosevelt said it well in his The Man in the Arena speech over 100 years ago, "I should say that both the critic and the creator are important, but in my humble estimation, there are too many now of the former and not enough of the latter." So while we spread the derisive words of the critic on social media, making it viral, let's not forget that this world is built on the blood, sweat, and tears of those who dare to create. If you enjoy this thing, subscribe on YouTube, review it with five stars on Apple Podcasts, follow on Spotify, support on Patreon, or connect with me on Twitter, @lexfridman. And now, here's my conversation with Michael Mina.

2. 2:32 – 6:45

   Interacting between viruses and bacteria

   1. LFLex Fridman2:32

      What is the most beautiful, mysterious, or surprising idea in the biology of humans or viruses that you've ever come across in your work? Sorry for the overly philosophical question. (laughs)

   2. MMMichael Mina2:45

      (laughs) Wow. Well, that's a great question. You know, I love the pathogenesis of viruses and, uh, one of the things that I've worked on, uh, a lot is trying to understand how viruses interact with each other. And, uh, so pre-, you know, all this COVID stuff (laughs) , I was, uh, I was really, really dedicated to understanding, uh, how, uh, how viruses impact, uh, 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, uh, 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, uh, measles gets into a kid's body. The immune system picks it up and, uh, essentially, uh, grabs the virus and, uh, does exactly what it's supposed to do, which is to take this virus and bring it into the immune system so that the immune system can learn from it, can develop an immune response to it, but instead measles plays a trick. It gets into the immune system, serves almost as a Trojan horse, and instead of getting eaten by these g- by these cells, it just takes them over and it ends up proliferating in the very cells that were supposed to kill it. Uh, and, uh, it just distributes throughout the entire body, gets into the bone marrow, kills off children's, uh, immune memories, and so it essentially, uh, what I've found and what my research has found is that this one virus was responsible for as much as half of all the infectious disease deaths in kids before we started vaccinating against it 'cause it was just wiping out children's immune memories to all different pathogens which is, you know, I think, um, just astounding. It's just amazing to watch it spread throughout bodies. We've done the studies in monkeys and, and you can watch it just destroy and obliterate people's immune memories in the same way that, you know, some parasite might destroy somebody's brain when... you know, it's...

   3. LFLex Fridman4:59

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

   4. MMMichael Mina5:08

      Oh, I think in that sense, it's just coincidence. Uh, it probably is a... so good way for measles to, uh... it's a good way for measles to essentially be able to survive, uh, long enough to replicate in the body. It just replicates in the cells that are meant to destroy it. So it's, uh, it's utilizing our immune cells for its own replication, uh, but in so doing, it's destroying the memories of all the other, the other immunological memories, so... But there are other viruses. So a different system is influenza, and, uh, flu predisposes to severe bacterial infections, and that, I think, uh, is another coincidence, but I, but I also think that there are, uh, that there are some evolutionary benefits that bacteria may hijack and sort of piggyback on viral infections. Viruses can...... uh, they just grow so much quicker than bacteria. They replicate faster and so there's this system with viruses, with flu and, and bacteria where the influenza has, uh, these proteins that cleave certain receptors and the bacteria want to cleave those same receptors, they want to cleave the same molecules that, uh, gave entrance to those receptors. Uh, so instead the bacteria fi- found out like, "Hey, you know, we could just piggyback on these viruses. They'll do it 100 or 1,000 times faster than we can." And so then they just piggyback on and they let flu cleave all these sialic acids and then the bacteria just glom on in, in the wake of it. So, there's all different interactions between pathogens that are just remarkable.

3. 6:45 – 10:17

   Deadlier viruses

   1. MMMichael Mina6:45

   2. LFLex Fridman6:45

      So does this whole system of viruses that interact with each other and so damn good at getting inside our bodies, does that fascinate you or terrify you?

   3. MMMichael Mina6:55

      I'm very much a scientist and so, uh, it fascinates me much more than it terrifies me. Uh, but knowing enough, I know just how well, you know, we get the wrong virus, um, in our population, whether it's through some random mutation or whether it's this same COVID-19 virus and it, you know, these things are tricky. They're, they're able to mutate quickly, they're able to, uh, find new hosts and rearrange, in the case of influenza. Um, 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, uh, much worse than it is. You know, same thing with H1N1 back in 2009. Uh, 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, it's hard to say, you know? The, the human species, we're, we're f- well, (laughs) I, I hesitate to say that we're good at responding to things because there are some aspects that we're, this particular virus, SARS-CoV-2 and COVID-19 has found a sweet spot where we're, where it's not quite serious enough on an individual level that humans just don't n- we haven't seen much of a useful response by many humans. (laughs) They, a lot of people even think it's a hoax. And so it's led us down this path of, uh, 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, um, I think, uh, I know enough about virus biology to be terrified for humans that, you know, it can, it just takes one virus, just takes the wrong one, to just obliterate us, or, or not obliterate us but, but really do much more damage than we've seen.

   4. LFLex Fridman8:45

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

   5. MMMichael Mina8:52

      Yeah. (laughs)

   6. LFLex Fridman8:52

      Like, figuring out how we can sneak past the defenses of the humans so it's not bad enough, and then the, 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, uh, there's a rhyme and a rhythm to the way this whole evolutionary process works and creates these fascinating things that spread throughout the entire civilization.

