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Gu AR d.com and use the code bubble for 15% off to learn more and get the Revolutionary activity masks designed to keep you and your family healthy. Welcome in the bubble. Is it Andy slavitt and modest love it. We got a toolkit episode today about testing so testings a big topic of conversation. I think we tend to think of it.
As a problem because we haven't had as much but I think this episode May convince people to look at it as an opportunity because the power of what we could do and we have a lot of test is pretty pretty high. Yep, testing more more availability of testing and more reason see around testing will provide a lot of freedom. Yeah. I've learned a lot about this along the way which is exactly what you said, which is frequency being able to get things out frequently will just give us more freedom to do more.
Oh things so I think taking the lens of not what do we do to end the virus? But what do we do to get back to normal life? It feels like testings a big part of that equation will be nice to get back to normal life sometime soon. It's true. Not that I don't love spending all my days and all my hours with you. I thought you did. Okay, in the meantime, let us introduce our guests for the show. We are very excited to have Michael Nina who is an epidemiologist immunologist and
Position at Harvard School of Public Health runs a major lab and he's at Harvard Medical School and he's done all that and he's looks like he's about half my age which is she probably is just annoying. Okay, but he's great. He's great. It's great explanations, but more importantly he's doing some amazingly cool stuff. Robbie. Sica is here in Minneapolis. He is the vice president of basketball performance and Technology of for the Minnesota Timberwolves. Why would that be
The important. Well, he's the only licensed physician have any NBA team and he's taken it upon himself. I should say the Timberwolves were the or the team that had the first death of anyone in the immediate family of a player their star player. And Robbie has been like a dog on a bone trying to get more rapid saliva tests out into the country and he's being successful. He is on his way and we're very close to being able to do that more. And so we're going to read your voicemails and your emails.
So let's bring them
both up.
Hello.
Hi great. Let me just those give it's been a second what we're trying to do here. I think that what I would love to do today is just how people do two things one is understand, you know, the fundamental basics of how to stuff works in a simple and short and explanation is possible. And then I think people are secondarily. They're curious like why the hell haven't you figured this out and I think a just a short explanation of other countries done it better.
Most things that people want to know is like what's going to change when's it going to change? How's it going to be cool and then that'll be the fun part and we'll read through emails and voicemails and and the idea is I think not to give people ideas give people a simple and straightforward and clear of you as possible and I think to build some momentum that hey the future is coming things are going to change things are going to get better. And so I'm just going to tell everyone now that we have two.
Very cool experts to help talk about testing today. One of them is Michael Nina and he is at a small school called Harvard where he is. What are you in charge of
Michael? I am an epidemiologist and an immunologist. I'm in charge of the laboratory that I run my research lab, but I'm also one of the heads of molecular virology diagnostics at Brigham and Women's Hospital, which is one of Harvard's main teaching hospitals.
Okay, so I will just get out.
Give you an A-Plus for qualifications. That's because you've got a lot of bases covered and Robbie spend a second on your background and why we're talking to you today.
So I'm the vice president of basketball performance and technology for the Timberwolves. I grew up in Minnesota and a proud will span but come from the medical background where I'm going to use is the ologist and was a clinical anesthesiologist working for for a Private Practice Group for the last six years and my exposure
To to covid is kind of a unique one in that I've been involved with the NBA's response to the sport Science committee and largely through my interest in academic research that put together an interesting work group that has really tried to stay at the cusp of technology and research and how we've approached the pandemic
great. Okay, so maybe we start this way Michael what a type of tests are there. Can you give us a little bit of a current state of affairs before we dive into the to the emails?
