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Testing is one of the most important and misunderstood elements of the pandemic. Andy brings it all into focus with Michael Mina, Chief Science Officer at eMed and the go-to testing expert. They break down the complex interplay between infections, symptoms, and the different kinds of tests, and answer your top 20 questions about COVID-19 testing. After listening to this episode, you’ll understand when you should test, how each of the three main types of tests work, when more tests should be available, and much more.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Michael @michaelmina_lab on Twitter.

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Check out these resources from today’s episode: 

• The FDA keeps track of all the antigen tests with an EUA here: https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/in-vitro-diagnostics-euas-antigen-diagnostic-tests-sars-cov-2#Individual%20EUAs
• Read the preprint study about rapid at-home antigen tests and Omicron that Michael mentions in today’s episode: https://www.nytimes.com/2022/01/05/health/covid-rapid-test-omicron-detection.html
• Learn more about the NIH’s Rapid Acceleration of Diagnostics initiative: https://www.nih.gov/research-training/medical-research-initiatives/radx
• Find a COVID-19 vaccine site near you: https://www.vaccines.gov/
• Order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response: https://us.macmillan.com/books/9781250770165

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.

For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble

Transcript

SPEAKERS

Michael Mina & Andy Slavitt

Andy Slavitt  00:18

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. When I asked you the number one thing on your mind right now, it is testing. How do they work? How do I get one? Why do they cost so much? The difference between the different types of tests? When will they become more available? How to interpret them? What happens if I get different results? So we have Michael Mina on the show today. And I want you to if you do nothing else, listen to the first 20 minutes, and tell all of your friends who have any questions about testing, this 20 minutes is probably the key to everything you need to know about testing. And after that, after those 20 minutes, we take you into the 20 questions you have, we entertained through Twitter, voicemail and email what your top questions were, we got 200 questions about testing. We’ve picked the Tony that were representative of every question, we asked them to Michael, and he answers them methodically, clearly, one by one. It’s rather long episode. So I’m going to skip any other introductory comments and let you listen to these first 20 minutes of Michael. And I think they are so important to what you need to hear. And I’m grateful for Michael, if you don’t know, Michael, he ran a big lab at Harvard. And now he’s the chief science officer, and he had one of the foremost experts on testing, and particularly stay home testing, here we go.

Andy Slavitt 

Here’s what we’re gonna do, I think it’d be great to start with a couple of the basics. Because I think everyone’s now sort of paying attention to how this stuff works. And I think you could do a great job explaining the basics. Then we went out to Twitterverse and said, we were having you on the show? And do you have any questions about testing and how it works? 200 questions later. So I think we’re gonna try to do is something a little bit of a different format, as we picked, we picked 20 questions and the 20 questions are really emblematic of I think, almost all the questions we got. So I thought we could try to do as rapid-fire possible way, if you’re up for it. If you’ve had your energy drink, of going through these 20 questions, so that we get as many of them answered, they’re very good questions. And I think if anybody listens to this episode, and sits through the 20 questions, in here’s your responses, then they’re going to be a lot more informed about what they’re curious about. How does that sound to you?

Michael Mina 

Sounds perfect. Happy to do that.

Andy Slavitt

Great. Okay, me start with the basics. Before we even think about a test, entering the picture, help us understand what’s going on in the body with the cells when someone gets infected. So, you know, we’re day zero. And there is SARS-CoV-2, exposure, and it comes into your body and infects you. What when do you become symptomatic? And when do you become contagious?

Michael Mina 

So it’s a great question. So what happens when the virus enters into your body, there’s a period of time where the virus has to either take hold or not. And this is why not everyone who has the virus and gets exposed to it will necessarily get infected by it. But let’s say the virus does take hold, it has to go through what we often call an incubation period where it literally is just settling itself into your cells. It’s figuring out how to invade your cells and start its process of replication inside the body, that replicates, literally hijacks human machinery that we use for our own cellular development, and production. And it hijacks that, and builds itself and explodes as a virus inside these cells. And then there’s like little mini-infections of nearby cells. And ultimately, it grows exponentially. But all the while when this sort of settling in phases happening, the immune system is starting to recognize it. And it starts to try to say, oh, man, we got a little viral infection. And we have this innate immune system, which is not the vaccine derived immune system initially, and it starts to attack the virus and try to and there’s like this tug of war. What we find with this virus is a lot of times it wins out, it wins that tug of war, and the innate immune system isn’t able to stop it from replicating. So then we get to a point where the virus just starts to really grow up exponentially. And so it’s infected one cell and then two and then four and no, and it grows exponentially, essentially.

Michael Mina  04:58

And what happens is that what we’re seeing with Omicron, especially, is it’s starting to replicate a little bit further down, it doesn’t start in the nose. But it seems to be starting in the throat and in the oropharynx, which is probably also what’s causing it to become detectable in the saliva early, it then sort of marches up as it’s infecting you, it marches its way north into the nose, and ultimately into the nasal pharynx. And all the while it’s starting to become infectious. It’s not infectious at the very moment, it infects you. But it has to grow up and have really high viral titers before it can actually have a good chance at infecting other people. And so it goes, there’s this little battle that takes place, if the virus wins out, it grows up to high numbers, and ultimately, your immune system starts getting things under control, the virus grows to massive numbers, trillions, can grow into the nose, and then it can start to get beat down again, by the immune system. And a lot of times it ends up being the acquired immune system starts to kick in antibodies, T-cells, especially if you’ve already had preexisting immunity, that happens that kicks in really fast. Otherwise, it takes a little while. And so that’s kind of what this virus does when it infects you.

Andy Slavitt  06:18

So at what point in that process do you start to feel symptoms? Do you start to feel sick? If you’re gonna feel symptoms? Is it right away? Is it after a day or two?

Michael Mina

So this is one of the most confusing things for people in this pandemic. And it’s confusing everyone from the FDA, to the CDC, to individuals in their home. The most important thing when we’re asking anything about symptoms is to ask what symptoms we’re talking about. Is it the symptoms of the virus destroying your cells? Or is it the symptoms of the immune system kicking in and trying to kill the virus, for example, congestion, runny nose, and a fever, those are symptoms of your immune response, loss of smell, diarrhea, GI symptoms, those are symptoms and breathing, of course, those are symptoms of the virus doing damage. So before any preexisting immunity existed, like when people first get an infection have been vaccinated, what it would turned out that the virus would grow up and it was only after the virus grew for about five or seven days and it got to peak, peak viral titers, that people would start realizing, Oh, wow, I don’t have any sense of smell anymore. Or oh, wow, I have a cough or I have diarrhea. And so that was happening after the virus had grown so much that you know, it did it did enough damage that symptoms of the virus pathology kicked in. Now, on the other hand, what we’re seeing today is a markedly different situation. Most people have either been vaccinated or infected in this country, if not in the world at this point. And what that means is we have preexisting immunity, our immune memory kicks in fast now. So you get exposed, and then we’re seeing people become symptomatic in a day or two, but the symptoms have changed. It’s no longer loss of smell and GI symptoms. Now, it’s congestion and runny nose, and normal, cold, like symptoms people are feeling first. That’s because it’s a sign that your immune system recognizes the virus real fast, and tries to start battling it, you know, within a day or two of getting first infected.