   7. MMMichael Mina9:23

      Absolutely. It's, um ... Yeah. I'm, I'm completely fascinated by this idea of, uh, social media in particular, how it replicates, how it grows, you know, I've been, how it inter- how it, like, actually starts interacting with the biology of the virus. Masks, who's gonna get vaccinated, politics, like, these seem so external to virus biology but it's become so in- intertwined and, uh, a- and it's, it's interesting and I actually think we could find out that, you know, the virus actually becomes, uh, obviously not, uh, intentionally, but, you know, we could find that choosing, people choosing not to wear masks, choosing, choosing not to counter this virus in a regimented and sort of organized way effectively gives the virus more opportunity

4. 10:17 – 11:51

   Will COVID-19 mutate?

   1. MMMichael Mina10:17

      to escape. Uh, 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, uh, 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 zero are at the end of however many viral particles there are in the world right now, you know, more than quadrillions (laughs) probably.

   2. LFLex Fridman11:02

      Yeah.

   3. MMMichael Mina11:02

      And so if you assume that at any given time somebody might have trillions of virus in them, at any given individual-

   4. LFLex Fridman11:08

      (laughs) .

   5. MMMichael Mina11:08

      ... so then, you know, multiply trillions by millions and-

   6. LFLex Fridman11:11

      Yeah.

   7. MMMichael Mina11:12

      ... you know, you get a lot of viruses (laughs) out there, and, and if you start applying pressure, ecological pressure to this virus so that, you know, when it's that abundant, God, the opportunity for, uh, a virus to sneak around immunity, especially when all the vaccines are identical essentially, um, it's-

   8. LFLex Fridman11:30

      All it takes is one to mutate and then jumps, oh

   9. MMMichael Mina11:33

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

   10. LFLex Fridman11:49

       I have a million other questions in this direction

5. 11:51 – 29:15

   Rapid testing

   1. LFLex Fridman11:51

      but I'd love to talk about one of the most exciting aspects of your work which is, uh, testing, or rapid testing. You wrote a great article in Time on November 17th, so this is like a month ago-... uh, about rapid testing titled "How We Can Stop the Spread of COVID-19 by Christmas." Let's, uh, jot down the fact that this is a month ago, so maybe your timeline would be different, but let's say in a month. So you've talked about this powerful idea for quite a while throughout the COVID, uh, 19 pandemic. How do we stop the spread of COVID-19 in a month?

   2. MMMichael Mina12:29

      Well, we, uh, we use tests like these, 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.

   3. LFLex Fridman12:41

      Yes.

   4. MMMichael Mina12:41

      Um, and so there's a few ways to stop the virus from spreading to each other, and that is, uh, you either can vaccinate everyone, and vaccinating e- 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, uh, so that may or may not, uh, 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, uh, and that's rapid testing. That is giving... It's empowering people to know, uh, 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. Um, we could have done this. We still can. Today we could start. We have millions of these tests. These tests are, uh, simple paper strip tests. They are, uh... Inside of this thing is just a little piece of paper.

   5. LFLex Fridman13:56

      Mm-hmm.

   6. MMMichael Mina13:57

      Um, now and I can actually open it up here. There we go. So this, this is how we do it right here. We have this little paper strip test. This is enough to let you know if you're infectious with somewhere around the order of 99% sensitivity, 99% specificity you can know if you have infectious virus in you. If we can get these out to everyone's homes, build these, make 10 million, 20 million, 30 million of them a day, you know, we make more bottles of Dasani water, uh, every day-

   7. LFLex Fridman14:30

      (laughs) .

   8. MMMichael Mina14:30

      ... we can make these 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, uh, 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, the transmission of this is, you know, for every 100 people that get infected right now, they go on to infect maybe 130 additional people," and that's exponential growth. So 100 becomes 130, uh, a couple days later that 130 becomes, uh, ano- another 165 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 100 people not infect 130 but infect 90.

   9. LFLex Fridman15:20

      Yeah.

   10. MMMichael Mina15:20

       All we have to do is remove say, 30, 40% of new infections from continuing their spread, and then instead of exponential growth you have exponential decay.

   11. LFLex Fridman15:29

       Mm-hmm.

   12. MMMichael Mina15:30

       So this doesn't need to be perfect. We don't have to go from 100 to zero.

   13. LFLex Fridman15:34

       Mm-hmm.

   14. MMMichael Mina15:34

       We just have to go and have those 100 people infect 90 and those 90 people infect, you know, 82, whatever it might be.

   15. LFLex Fridman15:41

       Mm-hmm.

   16. MMMichael Mina15:41

       And you do that for a few weeks and boom, you have now gone instead of 100 to 500, you've gone from 100 to 20.

   17. LFLex Fridman15:47

       Yes.

   18. MMMichael Mina15:48

       It's not very hard. And so the way to do that is to let people know that they're infectious. I mean, I've... We're a perfect example right now. I, I... This morning I used these tests, uh, to make sure that I wasn't infectious. Is it perfect? No, but it reduced my odds 99%.

   19. LFLex Fridman16:06

       Mm-hmm.

   20. MMMichael Mina16:06

       I already was at extremely low odds because I spend my life quarantining these days.