Voicemails people have sent in to us
sure. So the major test that exists the one that's been primarily used by most people since this pandemic started is the PCR test. This is a test that looks for the RNA of the virus. You could think of the RNA kind of the same way that we think of the DNA for of humans viruses like the coronavirus use RNA instead and and so one of the easy ways to look for viruses to look for its RNA because
we've built up over decades. We've built up really good tools to do that. And that primary tool is called PCR polymerase Chain Reaction don't have to know what those words mean, but just know that it's a very good tool for picking up pieces of RNA in a very very specific Manner and really looking at small small numbers of RNA molecules. So that's PCR. There's also these tests that are called and there's a whole variety of different types of PCR. We can go into that later, but then the
category of viral testing outside of PCR and molecular test has antigen tests antigen test differ because they're not looking for the RNA of a virus meaning they're not looking for the Genome of the virus are actually looking for the proteins the the arms and legs of the virus if you will and so in the same way that a human could we could technically go and look at somebody's DNA and know that that Joe Smith is Joe Smith based on their DNA we could also
so look at Joe Smith's eyes and nose and mouth and have a very good understanding that that is Joe Smith based on the physical properties of person. So that's more what antigen tests are doing. They're actually looking for the physical features of the virus and the important thing to know is that these types of tests can be done very fast to do PCR. You need a lot of instrumentation and things like that to look forward to the proteins of the virus. You really can do it at very very
Speed and for very cheap just on a piece of paper. Essentially. You can create little paper strip test that will turn positive or negative in minutes. So those are the two major classes and I do want to just mention the other one because it's been a source of a lot of confusion for people which is antibody testing antibody testing doesn't look for the virus, but it looks for evidence that somebody has been infected with the virus based on their antibody or immune response to it. And so it's a whole different class it
Doesn't really the important thing for antibody testing is it gives you information on somebody's immune status and the signal stays around for months to years potentially. So you could kind of get a window into somebody's past history of the
virus got it got it. And so, how are we doing as a country? Where are we in the development of both of these types of tests the PCR test and the antigen
test so we have we've really built up a
Out of capacity to do PCR in this country and slowly we're building up antigen test capacity as well. But PCR testing has been we really started it. We started working on it in a pretty failed attempt early on in February.
This is where the cdc's had a contaminated test,
right? That's exactly right that there were two to failings of the major one that was in the media a lot was the CDC had a contaminated test. They sent all these test kits out to all the state Laboratories and
then they had to retract them also that that delayed the US response to two in terms of testing by at least a month or so three weeks to a month. But what was really the failing that came to light was that the US network of Public Health Laboratories, just more than up to the task turns out we have Saudi funded public health for so long that it wasn't even close. It wasn't even a race. I would say to the State Labs never really had a chance and they are from a public health perspective. They are the
Health Labs of this country, but this this really just was a tsunami of infections that overwhelm them very quickly. So we've been trying to scramble and back up from that ever since and and the country is doing pretty good job at just building up PCR based testing molecular Tools in a whole array of creative ways. But these are these they're all laboratory-based tests. And so we've been building it up. We're now doing upwards of around, you know, between seven seven hundred.
Thousand and nine hundred thousand tests a day, most of those being pcr-based tests and we've gotten to a point where we can diagnose enough people but there's other uses for the test, which I think Robbie's can talk about
got it got it. It's worth saying that there's different types of labs. There's a Labs that are State Laboratories. There are Labs that are in hospitals there are commercial Laboratories. So it's important to that those things all operate a bit differently, Robbie. What would you add and how would you talk about the form function of these?