Andy Slavitt  08:25

So your immune system causes the runny nose and the cold like symptoms.

Michael Mina 

That’s right, that’s actually part of our defense system. To get to clear pathogens, we have all these secretions that will form the fever itself is literally a fever responses to kill the virus. Because virus don’t like heat, for example, it’s technically also part of the cytokines, […] that tries to combat the virus because of the fever. And so all of those symptoms are actually part of our natural defenses, to try to say, hey, virus, we don’t want you in us, we’re going to create all these secretions, we’re going to blow our nose a lot, you know, we’re going to do this and sometimes pathogens even hijack that so that they can transmit better.

Andy Slavitt 

So the first day you feel symptoms, which you say maybe symptoms, actually, that you’re fighting a virus then from the virus itself. Would it be one or two days after infection? What would that be right away?

Michael Mina

Yeah. So if it’s the first day that if you’re feeling symptoms, and it’s things like congestion and runny nose, that will usually be you know, one or two days after you get infected, and it resembles what we expect from a vaccine. Because if we remember the whole vaccines essentially have one job and one job only, to an extent, and that is to allow us to recognize very fast that we have an infection with a certain virus or pathogen and start responding to it. So now that we’re vaccinated, within a day or so we start feeling the symptoms because the immune system and the vaccine are doing their job. Got it?

Andy Slavitt  10:03

Okay. And then can you correlate that timing to when we become infectious? So let’s say after 36 hours, it start to feel a runny nose, start to feel maybe a bit feverish. Is that the time when we’re infectious? Were we infectious before that time? Or can we be infectious afterwards?

Michael Mina

Yeah. So, you know, I put out a tweet the other day that was saying, FYI, you can be infectious and have no symptoms have a lot of symptoms have been pre symptomatic, post symptomatic. So in general, the symptoms don’t correlate perfectly as the point but in general, what we’re finding with Omicron, which is where we are now, since probably the information people want to know, is that it’s starting to spread very fast. So you get exposed, you’ll start to feel symptoms, maybe a day or two later. And what we’re finding is people are likely starting to spread the virus already, when their symptoms are just starting within a day or two, they’re actually becoming starting to become infectious.

Andy Slavitt 

So it could be even before

Michael Mina 

it could be before although I would argue if you’re getting your symptoms, you know, a day after you’re exposed, you probably weren’t infectious yet. Probably and you might not, you know, if it’s been only a day, you might start being infectious a day after. But if you’re becoming infected, if you’re becoming symptomatic, say three days after exposure, you might have become infectious earlier. And just to be clear, this is a pretty big departure. For the majority of this pandemic, before there was any real pre-existing immunity, we had a good two or three days of real like peak infectiousness before anyone even felt their symptoms. So things have changed. And now it’s a good thing. Because now we can actually use symptoms as our first as to rely on for our first sign of infectivity. So the moment you feel symptoms today, assume you’re beginning to become infectious, regardless of any test.

Andy Slavitt  12:01

Got it. Okay, so before we get to our 20 questions, let’s lay over that the basically three types of testing that people are familiar with the hospital-based PCR test, the at home, or the instant PCR test, and you may say there’s no difference between those two, in which case, that’s fine, you just put them together. And in the rapid at home antigen test, the one that people are becoming much more familiar with now, tell us just a little bit of the 101 about how those work, what they detect, and when they when they detect things in those first few days relative to symptoms and relative to infectious this.

Michael Mina

Yep. So. So yes, we have laboratory PCR that’s the most sensitive, what that does is it looks for the nucleic acids, or the genetic code of the virus looks for the RNA. And what it does is when the way that that works is it literally zooms in on a small section of the virus RNA. So if there’s even a few molecules of it, the PCR can turn positive. So that’s so that’s really good. If you are trying if you’re a doctor, and you’re trying to, for example, reconstruct to know if somebody was infected. You know, you want all the evidence you can possibly get, even if somebody has such a low amount of virus, that they’re not infectious, or maybe they were infectious three or four weeks ago, the PCR can sometimes still keep being positive, because it’s almost like a forensics detective, going to the scene of a crime that did take place, picking up a piece of hair and running a PCR on that to say, yes, you know, John Smith was here, and you know, was at the scene of the crime, even though John Smith is long gone now, or the crime is done. So that’s PCR, it’s very, very sensitive, but it has to go to a lab, it has to be done usually in a lab, which means that there’s a day of delay just getting the swab to the lab, and then there’s usually a couple days, at least right now, to get the result once the swab arrives in the lab. So we’re looking at a three-day delay.

Andy Slavitt  14:05

If you did that swab, in that period of time, when someone when does it detect does it detect based upon, I want to relate it to how a real person would be feeling at the time does it detect before they know they’re sick? Would it detect after only afterwards and, importantly, with regard to being infectious.

Michael Mina

so we find when we follow people who have been exposed people who are in quarantine, and then you kind of swab them every day, for example, we find that they start turning positive on a swab taken for PCR based on a swab, usually around two to three days after they’ve been exposed. But it could be as long as 10 or 12 days later, depending on how well the immune system is kind of playing that tug of war. At the beginning it can actually keep the virus suppressed for quite a while but the actual average is less than five days after exposure, most people will start being positive. They might not have symptoms yet some of them might, but many of them won’t have symptoms yet as well, especially before with Delta and things. So it’s hard to put it in perspective of symptoms, but it is usually around 2, 3, 4 days after exposure.

Andy Slavitt 

So it sounds like it’s possible people could be infectious, and still not yet test positive other than PCR. Is that correct?

Michael Mina 

Yes. I mean, I would say anything goes especially, there’s just a preprint that came out today that was looking at saliva versus nasal PCRs. And it was doing looking at few comparisons, but certainly, like the saliva test may be turns on a day before a day or two before a nasal swab becomes positive, regardless of the type of test.

Andy Slavitt 

Interesting. Okay, so how does that differ from a rapid PCR? And then contrast that with the antigen test?