   21. LFLex Fridman16:11

       Well, the interesting thing with this test, which, uh, with testing in general, which is why I love what you've been espousing and it's really confusing to me that this has not been taken on, is it's one a- actual solution (laughs) that's-

   22. MMMichael Mina16:26

       (laughs) .

   23. LFLex Fridman16:26

       ... that was available for a long time. There's, there doesn't seem to have been solutions, uh, 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 w- with information essentially.

   24. MMMichael Mina16:58

       Yeah.

   25. LFLex Fridman16:59

       So, like, you... It's... It gives you more information about your s- like, your role in this pandemic and then you can do whatever the hell you want. Like, it's all up to your ethics and, and so on. So, like, i- and it's, it's obvious that with that information people would be able to protect their loved ones and also do, um, do their sort of, quote unquote, "duty for their country," right? Is protect the rest of the country.

   26. MMMichael Mina17:26

       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 b- be used. We have a political and a, a regulatory industry that doesn't want to see them be used. That sounds crazy. Why wouldn't they want them to be used? We have a very paternalistic approach to everything in this country, you know, despite this country kind of being founded on this individualistic ideal, pull yourself up from your bootstraps, all that stuff. Uh, when it comes to public health, we have a bunch of ivory tower academics who...... want data. They, you know, they want to see perfection. And we have this issue of letting perfection get in the way of actually doing something at all, (laughs) you know, doing something effective. And, uh, so we keep comparing these tests, for example, to the laboratory-based PCR test.

   27. LFLex Fridman18:28

       Yeah.

   28. MMMichael Mina18:28

       And sure, this isn't a PCR test, but this doesn't cost a 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, uh, unfortunately, a system that's not about public health. We have entirely eroded any ideals of public health in our country for the biomedical complex, you know, this medical-industrial complex which overrides everything. And that's why, you know, I'm just ...

   29. LFLex Fridman18:58

       (laughs)

   30. MMMichael Mina18:58

       Can I swear on this podcast? (laughs)
6. 29:15 – 38:59

   PCR vs rapid antigen tests

   1. MMMichael Mina29:15

      do them.

   2. LFLex Fridman29:15

      So, you have a lot of tests in front of you. Uh, could you maybe explain some of them? (laughs)

   3. MMMichael Mina29:20

      (laughs) Absolutely. So, there's a few different classes of tests that I just have here and there's more tests, there's many more different tests out in the world too. These are, these are one class of test. These are, uh, rapid antigen tests that are just the most bare bones paper strip tests. These, uh, are... This is the type that I wanna see produced in the tens of millions every day.

   4. LFLex Fridman29:43

      Mm-hmm.

   5. MMMichael Mina29:44

      It's so simple. You know, you don't even need the plastic cartridge. You can just, you can just make, uh, make the paper strip and y- you could have a little, a little tube like this that, you know, you just dunk the paper strip into. You don't actually need the plastic which I'd actually prefer because if we start making tens of millions of these, this becomes a lot of waste.

   6. LFLex Fridman30:04

      Mm-hmm.

   7. MMMichael Mina30:05

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

   8. LFLex Fridman30:16

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

   9. MMMichael Mina30:29

      These are just injection molded, I think, and, uh-

   10. LFLex Fridman30:32

       Got it.

   11. MMMichael Mina30:33

       ... they're, um ... you know, they can build them, uh, 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, uh, or some- somewhat of a bottleneck in manufacturing. The actual bottleneck, uh, which the government, I think, should use the Defense Productions Act to build up, is the, uh, there's a nitrocellulose membrane, a laminated membrane on this, that allows, uh, the- the material, the- the s- the- the buffer and 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 d- dunk that swab into some buffer, and then you put a couple drops of that buffer onto the lateral flow. And just like a paper, if you dip a piece of paper into a cup of water, the- the paper will pull the water up through capillary action. This actually works very similarly. It flows through- through somewhat a capillary action, uh, through this nitrocellulose membrane, and there's little antibodies on there, these little proteins that are very specific, in this case, for antigens or proteins of the virus. So, these are antibodies similar to how ... to the antibodies that our body makes, uh, from our immune system, but they're just printed on these, um, lateral flow tests, and they're printed just like a little ... a 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, um, one line means negative, it means the control strip worked, and two lines mean positive. It means, uh, you know, b- if you get two lines, it just means you have virus there, or you're very, very likely to have virus there. And so, uh, so they're super simple. This is ... it is the exact same technology as pregnancy tests. It's, uh, the technology ... this particular one from Abbott, this has been used, uh, for other infectious diseases like malaria and, and actually a number of these companies have made malaria tests that- that do the exact same thing. So, they just co-opted their ... the same form factor and, uh, and just changed the antibodies so it picks up SARS-CoV-2 instead of other infections.

   12. LFLex Fridman32:46

       Is it also ... the Abbott one, is it also a strip?

   13. MMMichael Mina32:48

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

   14. LFLex Fridman32:59

       Yeah.

   15. MMMichael Mina32:59

       It- it looks like a l- like ... I mean, it's just the simplest thing you could- you could imagine.

   16. LFLex Fridman33:04

       The exterior packaging looks very Apple-like. That's nice.

   17. MMMichael Mina33:07

       It does, yeah (laughs) . Yeah.