Relative to the types of needs we have as a society,
you know, I think there's this is a really large country. So when you're talking about 300 million plus people and we're doing a million tests a day or just under that that's just not even close to being able to test race an isolate. We're not close to being able to reach capacity. So we need to have all sorts of testing available whether its antigen testing PCR testing. We just need more of it and one of
Of the the real challenges here is the price point for PCR testing is really expensive and as Michael very eloquently said and describing the testing methods PCR testing largely has to go to a lab there are lateral flow assays and there are other options for PCR based or PCR concept test that are things that maybe we'll eventually be able to be consumer-facing test. But the reality is we need cheaper testing out to the masses. We need to be able
The screen populations and when we talk to hospitals they talk about their
capacity. Let me let me let me stop you there when you say the screen screen because I want to make a distinction. Okay, someone's sick. They have coronavirus. They need a test to confirm. They have it. That's somebody with a symptom. Okay, that's what that's one type of test. That's one need second you mentioned screen and I wanted to explain what this means. You've got a population where this virus spreads asymptomatic Ali and so there is a question and this was a
CDC controversy quite recently about what is the benefit of also testing people that don't have symptoms so you can understand where the virus is spreading and then there's a probably a third category, which is I am not in that category, but I myself might want to do something. I might want to visit my grandmother in the hospital. I might want to enter a basketball game. I might want to go to a party. I might want to get on an airplane. So I want to know myself it may not be screened for
Public Health purposes it's not because I have a symptom but it's because I want to want to do something.
Yeah, and
those are all different avenues for screening all different populations and different types of screening. It could be for schools. It can be for work. It can be to visit family. It can be for a lot of different things and we have to have screening test for all of those scenarios and that can mean PCR it can mean antigen testing but it needs to be cheap and it needs to be affordable and accessible in a way that you're also not waiting for your results for days. It's got to be faster
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Okay, so let's dig into some of the questions. I think the Baseline you've given us is we have some kind of big heavy expensive test that work when people are sick, but we have other needs and other purposes. So let's start with one of the other purposes and I'm going to play a
voicemail.
Hey Andy, this is Jeremy calling from New York. I was wondering when we can expect to get more reliable spit test. I am pretty tired of having that long swab shoved into my brain. Anyway, thanks for the great podcast and keep up the good work.
Robbie Seco. When is it going to be prevalence of these spit test or you might call them saliva
test? Yeah, so the EU a for saliva.
Actor group that we've worked with over the last few months with the Yale team in the NBA putting together just a very unique open source protocol around September 15th, you will start to see saliva direct be accessible in different parts of the country and we've had over 200 labs and over 10 different countries reach out about saliva testing. This is going to be something that as you go into October you will start to see more and more saliva testing and a move away from swab.
Herbs, particularly nasopharyngeal
swamps are saliva test as good as they zil's Whitney's nasal test.
There's an article that came out in the New England Journal of Medicine from the Yale team that did describe that lower limits of detection for saliva. Testing are as good as traditional swab based testing. We've looked at over 4,000 samples in the NBA population in our study and we found that the negative predictive value of saliva for asymptomatic screening and for detection is as useful as anterior.
Hazel or French or swabs?
Okay. So starting around the middle of this month and carrying forward. These tests will be more and more available. There are other saliva tests on the market. There are other saliva tests being created. Will they meet some of the purpose of the least is limited purpose you described of lower cost and more readily available results.
Absolutely and it's going to be something that you hopefully don't have to go to a health care worker go to a clinic or go to a hospital to get tested because what we don't want to test every patient is
in a medical setting we want to be able to test in the community so that people can move on with their lives and they can resume whatever The New Normal is
the okay. So Michael, I'm going to play a voicemail for you. I run another type of test.
Hi my question concerns at home tests, and when those might be available and also the reliability of Quick Test specifically if those are useful enough if they're not as reliable. Thanks a lot.
Bye. Yeah, so the antigen test which is really what what that question is referring to these are tests that are sufficiently simple to be used at home. I want to make a distinction just because there's been so much confusion out in the public about it. And that's that we have to separate out the the mode of collection from the mode of testing and I think Robbie just did a good job at describing that but just to be very concrete The Collection could be either a nasal swab that goes way back into the back of your brain.