Michael Mina 

Yeah, so most people, when they look at the rapid what a lot of people are calling rapid PCR is they’re all actually lamp assays or isothermal amplifications. They’re not quite as sensitive as PCR. But they’re a little bit more sensitive than antigen A little bit less sensitive than PCR, they sit in the middle. And they compare it, they do a very good job at detecting you, when you’re really close to having high viral loads. They can detect you a little bit earlier than an antigen test can but probably, you know, the reality is, if you were continuously monitoring somebody, let’s just go through a course of infection. If you’re testing somebody every single day or every hour of every day, and you’re asking when did the swab collected, you know, when was that positive PCR might turn positive, a laboratory PCR might turn positive, let’s say a day two or three, rapid at home molecular lamp assay might turn positive at day three or four. And a rapid antigen test might turn positive at like day, three and a half to four and a half. So it’s you know, the PCR is about a day before lamp which is about a half a day before antigen in general. There is one true sort of rapid PCR test and that’s one by Thermo Fisher called the Mesa but a lot of people haven’t been able to see that it’s more of a point of care at the doctor’s office kind of test.

Andy Slavitt 

So in all three cases, you’ve got the potential to be infectious before you test positive, I think the takeaway is that there’s some likelihood, do we are able to quantify that likelihood of being infectious. With those three different modalities?

Michael Mina  18:07

Yeah, I would say if you’re asking what’s the likelihood of being infectious on that first day and not yet being deemed positive on a test? Probably the first day that you’re infectious with Omicron, you’re probably going to be negative on an antigen test and negative on a rapid lamp test or rapid molecular test, your swab may or may not come back, I would give it like a 50/50 chance that your swab for PCR would come back positive.

Michael Mina 

But you wouldn’t get it for a couple of days anyway.

Michael Mina

Right? You won’t get it for a couple days, which this you know, I’m frankly, I’m very, very tired of people continuing to like make the comparison of between PCR and rapid testing. Without considering time, you know, with an infectious virus, we have to consider time as part of the metrics of the of the evaluation when we compare tests, you know, and but I would say you know, on average, there, everyone should assume that there might be as much as a day before any test would tell you that you’re positive the next day maybe and but you’ll be low positive, I mean, low, low lowly infectious, not like super infectious yet, the next day, you might actually become pretty infectious and a PCR might turn positive. And then it might not be the till the next day that the rapid tests become positive.

Andy Slavitt 

And due to the rapid tests with is one faster than the other in terms of being able to detect that?

Michael Mina 

Yeah, so the rapid molecular tests give you about a 12, you know, 6-to-12-hour head start, I would say, if you were to if you happen to use the swab, you know, right at the beginning of when a molecular rapid test could turn positive, it will be about a 6 to 12 hours before rapid antigen test does

Andy Slavitt 

So what I was really working on to ask you that is if we were defining false negative as saying someone is not just as infectious, not as not with illness, The likelihood of false negatives, it sounds like it’s entirely time dependent, that you have a lot of false negatives. If you’re testing right away, as soon as you know if you if you catch it right away and you test, but if you test a day or two later, then the number of false negatives goes down in order the as you described from each of the three tests, I guess what the what’s the sensitivity of false negatives, once you get into that third day when it’s more reliable?

Michael Mina  20:30

Yeah, that’s, that’s a great, it’s a great way to think about it, you know, we’ve so often focus on the gaps that says though, you’re like looking at a piece of Swiss cheese, and you can’t take your eye off the hole. And meanwhile, there’s actually a big piece of cheese there. So the first day is, you could have a completely 0% sensitive antigen test on the very first day, the very first moment that PCR turns positive, you know, that that swab would be collected, that would become positive. But then by day three, the tests are generally two or three, the rapid antigen tests in particular, becoming, you know, probably 80%, 90%, 95% sensitive, depending on your viral load. So once you really get to peak, peak viral loads, these testament a lot of studies have shown that when you’re if you really happen to swab somebody right on like day three or four of their infectiousness right at their peak virus load that these tests get almost 100% sensitive all of them do.

Andy Slavitt

Then let’s take it to the next phase, which is your day five, and you stop feeling symptomatic, you’re feeling better, or your day started feeling better, but it’s the day the day or symptoms and we feel it the fifth day forward, which is essentially what the CDC is now saying it’s the time when if you wear a mask, and they’d certainly recommend that if you have a test available, you take one but they don’t it says but at that point in time, tell us though, how the rapid antigen tests perform, versus how what you’re likely to see from either those other two PCRs.

Michael Mina  22:04

In general lab PCR will just stay positive, it’s going to stay positive, potentially for another week, two weeks, three weeks, four weeks.

Andy Slavitt 

And by the way, just to clarify, while you’re no longer contagious?

Michael Mina 

Correct. That’s right. So in the timeline of this, so you hit peak viral load, let’s say a day three or four being infectious. And then you might stay there for a few days. And then you’ll start to come back down. And then eventually, you’ll just get down to like non-viable virus, no transmission. And that will be maybe around like CDC wants to say day five, I strongly disagree with that at the moment, because symptoms are starting really early. You know, day five was no longer infectious when your symptoms started in the middle of your peak infectivity. But now day five is like just after your, you know, right around your peak infectivity.

Andy Slavitt 

To be fair, they’re saying day five, if you have no symptoms.

Michael Mina 

If you have no symptoms or resolving symptoms, it’s been pretty vague. But they do say resolving symptoms, which, you know, I’m not sure about how much I would choose resolving symptoms. But so that’s the timeline. So you’ll see PCR will stay positive for you know, potentially a month, you know, some people usually it’s more like 10-20 days, after you’ve been infectious, the lamp assay will probably stay positive for like, somewhere like 4 to 10 days after you’ve been infectious. And then the antigen test just because it doesn’t have an amplification step, it generally turns negative, you know, pretty much right as you stop transmitting when you don’t have enough virus to turn an antigen test positive, you’ll probably no longer be infectious. And on the contrary, if you have enough antigen, which is virus protein to turn a rapid test positive, so you could see it by the naked eye. That means you have a lot of protein there probably around a million viral particles per mil, it takes to start turning these tests positive. So you still have quite a bit. And I would say that it tends to be around a 95%, 90% to 95% Concordance between a rapid antigen test and culturable virus. So if you don’t have culturable virus, the antigen test tend to turn negative. And if you do the antigen tests tend to stay positive.

Andy Slavitt  24:23

So I know that was a bit of work to go through all of that. But I may be biased, but I think that’s one of the best explanations and most Thorough explanations of this very complex interplay between infections, symptoms, and how these tests work. And I think very helpful, I think if people did nothing but listen to what you just went through, it explains a lot, but it’s very confusing that it shows why by public health communication is difficult.