   18. LFLex Fridman33:09

       (laughs)

   19. MMMichael Mina33:09

       Yeah. So, it's nice, and it comes in a-

   20. LFLex Fridman33:10

       It's all about the branding.

   21. MMMichael Mina33:11

       This is the ... this is how they're packaged, you know, so y- and- and they don't have to. You know, this ... these are coming in individual packages against ... again, because they're really considered individual medical devices.

   22. LFLex Fridman33:23

       Yeah.

   23. MMMichael Mina33:24

       But you could package them in, you know, bigger packets and stuff. You- you want to be careful with humidity, so they all have a little, um, one of those, um, humidity removing things and oxygen removing things. Um, so that's ... the- this is one class, these antigen tests.

   24. LFLex Fridman33:40

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

   25. MMMichael Mina33:51

       Sure.

   26. LFLex Fridman33:51

       Just really quick.

   27. MMMichael Mina33:52

       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. Uh, we'll start with the first two. The t- the first two tests are just looking for the virus or looking for antibodies against the virus. So, we've heard about serology tests, um, or maybe some people have heard about it. Those are a different kind of test. They're looking to, uh, 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, uh, they- they actually can look very similar to this or they can be done, uh, i- in a laboratory. They ... those are usually done from blood, and they're- 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, you ... there's two ways to look for the virus. You can either look for the genetic code of the virus, like the RNA, just like the DNA of somebody's human cells, or you can look for the proteins themself, the antigens of the pro- of the virus. So, uh, I like to differentiate them. If you were a- a- a PCR, uh, test that looks for RNA in, uh, 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. Uh, the equivalent to an antigen test is sort of a- a test that, like, actually is looking for our eyes or our nose or physical features of our body that would, uh, delineate, okay, this is, this is, uh, Michael, for example. And so, so you're either looking for this ... a sequence or you're looking for a structure. Uh, 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, uh, by a company called Detect, this is one of Jonathan Rothberg's companies. Um, he's the guy who helped create, uh, modern day sequencing and, uh, all- all kinds of other things. So, this Detect device, that's the name of the company, this is actually a rapid RNA detection device.

   28. LFLex Fridman36:02

       Uh-huh.

   29. MMMichael Mina36:02

       So, it's almost ... it's like a PCR-like test, and we could even do it here. Uh, it's really ... it's- it's a beautiful test, in my opinion. Works ex- exceedingly well. It's gonna be a little bit more expensive, so I think it could confirm, could be used as a confirmatory test for these.

   30. LFLex Fridman36:16

       Is there a greater accuracy to it?
7. 38:59 – 42:51

   Medical industrial complex

   1. MMMichael Mina38:59

      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, uh, and what that means is that we don't even... We don't have a, 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, uh, and that becomes very problematic when we're trying to tackle a public health threat and a public health emergency by definition. (laughs) 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, I am a physician so I'll put on that physician hat for a moment-

   2. LFLex Fridman39:59

      (laughs)

   3. MMMichael Mina39:59

      ... and if I have a doc- uh, if I have a patient who comes to me and wants to, uh, know if their symptoms are a result of them having COVID, uh, then I want every shred of evidence that I can get to see does this person currently or did they recently have, uh, 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... Your, you said your symptoms started two weeks ago, you probably were infectious two weeks ago and, and you have lingering symptoms from it." But that's a phys- that's a medical diagnosis. It's kind of like a detective recreating a crime scene. They want to go back there and re- recreate the pieces so that they can, um, a- assign blame or whatever it might be. But that's not public health. In public health we need to only look forward. We don't want to go back and say, "Well, was this person... Are there symptoms because they had an infection two weeks ago?" In public health we just want to stop the virus from spreading to the next person, and so that's where we don't care if somebody was infected two weeks ago. We only care about finding the people who are infectious today, and unfortunately our regulatory landscape fails to, uh, 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, um, complaints that say this test which detects 99 plus, you know, 99.8% of, of current infectious people, uh, on, by the FDA's rubric they'll say, "No, no. That's, it's only 50% sensitive." And that's because when you go out into the world and you just compare this against PCR positivity, most people who are PCR positive in the world right now at any given time are post-infectious.

   4. LFLex Fridman42:00

      Mm-hmm.

   5. MMMichael Mina42:00

      They're no longer infectious because you, you might only be infectious for five days but then you'll remain PCR positive for three or four or five weeks. And so when you go and just evaluate these tests and you say, "Okay, this person's PCR positive, does the rapid antigen test detect that?" More often than not it's no, but that's because those people don't need isolation, you know, they- they're post-infectious. And this is, uh, it's become much more of a problem-... than I think, uh, even the FDA themself is recognizing because they are unwilling, at this point, to, to look at this as a public health problem requiring public health tools.

   6. LFLex Fridman42:39

      We'll definitely talk about this a little bit more because the concern I have is that, like, a bigger ca- pandemic comes along. What are the lessons we draw from this and how we move forward? Let's talk about that in, in a bit.

   7. MMMichael Mina42:50

      Mm-hmm.

   8. LFLex Fridman42:50

      But sort of,

8. 42:51 – 49:35

   Lex takes COVID test

   1. LFLex Fridman42:51

      can we, (laughs) can we discuss further the lay of the land here-

   2. MMMichael Mina42:55

      Sure.