Could be not literally but it could be a front nose swab which we largely is called a nasal swab or an anterior narrow swab and then there's saliva and so each of those have their benefits and trade-offs, but that's the collection and then the testing is either laboratory or point of care or even at home. And so we're going to start seeing these at home tests. I think in the near future, they haven't quite gotten to at home yet but a bit for example, they this is
Ager company that makes a lot of lab tests. They just came out with a what they call a by necks now a say it's essentially a cardboard cardboard test does the whole test on a piece of cardboard and 15 minutes and how does it work? So it works these are these are called lateral flow asses they work very much like a pregnancy test in the same way. You'd essentially put some of your saliva on one of these tests or you'd put a nasal swab that you can do yourself. It's like a Q-tip that you put in the front of your nose and then you put it in Saline and then
Drop drops of that onto these test strips and their little pieces of paper essentially maybe in a in a little piece of plastic the sample will flow over the piece of paper and if there's virus in it, it will make a line turn red for example, and so these are called lateral flow asses there. They look just like pregnancy test. And in fact, the technology is extremely similar to a pregnancy test. So these could be done at home. They could be done at the school so that the the
approval that this test just got is for symptomatic people to be used as in the doctor's office for example, but it's really going to very quickly be used what we call off label and that means it's going to infect Health and Human Services Brett Gerard just just brought it out the other day and pretty much all advocated for the broader use of these tests. And so so I think we should start to see them and that's really the first major step that needs to happen before home
use. So I would go to CVS or I would get on
Amazon and I would say I'm going to buy a whole bunch of these pieces of paper. We have it home and then either think of a tasty food and drool a little bit or use a Q-tip and put something on here and it will tell me whether I have coronavirus with what kind of accuracy
sure. So this has been such a topic of conversation. What's the accuracy these tests accuracy? I want to make clear as
Is it's a function of what your target is the way that I look at these antigen test is really rapid test. I actually look at them as transmission indicators more than I look at them as true medical Diagnostics and the difference here is you're a doctor and you have a sick patient in front of you. You want the absolute you want to know if there's any shred of evidence that this person has coronavirus. These tests probably wouldn't be it. But if you're trying to create a public health platform that stops the transmission of the virus.
You really just want to know who has sufficient amount of virus in their mouth or nose that they might be able to transmit it. And these tests will be very accurate probably somewhere around 95% sensitive to detect people who are very likely to be transmitting the virus to other people
who know just just to put that in context that sounds higher than what most people are hearing about test which they you know, I think people you know,
The popular press will talk about 80% and then all kinds of exaggerated claims and I worry that people change the denominator slightly or the description slightly to say. Well it's 90% of some other thing. So just just to keep it really basic if I were to do one of these tests right now and I had and I had coronavirus what's the percentage chance that it would tell me that I had coronavirus.
Well, it depends on where in your course of infection you are. Okay, and that's why I say 90 in this case. You're absolutely right. It's always changing the
My denominator in this case is people who are most likely to transmit the virus to other people and that's because if you're likely to transmit it, you're also very likely to have very high amounts of virus. But if you're just kind of give a very mild infection that might not be particularly transmissible. It's we're not quite sure of what that sensitivity is. But if you're say a super spreader something like that, it would probably be very very accurate to find you very quickly
Rob. You've got a question that's coming by email from I think
Name is pronounced Kelly Dumont. If we really need to test on a massive scale, how will that affect the labs we have for processing now, do we need more Labs?
It's a good question. And I think it goes to some of the stuff that we've already talked about. We need labs to understand that they are running at capacity. They are testing as much as they can attest like saliva direct has a positive impact on the efficiency of the lab, but more importantly than that. We need to start screening the community, too.
Avoid having spreading and to reduce our Hospital population to reduce the viral burden in the community. We need to screen more. So the public health folks will tell you that we need to screen the lab folks will to say that you know, we've got to test possible folks. We need to find a better balance of how we test the community and I think Michael was alluding to this earlier the test Cadence matters more than the sensitivity of a pure test the more we test the more often we test the better these tests will perform.
And the more likely we are to pick out positives and reduce the spread in the community. And I think that's something we can all get behind. We have to test more and more frequently and that's going to mean that we have to test asymptomatic individuals to avoid Hospital burden and having people who can spread the virus more.
Okay. So here's a voicemail for you from Carol Corgan.