Michael Mina 

I mean, I do want to say like this, you know, it’s like in my mind, I have a picture of all of it, you know, and it makes it very, very crystal clear what all the caveats are and what all the plus or minus but I do have to say, you know, to give credit to the public really like it is exceedingly difficult. When you don’t have a biological understand when you’re not a physician when you’re not a PhD pathologist, whatever it might be, to put all these things together. So, you know, thank you for asking the questions. But you know, for people listening, don’t be discouraged that you’re having such a hard time understanding this stuff, like most people weren’t trained to be, you know, I’m an expert in this. It’s what I do for a living and, and I think I’ve seen a lot of people getting really discouraged, because it’s just so darn confusing. And, you know, it’s, it’s, it’s unfortunately the case, you know, it is a confusing subject.

Andy Slavitt 

So Michael, there are people who will sometimes take note that Hey, Slavitt, he’s not a scientist. He’s not a doctor. Don’t listen. My point is exactly. I mean, I am not an expert. And what I try to do is ask the questions that my sister has, my friends have, all the people listen to the show have and get people on who are good at explaining it. So thank you for that. Let’s jump into 20 questions, and we’ll see how quickly we can do this. So if you could get the short answers for these questions. Kenneth Levine asks, there are three main tests, number one rabid antigen hard to find in stores needs a lot of virus to show positive, number two, rapid PCR expensive and only found at private company sites, but was quicker results. Number three, lab PCR most accurate but hard to find appointments and long delay for results. Can someone explain the difference of timing and accuracy of each? What tests should we rely on and when I think we just did that? I think we just nailed Kenneth’s question.

Michael Mina  26:47

That’s right. We absolutely did.

Andy Slavitt

Well done. Well done. Okay. Question two is from Dana Sasso. Can you tell us? What are the best practices for testing? I.e, which test what day is best to test? What to assume when there are mixed results, i.e, at home negative but on PCR positive or vice versa? And why might you get miss results?

Michael Mina 

Okay, so I’ll try to make this as easy as possible. Fact is today, if you’re feeling symptoms, and it’s your first day of symptoms, assume you’re positive with COVID. Right now your symptoms are good, are a good signal that you might have COVID. And that means pretend like you’re positive, pretend like you know you’re positive, take steps during that day to not infect others. Use a test, don’t try to use a test the very first day of symptoms right now, because it’s a good chance you’ll be negative. If you have a small number of tests available, like one or two, I would say wait until 24 hours or 48 hours to use that test before using it just to give the virus a bit of time to grow. So that actually is a chance to turn positive.

Andy Slavitt

And Michael, is it true that, I know it used to be that you wait a day to test again. But it’s true now that if you sometimes you have to wait just 12 hours, and that things could be changing that rapidly. What do you recommend?

Michael Mina  28:13

Yeah, well, there’s always going to be a period of time where you go from negative to positive. And it’s, you know, it could be a minute. But in general, what I would recommend given that we do have a situation where we have limited test availability, wait 24 hours, you know, just spend the extra, you know, if you’re going to go to sleep that night, don’t use the test that night, wait till the next morning to use it, which is also a good you know, I would also say the best time to use a test during the day is generally you know, after you wake up and right before you start seeing people, because that give don’t use it the night before you go to sleep because that’s kind of a whole period of time where you’re kind of self-isolating at during sleep, that you could be allowing the virus to sort of incubate a little bit longer, so your best sensitivity is the next morning.

Andy Slavitt 

Got it. Great. Okay, from Kathy Aster, are there different kinds of PCR tests? And if so, are they all equally accurate? I’m asking because I was comparing notes with colleagues at work. And we’ve all gotten PCR tests yet they have been physically administered differently.

Michael Mina 

For the average person, just assume that PCR is generally kind of the same sensitivity altogether. But you can get different results and that’s not necessary because the test might be one person might be collecting a saliva sample. One person might be collecting nasal pharyngeal, and one might be collecting a nasal swab the front of your nose. There is a CDC study that looked at 50 people all positive with a sampling of the saliva sampling of nasal pharynx and sampling of nasal, and no matter which way you went, there was about a five to 10% loss I’m sensitive compared to the others. So it wasn’t that […] was always correct. There was always a five to 10% loss and false negative rate on either one when compared against the other sampling site.

Andy Slavitt  30:04

Susan Hilbert asks, are the ad home antigen test the same as the rabbit entity just given at CVS for example?

Michael Mina 

Identical. Same test.

Andy Slavitt 

Brenda asks, are all the rapid tests […] equally reliable, what does positive test and negative test accuracy mean?

Michael Mina 

So they are generally equally reliable they’re at the biggest place where there is discordance between the test is in the false positive rate. What’s the likelihood that a test is going to tell your positive when you’re not actually. What we found it for example, the BinaxNOW, the Abbott test has a false positive rate of like one in 3000 or so. So it’s really good it’s about as good as PCR. Meanwhile, […] loom you know, loom came under fire a bit from the FDA for being for having too many false positives. And quite says around 1 and 150 tests will potentially turn falsely positive. And so that’s an important piece to consider if you’re going to be testing 300 people at your wedding, for example. And you want to test everyone beforehand, what I would suggest is if you’re doing that have a small handful, like three additional tests from another company, they can very quickly if you get a positive on somebody, and they’re like, you know, I really don’t know how I’m positive, use another test just to confirm. So there can be marked differences in orders of magnitude for false positives. But on sensitivity, the tests are generally pretty darn similar BinaxNOW it’s shown to be a little bit better, but you know, nothing too much better. And importantly, the test doesn’t care about your symptoms. If you’re asymptomatic if you have symptoms, the test will if the virus is there in the right amount, the test will find it regardless of symptoms, just give you a bit of a head start to know if you should be sticking the swab in your nose.

Andy Slavitt

Got it. Okay. Number six, Chrissy asks, Will every test on the market have an EUA from the FDA or as consumers do we need to make sure a test has EUA before purchasing?

Michael Mina  32:10

They all have an EUA if they’re sold in the United States.

Andy Slavitt 

Vanessa Frank asks, I’ve been looking for clarity. Once you have COVID which tests do you use to determine when you can stop quarantining, i.e., that you have stopped shedding virus? My doctor’s office today told me that my son needs 90 days to get a negative test in order to return to school. What? The LA Times says it’s five days.

Michael Mina 

So you definitely don’t want to use a PCR to know if you need to stop isolating because PCR can stay positive for a long time the only test, the only test that you should use to tell you if you should stop isolating is a rapid antigen test because it’s the only one that is likely to turn negative when you stop infecting other people.

Andy Slavitt 

Do you believe a doctor really told her 90 days?

Michael Mina 

Hey, you know, I, yes, I do.

Andy Slavitt 

It’s so confusing the stuff is that even physicians don’t have the right answer that you shouldn’t be so confident when they don’t have the right answer.