   3. LFLex Fridman42:55

      ... of the different tests before us?

   4. MMMichael Mina42:57

      Absolutely. So I talked about PCR tests and those are done in the lab or they're done essentially with, with a rapid test like this, the Detect. And we can even try this in a moment.

   5. LFLex Fridman43:07

      Mm-hmm.

   6. MMMichael Mina43:08

      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. Um, or you could have one that has 100 different, um, outlets. This is just to heat the tube up. These are the rapid tests, they're super simple. No frills, you just swab your nose and, uh, you put the swab into a buffer and you put the buffer on the test. So we can use these right now if you want.

   7. LFLex Fridman43:34

      Yeah.

   8. MMMichael Mina43:34

      Um, we can try it out.

   9. LFLex Fridman43:35

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

   10. MMMichael Mina43:41

       That's still the main-

   11. LFLex Fridman43:42

       ... that's the-

   12. MMMichael Mina43:42

       ... yeah. There, there are some saliva tests coming about and they, these can all work potentially with saliva, they just have to be recalibrated. Uh, but these, these swabs are really not bad. The- this isn't the, the deep swab that goes, like, way back-

   13. LFLex Fridman43:56

       (laughs)

   14. MMMichael Mina43:57

       ... uh, into your nose or anything. This is just the, uh, just a swab that you do yourself, like, right in the front of your nose. Um, so if you wanna do it.

   15. LFLex Fridman44:04

       Yeah. Do you mind if I-

   16. MMMichael Mina44:05

       Sure.

   17. LFLex Fridman44:06

       ... do it?

   18. MMMichael Mina44:07

       Yeah. Yeah, why don't we start with this one 'cause this is, uh, this is Abbott's BinaxNOW test and it's really, it's pretty simple.

   19. LFLex Fridman44:13

       This is the s- the swab from the Abbott test, right?

   20. MMMichael Mina44:16

       That's correct. That's the swab from the Abbott test. So what I'm gonna do to start is I'm going to take this buffer here, which is, uh, this is just the buffer that goes onto this test. So this is a brand new one, I just opened this, this test out, um.

   21. LFLex Fridman44:31

       Mm-hmm.

   22. MMMichael Mina44:32

       Uh, I'm gonna just take six drops of this buffer and put it right onto this test here.

   23. LFLex Fridman44:40

       Two, three, four, five, six.

   24. MMMichael Mina44:43

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

   25. LFLex Fridman45:03

       This always makes me wanna sneeze.

   26. MMMichael Mina45:05

       Yeah. (laughs) Okay. Now I'm gonna have you do it yourself. Um...

   27. LFLex Fridman45:10

       (laughs) I'm getting emotional.

   28. MMMichael Mina45:13

       (laughs) Hold it parallel to the test, so put the test down on the table, yep, and then go into that bottom hole, yep, and push forward so that you can start to see it in the other hole. There you go. Now turn, if it's ... once it hits up against the top, just turn it, uh, three times, one, two, three, and sort of, yep. And now-

   29. LFLex Fridman45:32

       All right.

   30. MMMichael Mina45:32

       ... you just close, so pull off that adhesive sticker there, and now you just close the whole thing.
9. 49:35 – 52:21

   FDA and cheap tests

   1. LFLex Fridman49:35

      Okay.

   2. MMMichael Mina49:35

      That's right. So then there's this, there's this test here which is, you know... This is another... You know, it's funny. This, let me open this up and show you. This is a really nice test, it's another antigen test. Works the exact same way as this, essentially. But what you can see is it's got, like, lights in it and a power button and stuff. This is called an Ellume test, which is, you know, f- fine and it's a really nice test, to be honest. But it, um, but it has to pair with an iPhone. And, and so it's good as a... I think that this is gonna become a th- 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 with an iPhone, uh, it can immediately send, uh, send the report to a Department of Health. Whereas these paper strip tests that ... they're just paper. They don't report anything, unless you wanna report it. So I'm gonna just pick it up and pick it apart. And so what you can see is there's like fluorescent readers and little lasers and LEDs and stuff in there, you can actually see the lights going off.

   3. LFLex Fridman50:36

      Oh.

   4. MMMichael Mina50:37

      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.

   5. LFLex Fridman50:43

      Mm-hmm.

   6. MMMichael Mina50:43

      Right? And so this is the kind of thing that, you know, the FDA is looking for-

   7. LFLex Fridman50:51

      (laughs)

   8. MMMichael Mina50:52

      ... um, for like home use and, and things like that because it's kind of fool-proof. Like, you, you can't go wrong with it, it pairs with an iPhone so you need Bluetooth. So it's gonna be more limited. It's a great test, don't get me wrong. It's as good as any of these. But, you know, when you compare this thing with a battery and a circuit board and all this stuff, it's got its purpose but, you know, it's not a public health tool. I don't want to see this made in the tens of millions a day-

   9. LFLex Fridman51:16

      Yeah.

   10. MMMichael Mina51:17

       ... and thrown away. Um, this is just-

   11. LFLex Fridman51:19

       But FDA likes that kind of stuff, so-

   12. MMMichael Mina51:20

       FDA loves this stuff, you know-

   13. LFLex Fridman51:21

       Yeah.