Hi, Andy, if you think you've been exposed or you've been in a situation where you couldn't expose, I understand you should get a test. If you get that test, they three days later and you test negative. Should you get tested again five days later. Ten days later 14 days later, or do you just wait to see if you have symptoms. It's a little confusing to me about the period of of testing and how when and how often you should get tested. Thanks a lot. I appreciate your
But for Matthew and your service, bye-bye, that's the situation we've been living in because when do you test and those are those are complicated situations where you know, I typically tell someone if you've been exposed your job right then and there is to stay home and to minimize your exposure to the community and until we have more and cheaper testing available. We don't want to go and test everybody but we're getting to that point now where we should test you and we should test you more often. So let's experiment and let's figure out how we're going to
to figure out that test Cadence because we can figure out how to ramp up and go test everybody in a small segment of the population. We also don't know how to ramp down. So if there are no cases we don't want to be in a situation where that we ramped down and then we have more cases and we got to ramp up again. We have to have consistency that's out there that this just becomes part of what we do we test to go into certain situations to go to a game to go to school to go to a restaurant so that you can limit the viral burden in the community. So to answer your questions to think
Even though that was a long answer I would stay home for a period of probably five days minimize your contacts. And then at that point if you develop symptoms, I would certainly get tested and if you don't before you go out, I would consider getting a test before you you clear yourself at probably five days after your exposure to clarify that it's because there's this period called the incubation period I think a lot of people are confused about this if you get exposed today, there's almost no point in going and getting a test tomorrow.
Just none, you'll be negative. Even if you're positive, you know, it's a during the incubation period you have to let the virus grow enough so that even the PCR test can detect it. So the best window as Robbie is alluding to is that it's probably around a five-day period maybe a Six-Day period if you want to be conservative and then get a test a lot of people remain asymptomatic says symptoms alone won't necessarily be able to tell you that your negative. But but if you do it before five five days or so, you're very likely to just do it too early.
And this is really similar actually to a pregnancy test again, actually, if you become pregnant and you go and take a test two hours later, it's not going to show that you're positive. You have to wait a couple of days
interesting. Okay, so stay home for five days. Then go take a test. Do you need to take another test at the end to make sure that at the end of 14 days that you are no longer carrying the virus. There's been some conflicting reports and I will tell you that we have had.
Add a situation here where we had someone in our household who had coronavirus and kept testing positive for weeks and weeks and weeks and weeks and weeks later. He came he had no symptoms. You know, they were telling us that the time you need to negative test before you can let him out of his prison cell. He was in a prison cell. He was in our basement with a computer and everything so he was fine, but we come to find out later that maybe we didn't need to wait so long, sorry and made for to negative test.
Well,
I think that those are interesting scenarios because one the more you test the more you will have false positives and false negatives in the community. So you better be prepared to handle some of those situations. Those are complicated situations where you have to be able to communicate and figure out how you're going to move forward. We've developed a lot of tests that have really good specificity. So if you're positive you're more than likely positive, but what that means in terms of your infective necess versus your infectiousness not by person.
Ality, and you have an infectious personality, but it did thank you, but you don't spread it to people we need to understand and I think this is one of the points that Michaels made if you have the virus and you have low levels of that virus and you're not spreading it to people you are not as much of a risk to the community
sure. So at 14 days can people go out
so that the 14-day Mark is is the conservative Mark. I would say that it's designed to account for both an incubation period and a whole course of maybe
Asymptomatic infection for somebody who's not who doesn't get symptoms. So it's it's conservative. I would say that if you test negative at day six or seven this is not what the CDC currently says, but if you have access to a test on day six or seven after exposure, I would say you can probably go out if it's negative. But if you haven't tested again and you're waiting the whole 14 days and you still have not shown any signs then in general the recommendation and I agree with it is that you could start to go out. I actually really push for the use of
of physic value that comes along with these PCR tests. It's called the CT value and it essentially kind of reflects the viral load and I actually think that this whole new guidelines that should be made that actually interpret the CT value to say to somebody look you're somebody like your family member who is stuck in side for potentially week. Some people get stuck for four months in in a positive State and that's confusing to a lot of people so we should be able to look at the viral RNA load and say
This person has very low RNA amounts for weeks. Now. There's no way that they're transmissible anymore. It's just remnants
don't go anywhere. We've got to go earn some money to donate to
charity.