Michael Mina

Well, that’s you know, doctors are literally trained to be confident in whatever situation, you know, the big problem of medicine, you know, doctors are always overly confident with things they don’t know. And to be honest, you know, this is not to bash doctors here. But doctors have been unfortunately, because they’re seen as voices of knowledge and data. Unfortunately, they have been some of the greatest perpetrators of sort of misinformation unintentionally, because it’s such a confusing topic, and most doctors don’t focus on infectious disease diagnostics.

Andy Slavitt 

Got it. Number eight, you already answered which to people last, which was, should you test yourself as soon as you feel symptoms? I think you’ve said you should wait 24 hours number nine from Allen, I’m seeing more people saying that people without symptoms should not test regardless of exposure. Should we listen to this?

Michael Mina  34:08

No. So one of the very first things we learned in this pandemic is that people can be at high viral loads regardless of their symptoms. And that’s just how people’s immune systems tolerate the virus, things like that. So I would say do not like nobody should just assume that because they don’t have symptoms. They’re not infectious. You know, you don’t have to go crazy every day when you wake up with no symptoms thinking you are infectious. But certainly if you have a reason to believe you’ve been exposed. Don’t assume that the lack of symptoms means that you do not have virus and you’re not infectious.

Andy Slavitt

Well, let me give you a curveball on this. This one is from Andy, actually. But so what about there’s kids that at a university, who get tested with some sort of surveillance testing regularity. And there’s a whole bunch of them that have no symptoms, they’re fine to go in the class. But they go to take a surveillance test. And let’s say they get a positive test, but they’re asymptomatic. They then have to go miss class for 10 days, and potentially move out of their dorm and move into an isolation dorm and things like this. So all of this surveillance testing you have done has a real cost to people, because they have that they really have to isolate, given the odds, and given the time that you know, if someone’s that tested, but once a week, like is it really smart to do surveillance testing that and frequently, I mean, I can understand if you’re doing surveillance testing every day, but if you’re doing surveillance testing, like once a week or once every two weeks, and then taking a bunch of kids and pulling them out of class. Does that make any sense?

Michael Mina 

Well, first, it does not make sense if you’re using PCR, nobody should be doing surveillance testing with PCR. At least not if the consequences that somebody goes into isolation. It is, you know, most people who are PCR positive on a not daily kind of test, you know, if you’re doing it twice a week, then okay, but if you’re doing it once every two weeks, the chances are you’re no longer infectious by the time you’re detected on a PCR positive. So but if you are doing that kind of surveillance testing, with an antigen test, which is only going to be positive, if you’re infectious. You know, I think it is there, there is always a cost to public health. And this is why I’ve been so adamant in saying that if testings not being done for medical purposes, should we be utilizing different metrics in the authorization process that are commensurate with how we’re actually using it, which is for public health. And you know, the downfalls of PCR is a great example, like, we don’t want to isolate somebody who’s not infectious because isolation is not a medical outcome. So what you just said is, all these kids are totally healthy, they seem fine. Why would we isolate them? Well, we isolate them because we’re trying to cut off transmission chains, because we don’t know who they might infect, who then might go and infect some elderly person. And so you know that but it is, you know, I think we’re at a point, the pandemic where we have to have a good heart to heart with ourselves and decide as a society, as I’ve said, for over a year now, at some point, we as a society have to decide when we’re okay with transmission going unabated if people are not symptomatic, but it’s a scary, it’s a scary thing when we still have a segment of the population that’s going to be at risk.

Andy Slavitt 

Okay, now we’ll play a voicemail for question. 11. This is from Elena.

Elena 

Hi, Andy, this is Elena from Long Island in New York, will the CDC be sure to advise the country that testing by swab by nasal is not suffice for this Omicron virus? This is scary. Thank you have a good day.

Michael Mina  38:19

So a nasal swab is you know, there, you’re going to miss a day or two of infectiousness. But we have to remember that people are also then infectious for a day 2, 3, 4, 5, and 6 as an example. And so I would urge people that as we find that there is that a nasal swab might not be detecting you on day one, and a saliva specimen might be detecting you on day one. We have to use the tools that we actually can get and you know, which is not exactly rapid test at the moment for a lot of people, but the nasal swabs will still turn positive. You know, the bulk of the time that you’re infectious. And just like a seatbelt, these are all risk mitigation strategies. They’re not risk erasing strategies. And so just like a seatbelt and an airbag, neither of them are perfect. These tests are still there, what we can get, we don’t have a huge number of saliva bass rapid tests right now, you know, and if we did, great, but we don’t and so these are some of the best tools we have to stop transmission chains.

Andy Slavitt

Julie asks a related question, must we swab our throat If we suspect Omicron, the swab contains formaldehyde. I didn’t know this, by the way. Is it safe to swab our throat with it? Should we substitute with a Q-tip swab?

Michael Mina 

No, do not use a Q-tip swab. Please don’t use that the cotton can cause issues. The regular swabs and some tests actually have swabs that look like Q-tips, but they’re actually special polyester looking Q-tip swabs. So, you know, I would argue that the data is sufficient at this point or is really getting there that you know we could follow in the footsteps of the UK, and we could do a throat swab or kind of a cheek and back your throat swab and then still stick that same swab in your nose. You know, that’s actually what people do, I do it here at my house, the FDA won’t, won’t tell you to do that, because it’s not part of their, it wasn’t authorized for that. But the data shows you know that that’s actually improving the sensitivity quite a bit.

Andy Slavitt  40:22

Do you worry about this formaldehyde?

Michael Mina 

I don’t know. I mean, formaldehyde, at the end of the day is a natural substance to I’m not I’m that the any of I don’t actually know that that’s true. So I want you know, I don’t know that it contains […] it’d be such […], these swabs are still going into your nose like they’re there if the swabs are all also authorized for use in the United States. And so they’re safe for people to stick in their nose or their mouth.

Andy Slavitt 

And for what it’s worth the last time I did a test, I did a back of the throat swab, and then did the circles in the nose. And I personally find the circles in the nose to be way too ticklish for me, the throat was actually even easier. But I think that’s a recommendation that’s starting to come out now. And I think it’s really important to reduce your risk of having a false negative. This one is from Kim. I’m wondering what the latest data is showing regarding the sensitivity of rapid antigen tests in detecting the Omicron variant. Anecdotally, the recent cases I know of all tested negative for several days after exhibiting symptoms, only to ultimately test positive.