   14. MMMichael Mina51:22

       ... because they can't get it out of their mind that this is a public health crisis. You know, we need-

   15. LFLex Fridman51:26

       Yeah.

   16. MMMichael Mina51:27

       ... we need... I mean, just look at the difference here, like-

   17. LFLex Fridman51:29

       Something with flashing lights is-

   18. MMMichael Mina51:30

       (laughs) Yeah.

   19. LFLex Fridman51:31

       ... is essential.

   20. MMMichael Mina51:32

       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. (laughs)

   21. LFLex Fridman51:39

       Yeah.

   22. MMMichael Mina51:39

       And so, you know, I, 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-

   23. LFLex Fridman51:49

       But it goes against the principle of just, uh, 20 million a day-

   24. MMMichael Mina51:52

       Exactly.

   25. LFLex Fridman51:52

       ... the easy solution, everybody has it, you can manufacture and, and probably... You could have probably scaled this up in a couple of weeks.

   26. MMMichael Mina52:00

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

10. 52:21 – 59:29

    Explanation of Elon Musk's positive COVID tests

    1. MMMichael Mina52:21

    2. LFLex Fridman52:21

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

    3. MMMichael Mina52:37

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

    4. LFLex Fridman52:41

       (laughs)

    5. MMMichael Mina52:41

       That's when-

    6. LFLex Fridman52:41

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

    7. MMMichael Mina52:45

       Well, he was using a slightly different one, one of these but that requires an instrument called the BD Veritor.

    8. LFLex Fridman52:50

       Mm-hmm.

    9. MMMichael Mina52:50

       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.

    10. LFLex Fridman52:57

        Yes.

    11. MMMichael Mina52:57

        He got two positives, two negatives. Um, 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 an... This was actually right before he was about to send those... It was the day of essentially that he was sending the astronauts up to the space station the other day. So he used, uh, he was using these rapid tests because he wanted to make sure that he was good to go in and, um, he got discrepant results.

    12. LFLex Fridman53:23

        Yeah.

    13. MMMichael Mina53:23

        Ultimately, they were correct but, you know, two were negative, two were positive, but what, what really happened once he got his... He shared his PCR results and they were very low positive. So really what was happening is, uh, my guess is he found himself right at the edge of his positivity, of his infectiousness, and so ... You know the test worked how it was supposed to work. It, uh ... 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 he used the test, so the PCR would always pick it up 'cause it's still ... 'Cause that will still stay positive then for weeks potentially. But the rapid antigen test was starting to f- to falter, not in a bad way but just he probably was really no longer particularly infectious-

    14. LFLex Fridman54:07

        Yeah.

    15. MMMichael Mina54:08

        ... and so it was kind of ... When it gets to be a very low viral load, it becomes stochastic.

    16. LFLex Fridman54:12

        It's fascinating, this, this duality. So one, you can think from an individual sp- individual perspective, it's unclear when you take four and half are, uh, positive, half are negative, like what are you supposed to do? But from a societal perspective, it seems like if just one of them is positive, just stay home for, for a couple of days, for, for a while. So when you're a CEO of a company and you're launching astronauts to space, you may not want to rely absolutely on the (laughs) antigen test as a, as a thing, uh-... by which you steer your decisions of, like, 10,000-plus people companies. But us individuals just living in the world, if you can, if it comes up positive, uh, then, uh, 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, uh, stop spreading. That's the whole point.

    17. MMMichael Mina55:07

        That's exactly right. You don't have to catch every single one.

    18. LFLex Fridman55:10

        Yeah.

    19. MMMichael Mina55:10

        And, and the nice thing is that these will, these will catch the people who are most infectious. So with Elon Musk, it, it 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. Uh, but, uh, my guess is the fact that it was catching two out of the four even when he was down at a CT value, a really, really very, very low viral load on the PCR test, suggests that it was doing its job. Um, and you just wanna ... And the nice thing is because these can be produced at such scale, uh, getting a po- getting one positive doesn't immediately have to mean 10 days of isolation. Uh, that's the CDC's more conservative stance to say, "Uh, if you're positive on any test, stay home for 10 days and isolate."

    20. LFLex Fridman55:59

        (coughs)

    21. MMMichael Mina55:59

        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.

    22. LFLex Fridman56:10

        Yeah.

    23. MMMichael Mina56:10

        And the nice thing there is, you know, right now people just aren't testing 'cause they don't wanna take 10 days off.

    24. LFLex Fridman56:15

        Yeah.

    25. MMMichael Mina56:15

        They're not getting paid for it, so they can't take 10 days off.

    26. LFLex Fridman56:18

        Do you know what, uh, Elon thinks about this idea of rapid testing for everybody? So I, I, I understood, I need to look at that whole Twitter thread. So I understand his perhaps criticism of, uh, he, he had like a conspiratorial tone-

    27. MMMichael Mina56:33

        Mm-hmm.

    28. LFLex Fridman56:33

        ... from my vague look at it of, like, "What's going on here with these tests?" Uh, but what does he actually think about this very practical, to me, engineering solution of just deploying rapid tests to everybody? It seems like that's a way to open up the economy in April.

    29. MMMichael Mina56:48

        Well, to be honest, I've been trying to get in touch with him again. I think take somebody like Elon Musk-

    30. LFLex Fridman56:54

        Mm-hmm.
11. 59:29 – 1:02:58

    Role of testing during vaccine deployment

    1. LFLex Fridman59:29

       Now, a lot of people believe because vaccines started being deployed currently that, you know, we are no longer in need of a solution. We're no longer in need of, uh, s- uh, slowing the spread of the virus. Uh, 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? Uh, what's the role of rapid testing current- in the next, you know, what is it, three, four months maybe is-

    2. MMMichael Mina1:00:01

       Even more. This, the vaccine rollout isn't gonna be as peachy as everyone is hoping. You know, and I hate to be the Debbie Downer here, but, um, 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. Uh, you know, I hope that that might change as things move forward and people see their neighbors getting it and their family getting it and they're, and it's safe and all. We don't know how effective the vaccine is gonna be after two or three months. We've only measured it in the first two or three months, which is a massive problem, uh, which we can go into biologically, 'cause there's reasons to, very good reasons to believe that the efficacy could fall way down after two or three months. Uh, we don't know if it's gonna 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 blockade.... and, uh, and frankly, we don't know how easily we're going to be able to roll it out. Some of the vaccines need s- really significant cold chains, have very short half-lives outside of that cold chain. Uh, we need to organize massive, uh, uh, numbers of people to be able to distribute these. Most hospitals today are saying that they're not, uh, equipped to hire the right people to be even administering, uh, enough of these vaccines. And then a lot of the hospitals are frustrated 'cause they're getting much low- 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, uh, w- I mean, the country has the capacity to build them. We have, we're s- 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. Um, they need to authorize these as public health tools or, you know, frankly, uh, the president could. Uh, you know, there's a lot of other ways to get these tests to not have to go through the normal FDA authorization program, but maybe have the NIH and the CDC give a stamp of approval. Uh, 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, the spread of this virus by Christmas. We could. You know, now it's getting late and so, uh, we have to keep updating that timeframe. Maybe putting Christmas in the title wasn't- I should've said may- "How we can stop the spread of this virus in a month."

    3. LFLex Fridman1:02:35

       Yeah.

    4. MMMichael Mina1:02:36

       It would be of a little bit more timeless, but, uh, but we could do it. You know, we really could do it and that's the most frustrating part here, is that, uh, we're just choosing not to as a country. We're choosing to bankrupt our society because some people, uh, 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.

12. 1:02:58 – 1:12:38

    Public health policy

    1. MMMichael Mina1:02:58

    2. LFLex Fridman1:02:58

       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, I love in terms of the, uh, MIT, uh, engineering approach to public health. Is there a way to push this? Is this a, is this a political thing, like where some Andrew Yang-type characters need to like, uh, start screaming about it? Is it, uh, more of an Elon Musk thing where people just need to build it and then on, on Twitter start talking crap to (laughs) to politicians-

    3. MMMichael Mina1:03:30

       Yeah. (laughs)

    4. LFLex Fridman1:03:30

       ... for not doing it? What are, what, what, what d- y- w- what are the ideas here?

    5. MMMichael Mina1:03:34

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

    6. LFLex Fridman1:03:42

       Are they receptive?

    7. MMMichael Mina1:03:43

       Oh, yeah. I mean, that's the crazy thing. Everyone but the FDA is receptive.

    8. LFLex Fridman1:03:47

       (laughs)

    9. MMMichael Mina1:03:47

       I mean, it's, it's astounding. I mean, I advise, you know, uh, informally I advise the president and the president-elect's teams. I talk to Congress, I talk to senators, governors, you know, uh, and then all the way down to, you know, mayors of towns and, and things. And, um, I held, I mean, months ago I held a round table discussion with Mayor Garcetti, uh, uh, who's the mayor of LA, and I brought all the, uh, all the companies who make these things. This was in like July or August or something. I brought all the companies to the table and said, "Okay, how can we get these out?" And unfortunately, it, it went nowhere because the FDA won't authorize them as public health tools. Um, 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.

    10. LFLex Fridman1:04:35

        (laughs)

    11. MMMichael Mina1:04:35

        And like you said, it's, it's a real solution.

    12. LFLex Fridman1:04:38

        Yeah.

    13. MMMichael Mina1:04:38

        Lockdowns aren't a solution. They're, they're a, a, a, a 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 wellbeing. It f- includes their psychological wellbeing, their financial wellbeing. 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 an, uh, it's a m- myopic or, or, or very, uh, tunnel-visioned approach to a viral- virus that's spreading. Uh, this is a simple solution with essentially no downfall. You know, there is no, nothing bad about this. It's just giving people, uh, 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, uh, 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.

    14. LFLex Fridman1:05:45

        So why, why do you think, uh, like the mayor of LA, why do you think politicians are going for these, um, from my perspective, like kind of half-assed lockdowns, uh, w- which is not ... So I have seen good evidence that like a complete lockdown can work, but that's in, in theory. It's just like communism in theory can work. (laughs)

    15. MMMichael Mina1:06:08

        Mm-hmm. Yeah.

    16. LFLex Fridman1:06:09

        (laughs) Like if 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.

    17. MMMichael Mina1:06:23

        Mm-hmm.