Michael Mina

Yeah, so that’s an again, so in general or finding is the rapid antigen tests work just fine for Omicron in terms of being able to detect the virus, but what might be changing with Omicron is A, people are getting symptomatic much earlier than before. So they weren’t even, you know, before, if you didn’t have symptoms, on the first few days, you weren’t even bothering to use a swab on the first few days. So that’s on the one hand, why some people are finding that their test is negative, but it’s not necessarily Omicron thing. It’s the symptoms associated. But the other piece is the tests are working well. But Omicron does appear to be more infectious. So it might be taking off and actually spreading the first day or two before your antigen test. Before there’s enough virus in your nose to turn the antigen test positive or the PCR test positive for that matter. You might already be infectious. And that’s potentially because the virus now is just so able to potentially aerosolize and get out of people at lower amounts.

Andy Slavitt  42:32

We’ve got a few more questions that were exactly the number of people saying there scenarios where people have been symptomatic and boosted but were negative and rapid tested and ultimately positive on a PCR. So it sounds like this is something that people are experiencing. Number 13 or I should say 14, I guess what are the false negative rates? In which time window compared to PCR? What are the false positive rates of PCR? This is from Jason. And then what are the false positive rates of PCR? In which time when compared to rapid tests? How can one tell the difference between a false positive and an asymptomatic case? I think we covered this mostly I don’t know if there’s anything else you want to review on that.

Michael Mina

Yeah, I think I mean, just in general false. You know, the vast majority of time when you’re getting a what appears to be a false negative on a rapid test is, you know, a period of time when you’re not infectious anymore. As we’ve covered, you know, the first couple days of infectivity, you might be negative on a rapid test. And that would be a true false negative. But remember, if anytime you’re comparing a rapid antigen test to a PCR, the vast majority of time somebody is PCR positive. They’re no longer infectious. And so, you know, many studies, many, many studies, unfortunately, make this error, where they just compare antigen test to PCR and then they say PCRs, 30% or 40% or 60% sensitive, but actually, it’s because most of those PCR positives, antigen negatives were spent after the infectious period was done.

Andy Slavitt  44:10

Great. Okay. Got another voicemail. Now, I think we’re delving into questions of supply and access a little bit which you may have some perspective on and for those listening, Michael and I participated in some calls on this with the White House and Michael has been really active in a positive way and working to try to look at how to increase throughput and supply so these will be good questions for you. Here’s the first voicemail.

Speaker 4 

When might we actually find more tests available at Walgreens or CVS? They’re not to be had all across from Jupiter to Sarasota in Florida. Thank you love your show.

Michael Mina 

So the Biden administration is out have recently, really putting a lot of effort on this, you know, and I think everyone’s dismayed that, that we didn’t have these earlier. Me probably more than anyone in the country but I will say that people should expect to start seeing these in greater supply. As we move into the latter half of January, February, the Biden ministration, has done a good job now at trying to procure these tests for Americans. The reality is that there are a lot of people in America and the Tesco quick. You know, we don’t have billions of them available at the snap of our fingers right now. And so it’s going to be a struggle. And I think that a struggle for the administration is going to be now that this has become available, is there that there might be allocation in some sort of way, like maybe to healthcare workers or schools. So I think the average person might continue to find some difficulty, unfortunately, getting them at their local Walgreens or CVS.

Andy Slavitt  46:02

So Rachel asked a similar question. My question is, why are we nearly two years into the pandemic and still can’t easily get tests? Where is the bottleneck?

Michael Mina 

Yeah, well, I mean, I have a very strong opinion about it. Now, I’ll just, you know, to briefly said I think we had a hard time figuring out how to regulate these tests in the United States in a way that was kind of able to give EUAs in a timeframe that was needed from the FDA. And I think that that, you know, I would say that this wasn’t so much an administrative thing. And I can say, you know, it’s a chicken and the egg issue. Last year in the Trump administration, I spoke quite a lot with the both the CDC and the White House then and, you know, I would have a conversation with the White House about or what the CDC and I would say, you know, we need these tests, you know, this is how they could work, especially before we have vaccines. And they’d say, Michael, that sounds great. You know, Andy, I’m pretty sure you had me on your podcast around that same time, we talked about this, you know, this sounds great, you know, lots of tests could certainly help curb spread. But we don’t have the supply. So we’re not going to make policy around it. And then when it came to talking to the FDA, about the like really a massive need for these tests, you know, it’s like, well, we don’t really need them too  quickly because there’s not even any policy, requiring them, you know, and so it’s a chicken and the egg kind of issue. And it really came to a head, just in the last month or two are really in October. So when the administration started really pushing to get to get more of these tests authorized.

Andy Slavitt 

So let’s talk about what’s happened. Just so people are aware, the administration has spent, I think, $3 billion to get more tests, more and more to help with scalability. There’s a process I think that was similar to what you suggested to the administration to fast track more tests with the FDA. At the end of December was sort of nobody noticed that because there’s a lot going on, there was, I think, pretty major news about some new tests being approved. Do you want to talk about that. So give us a sense for what’s coming and how much more volume we might see from these two tests?

Michael Mina  48:19

I’d love to yeah, so you know, it was back in September, I spoke with the CEO of a major diagnostics company, and I said, you know, why aren’t you tests here in America? He said, well, you know, the FDA process is slow. You know, why are we you know, why do we need, you know, why would we go through that US process when we can sell test to the rest of the world? And that really lit a fire I think for myself, but also, you know, kind of accelerated some talks, perhaps, and what is extraordinarily important but has gone almost completely undiscussed, it’s kind of just happened in the background is one of the most important things for these tests is that the NIH is stepping in to really support the acceleration of EUA is being given out by the FDA by creating a platform to evaluate and accelerate the evaluation of these tests and so that the EMA process is now being accelerated. We had Roche and Siemens get authorization just recently, these are two of the largest diagnostic manufacturers in the world, got through the FDA process very quickly, because of this new program under Bruce Stromberg at the NIH and I have to give him a million, you know, all the credit in the world for how he has run the NIH Radx program and this new ITAP program to accelerate the work with the FDA, and also to the Emory crew, and the UMass crew who are helping the Radx program and Bruce bring this to fruition. They’ve just done an amazing job and, you know, ultimately, Roche and Siemens got their EUA and kind of record time because you know, there’s some innovation going on now with FDA and NIH and really working collaboratively on it. Take a bit of a load off of the FDA, which, in fairness to them has been working their butt off for two years, despite my criticism of them frequently, I have to give them credit for, you know, powering through and they have been doing, you know, heroic job as well.

Andy Slavitt  50:16

I can say that fair to say we all wish that have been done sooner. You’d been talking about this for a long time. But in your mind. And look, I I’m sure that I will be criticized of, of not doing a good enough job exposing criticism of the administration. So I want you to feel free to say where you think we really are. Are we all the way there in terms of the policies you’d like to see now? Or are we still short some things that that you think need to be done?