    18. LFLex Fridman1:06:24

        That's really dest- really hurting small businesses. Um, like why are they going for that?

    19. MMMichael Mina1:06:29

        And big businesses. (laughs)

    20. LFLex Fridman1:06:30

        And b- yeah, all businesses.

    21. MMMichael Mina1:06:32

        Yeah.

    22. LFLex Fridman1:06:32

        Uh, but like basically not just hurting-

    23. MMMichael Mina1:06:35

        Yeah. Destroying.

    24. LFLex Fridman1:06:35

        ... they're destroying small businesses, right? Uh, which is going to have potentially, I mean-

    25. MMMichael Mina1:06:42

        Very long-lasting consequences.

    26. LFLex Fridman1:06:43

        Yeah. I've been reading s- e- as, as I don't shut up about the, the rise and fall of the Third Reich and, you know, there, (laughs) there's economic effects, uh, that, uh, take d- a decade to, you know ... There's going to be long-lasting effects that may, uh, may be destructive to the very fabric of this nation.

    27. MMMichael Mina1:07:02

        Mm-hmm.

    28. LFLex Fridman1:07:03

        So-... why are they doing it and why they're not using this solution? Is there, is there an intuition? I mean, you've said that-

    29. MMMichael Mina1:07:08

        Hmm.

    30. LFLex Fridman1:07:09

        ... FDA has a stranglehold, I guess, on this whole public health problem.
13. 1:12:38 – 1:29:30

    A weather system for viruses

    1. MMMichael Mina1:12:38

    2. LFLex Fridman1:12:38

       Well, what do you think, uh... Sorry if I'm stuck on this.

    3. MMMichael Mina1:12:41

       No, that's fine.

    4. LFLex Fridman1:12:41

       Your, the, your mention of MIT and, uh, public health engineering, right?

    5. MMMichael Mina1:12:46

       Mm-hmm.

    6. LFLex Fridman1:12:47

       I mean, it, it has a sense of, uh, I talked to competition biology folks.

    7. MMMichael Mina1:12:51

       Mm-hmm.

    8. LFLex Fridman1:12:51

       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, uh, in this space?

    9. MMMichael Mina1:13:14

       Oh, yeah. Uh, I mean, I can speak to, to one of the major, um, activities that I want to do. So what I normally do in my research lab is develop technologies that, uh, can take a, 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.

    10. LFLex Fridman1:13:35

        That's awesome.

    11. MMMichael Mina1:13:36

        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, uh, uh, tools to, A, interpret that. But what I really want to do, for example, to kind of kick off this new field of what I consider public health engineering, is to create, maybe it's a little ambitious, but (laughs) create, uh, uh, 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?

    12. LFLex Fridman1:14:12

        Hmm.

    13. MMMichael Mina1:14:13

        Is it a rhinovirus, an adenovirus, 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 or does it, you know, completely change the way that we go about our days? Uh, absolutely. Uh, you know, I, I envision, for example, right now, we open up our iPhone, we plug in a ZIP code, and if it tells us it's gonna rain today, we bring an umbrella.

    14. LFLex Fridman1:14:53

        Mm-hmm.

    15. MMMichael Mina1:14:53

        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. Uh, but if we know the rules of the game that these viruses play by, we can start preparing for those. And, you know, every year, we go into every flu season blindfolded with our hands tied behind our back just saying, "I hope this isn't a bad flu season this year." Why don't... I mean, this is, you know, (laughs) 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 gonna be a bad flu season this year. Let's act accordingly and with a targeted approach." You know, 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.

    16. LFLex Fridman1:15:56

        (laughs) Right.

    17. MMMichael Mina1:15:56

        We, we wait, and if we know that there's one coming, then we act for a, 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, uh, ruin our days.

    18. LFLex Fridman1:16:09

        I can't tell you how exciting that vision of the future is. Uh, I think that's incredible and it seems like it should be within our reach. The, (laughs) just these, like, weather maps of viruses-

    19. MMMichael Mina1:16:22

        Mm-hmm.

    20. LFLex Fridman1:16:22

        ... floating about the Earth and, and it seems obvious. It's one of those things where right now it seems like maybe impossible, uh, and then looking back like 20 years from now, we'll wonder, like, why the hell this hasn't been done way earlier. The one difference between weather... May- I don't know if you have interesting ideas in this space, the difference between weather and viruses is it includes... The collection of the data includes the human body-

    21. MMMichael Mina1:16:52

        Mm-hmm.

    22. LFLex Fridman1:16:53

        ... uh, potentially. And that means that there is some, as with the contact tracing question, there's some concern about privacy.

    23. MMMichael Mina1:17:03

        Yep.

    24. LFLex Fridman1:17:03

        There seems to be this dance that's really complicated, um, you know, with Facebook getting a lot of flak for basically misusing people's data or, you know, just whether it's perception or reality, there's certainly a lot of reality to it too, where they're not good stewards of our private data.

    25. MMMichael Mina1:17:25

        Mm-hmm.

    26. LFLex Fridman1:17:25

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

    27. MMMichael Mina1:17:56

        Absolutely.

    28. LFLex Fridman1:17:56

        How big is this problem?

    29. MMMichael Mina1:17:58

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

    30. LFLex Fridman1:18:19

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

Episode duration: 2:14:10