Michael Mina

Yeah, no, I think there there’s one rule or there’s a few rules at the FDA that, you know, unfortunately, I think that we should have an evaluation process at the FDA for testing, especially testing in a pandemic, that is somewhat commensurate with how the FDA deals with vaccines and pharmaceuticals for this in this epidemic. We have committed, we have expert committees who advise the FDA on what metrics to look for in a vaccine. And then the FDA, you know, has opened conversations with those experts in that domain or on vaccines. And they say, okay, the experts have told us we need to hit 50% of efficacy to reduce symptomatic disease, etc. And then they go and regulate based on expert advice. I do think that thus far into the pandemic, we still have an approach for testing. Despite that testing is one of the most critical tools from day one of a pandemic response for public health emergency, all of our testing probe protocol in terms of getting the EUAs out, still has not deviated from the medical diagnostic claims that existed at the beginning or before the pandemic, there’s been some slight changes. But I would really like to see in the future, that you know, that there’s a public health body who says, look, these are the metrics we need for a test in this pandemic, we do not want to take the authorization power away from the FDA, which is something I’ve called for out of desperation frankly, I would like to see the […] continue within the FDA. But I would also like to see that during a public health emergency, we can be more nimble than how the EUAs have played out. And just one example of that is to this day, the FDA has been unwilling to budge on the necessity to evaluate an antigen test against a PCR. And, you know, as we just discussed, they have two totally different roles. And the reality is for public health isolation and who how we’re using it, PCR is the wrong tool. And so, you know, I would hope that at some point, the FDA would say, Look, we have this great predicate device, it’s called an antigen test that we’ve already authorized, let’s just take the best antigen test we have, and make every other antigen test that needs to get an EUA live up to that one, you know, that would be a really good change that would massively accelerate the acquisition of the data needed to get through the FDA process.

Andy Slavitt 

Got it. Okay. Great. Let me return to thank you for doing that. And let me turn just to a few more final questions, and we’re 17. From Alicia. With the ultimate question. There’s so much wrapped up into this one. Why are these tests still so expensive?

Michael Mina

Well, you know, market competition, we need market competition, or government contracts to get the prices way, way down. You know, when we go back in time, the Trump administration was able to get a $5 price tag for every buyer. Next now test from Abbott, we kind of allowed, we expected free market competition to really bring prices down in this domain. But the reality is, we had a whole year of only two companies having an EUA they created a new expectation for what the prices could be. And ultimately, now every other company could come in and say, look, yeah, I could still sell these for 14 bucks that’s on par with everyone else. So market competition generally doesn’t work, A, if demand is so high, we’re not going to see prices come down because people will still buy. But my concern is this is a public health good. This is a public health need. And probably I wish that the administration would do more to work with the manufacturers, if we’re going to put public health in the hands of private manufacturers, then we should either give them pre orders as a government pre big contracts and say, we’ll give you this contract, but you have to get the price down to four bucks or whatever. And, and, you know, I don’t think we’ve been aggressive enough at really intervening and to give Trump credit, which I don’t do a lot. But Brett giroir and really did an amazing job at working to get these tests out during the administration and getting the prices down. It sounds

Andy Slavitt  54:51

Like we do have a big order coming government purchase order which does help you know, although I’d say with at least with regard to vaccines and therapeutics, those are still at very high price levels. Yeah, I think that there was some step made in requiring insurance companies to cover these tests. And I think there’s some logistics that can be worked out to get baked that could be easier for consumers, so they don’t have to pay anything. But as it is, you know, I feel like, the biggest issue I have with these tests now is that there’s a real haves and have nots situation. A lot of people who can afford it, you know, they can go to dinner parties, they can see their friends and family, they can do lots of things because they have access to these tests. But you know, $15, is what a lot of people make in an hour and an hour it’s pay, you can’t do that very often. And so you you’re forced to take the risk. So making these available, particularly to people lower incomes, to me feels like the societal priority. And those are folks that are, by the way, the same people that are forced to stand in front of us at the grocery store, and work every day. So that’s my own view.

Michael Mina  56:02

Yeah, and I would say that it is exacerbating a public health, nobody should have to pay out of pocket for public health or participate in public health. And this is the problem of continuing to think of these tools as medical commodities or as medical devices, that the benefit is of the user, the benefit of somebody who’s willing to stick a swab into their nose, get a positive test and isolate we should be, we should be raising our hands and thanking those people not asking them to pay for the privilege to do that, you know, and I think that’s a real, it’s a real problem that we still this far into the pandemic haven’t figured out that tests, where you’re using them to know that you’re safe to protect other people should not come out of individual people’s pockets in terms of the costs of those.

Andy Slavitt 

You know I realize you’re too interesting to talk to you to force you into short answers and 20 questions so much as much as that’s my theory. I’m bad at because you’re just too interesting. Who do it three more questions. Number 18. From Jimmy, there are pop up COVID-19 testing facilities all over the Northwest Chicago suburbs. Every strip mall has one with huge signs, a lot of off brand, quote health pharmacies now have prominent free COVID test signs touting PCR, RT, or lateral flow rapid tests. Are these pop ups legit? Or are they a scam that’s harvesting personal information.

Michael Mina 

Well, I can’t speak for all of them. But I can say that the government, the federal government has given a lot of money to the states. And the states are using them in different ways. And some of that is to ensure that these pop-up tents do exist for people to get tests. So I would say that the vast, vast, vast if not all of them, majority are legit. The one thing I would say is if you arrive at a pop-up site, and it’s cold out and they’re doing a lateral flow test on your rapid test, do not trust the answers rapid test should not be done in the cold. I just want people to know that because it’s not discussed. That shouldn’t be done in the cold.

Andy Slavitt  58:08

So I tend to agree with you. I think that that leave rapidly expanded the number of places to do testing, but if there is there one question someone could ask or should ask, if they’re concerned about the legitimacy of the site? Is there some signal some tells at the type of test type of machine? How long it takes? What would you say to ask if someone’s concerned?

Michael Mina

Yep, so any place that you’re generally getting a test should have a CLIA waiver, they should be reporting to the government your results are reporting to public health anyway. But I would say the biggest question ask is just ask what tests they’re giving you, you know, what test you using? And if it’s a laboratory based PCRC? Where does this test go? Is it quest, is it lab core? Is it some other company and I would say you can, you know, there’s only a handful of tests, manufacturers that are out there and available in terms of the rapid tests sold in the US. So you can check that against the FDA or we could put a small list in this podcast, perhaps in the, in the writing below it or the description, rather, something along those lines, but in general, there’s not a huge number of tests. So just ask what kind of test it is they’re giving you.

Andy Slavitt 

We’ll do that. That’s great idea. Number 19. Debbie, with rapid home antigen test in short supply, can two people do a pooled BinaxNOW test by inserting two swabs into the card? And so where do we get the right kind of swab?

Michael Mina 

Yeah, I will you know that the by next now is the one test that I wouldn’t really I mean, it could but it’s not exactly the right format to do it. The swabs are you know, it really only fits one swab, but some of the other tests can do that you know, and it’s not discussed a lot here but you know, in the FDA won’t author who has an authorized it, etc. But it’s done in Israel quite a bit. I have a lot of colleagues who do it. So any of this any of the tests where there’s a buffer like a little too buffer liquid that you put your swab into. You could put a couple swabs in there maybe even three or four and have the whole family you know, do one lateral flow swab and is testing is actually something I argued back in October, maybe no, maybe it’s in the summer, something that we should do as a country to really increase the fallibility of testing is you can have a whole household of three or four people do that. But we have to make the swabs available, don’t use the same swab. You know, that’s just gross, and, you know, not the right thing to do.

Andy Slavitt 

Okay. Final question. And this is actually a question that I get asked on TV a lot. And now I can finally get a real professional answer, as opposed to the one I give and it’s a voicemail.

Speaker 5 

Hello, Andy Slavitt, if you guys can come up with some ideas about how folks can report results quickly and easily. That would be great. I live in New Mexico, southern New Mexico. And we’re thinking about trying to do something with local agencies not for profits, who can gather the data and report it to the State Department of Health. Without something like that, I don’t see how people are going to be even motivated to go through the problems of trying to find the damn tests using them. And they’re just not going to report anything. And so my data is going to continue to be challenged. Okay, thanks so much appreciate the opportunity. But

Andy Slavitt 

I think what they’re asking here, of course is it but people take rapid antigen tests, we don’t end up knowing the results. And as more and more and more people take those tests, we’re only getting part of the picture. So I think the really interesting question here is, what could be done? And what level of by whom? So that we could change that so that we can close the loop on the results of these at home tests?

Michael Mina

Yeah, well, as you know, I recently left Harvard. And specifically, to help focus on this, I joined a company called E-med. And what E-med is focused on right now is to do this to get a rapid test to be reportable to public health, and to have downstream action associated with it. So you can have some rapid tests at your house. And you can E-med it, which means use a proctored version of the test. So a proctor actually pops onto your computer screen, you scan a QR code, and they walk you through using it or if you know how to use it already. They watch you use it, they authenticate that you actually did the test, and then report the result back to you, of course, to an employer or a school, if you’re using it for those reasons or for prescription for Pfizer, but importantly, they get the results of the public health agency based on a rapid test you did at home. The reason it’s so important to do this is because you know, as much as I called for last year, I listened to the public health directors, APHL and other laboratories who all said, we can’t rely on people self-reporting, I said, No, you’re going to get a lot of people reporting, it’s okay. But the reality is, if we use self-reporting that’s fully voluntary, there is no incentive for somebody to voluntarily report that they’re positive. So we’ll completely throw off any of the epidemiological use of those reports, because we won’t know what 1% means does 1% positive mean 10% positive? And so that’s where E-med is, you know, we’re starting to work with, you know, a lot of state governments are now using this service. It’s not a test manufacturer at all. But it’s a service to enable verification of who the person is so that they can get an actual lab report that says Yes, John Doe, did his test at 8am. This morning, it was negative, and that gets immediately put to public health, or it says John Doe was positive. And five minutes later public health can have that result in contact, trace them if they want. So it’s very powerful platform to address this issue.

Andy Slavitt  1:04:00

Is that the only way it’s gonna happen?

Michael Mina 

Well, it I think that there’s not a lot of ways to do it in a verified way. But there are apps that you can now like NIH, for example, has to say yes to the test program. And if you’re in that program, and you’re getting a free test, you know, they’re pretty limited across the country, but they’re if you’re in one of those cities, and they do it for a couple weeks at a time. They give you a self-reporting approach on a website. Again, the issue is how to interpret those rates because we know that you know if you’re not if it’s not automatically being recorded, and reported, then you know, we know that there’s no incentive, the reality is you know, as much as I hate to say it, the reality is there’s no incentive to report a positive and so individuals you know, if you want to report your positive, that’s great. The problem is the people looking at those results, won’t really know you know, was it just you or was it everyone who is positive actually reported their positive result and in generally that’s unfortunately just not the case.

Andy Slavitt

They Bluetooth my toothbrush, so someone knows how many strokes of my upper teeth and my lower teeth are going out at all time. So probably won’t be long before they Bluetooth that little pink strip.

Michael Mina 

That’s right. And actually the FDA is there is some effort to get those, to get the results automatically reported. So it’s not really easy to do when you’re trying to keep the costs, you know, three or four bucks apiece.

Andy Slavitt 

Well, I know for sure if he asked for an extra step. You’re exactly right. You won’t get way people doing well, we made it through 20 questions.

Michael Mina 

Fun 20 questions, they’re good. You have a good listener base.

Andy Slavitt

Smart people, some very smart people listen to the show, and some good people that appear on the show. So thanks for coming IN THE BUBBLE

Michael Mina 

Well, I’m happy to this is a lot of fun.

Andy Slavitt

Okay, that was a lot of information. I hope you got it all. Hope it helped you, really do. Let me tell you what our next four shows are all about one on an update on what’s going on with kids, kids, vaccines, schools, COVID, etc. My guest Paul Offit. The second is with the chief science officer of the United States, David Kessler. He is the equivalent of the person who ran warp speed for the Trump administration. He does all of the purchasing and design of what we get from our vaccines and what we get from our antivirals a therapeutic so we’re going to talk a lot about the antiviral we’re going to talk about when they get here we’re gonna talk about the inner workings of all that stuff. It’s gonna be very cool very in the bubble inside every conversation. Next, indoor air quality ventilation will be our third time guests Rich Corsi. Yes, that Rich Corsi, he’s a wonderful, and fourth, we will have, we’re gonna go inside a hospital to see what it looks like right now during COVID. So we can look at the difference between Omicron and other variants inside these hospitals. We’re going to do a day in the life of Medical Center in Rhode Island with Megan Ranney, who if you haven’t listened to her or heard her before, she is wonderful. She took us on a tour of her rounds. He’s a physician. And it’s been a day in life in hospital was really amazing emotional episode, but more than anything else, it’s insightful. So anyway, those are four upcoming shows. You’ll be hearing from us in January. Stay tuned and let’s talk again on Wednesday.

CREDITS

Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev and Veronica Rodriguez. Jessica Cordova Kramer and Stephanie Wittels Wachs are the executive producers of the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, please tell your friends and please stay safe, share some joy and we will definitely get through this together.