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I want to talk to you guys both about a different type of testing because a lot of what I want people to take away is understanding kind of the Innovation that's making it should be making us more hopeful because of the things we be able to do in our lives. Someone asked a question about sewage testing. Thank you Paul fennel for asking this question. He mails testing of sewage.
Looks like a good early indicator of covid infection. Could there be an at-home version you you drop a paper strip in the toilet? And it turns color if tells you whether you're infected maybe we start this way Michael what sewage testing is does it work? What is it useful for? How is it being used? What can it be used for
assuage testing is a it's a very good surveillance tool that we have at our disposal. It's essentially this this is a particular virus.
Is that likes to grow in our intestines? And that means it comes out in our
feces all the time or just some of the
time just some of the time not not everyone would necessarily have a high signal of it, but it seems to be the more we learn about it seems to be a pretty common phenomenon that people if they if they have this virus you can usually detect it potentially for quite a bit longer actually in the school than in the respiratory tract and that that's for a number of reasons is some new research coming out that showing that the virus is actually turning up changing the properties of these cells to
To turn up this thing called the the a stew which is what the virus binds to in any case. It seems to the virus seems to really like the gut and so when your body starts clearing it you essentially shut it into your feces and that and there's a lot of RNA from these viruses so you can actually start to pick that up Downstream in the sewage water. The question is what you do with that information. And if you're like at that outflow tract of an entire University and you start to see a positive coefficient,
Did RNA in the sewage from the outflow tract of a whole university do shut down the hall University? You know, how do you act on it? And that's where we really have to say Okay. This is a public health issue. This is a very powerful potential public health tool but you have to have pretty good plans in place about how to act. How are you going to identify the people who are transmitting? It could be two people in a university of 50,000 who are leading to that. So
right but one of the things that I think is important to understand I think
About sewage test. You can both can correct me if I'm wrong here. Is it when we get this under more control when it's not such rampant Community spread. We are still going to want to be able to get it at the earliest possible time. And so right now we're in a situation where you know, you could as you say you're gonna be the school and lots of people could have the virus, but hopefully we're in a situation a few months from now or at some point in time when you got communities where you're not seeing any spread but
You want to know when's the first time I should start because I don't want to close the bars and the restaurants and everything too early. But but I want early indicators I want to signal and so if you're in a county somewhere and you're doing the sewage test on a daily basis and you find up we just saw it again. It's been we haven't seen it in a month and a half that at least can begin the beginning of a detective Trail for you.
That's that's exactly right. And this is really how I think not just like think but this is how surveillance
Graham's across the globe for infectious diseases like this have generally work not always through sewage things like antibody testing other types of testing that are not so frequent. And so intrusive into people's lives are generally used during what I call piece time when there's no cases and you just want to have you know, risk is very very low on an individual basis and you just want to have a signal set up a surveillance system setup that very frequently is monitoring for any
Light signal that the virus is coming back into the community and then you can act appropriately to to deal with it.
What about Paul's kind of billion-dollar idea. Can you just drop a piece of paper in your own toilet and not have it as a surveillance test, but use that as your as your test,
well, I have thought a lot about it and I think that the I think it's possible it doesn't exist right now, but I think given the right people working on the problem. You could have crisper base types of test out potentially, you know, if they target some of the RNA from the virus it sets off a little chain.
Action and and you get a little
signal. Let's let's Workshop this okay where we launched the product? What should we call it? Pope direct looks right. What do you think? Robbie got you got a name with which we call it. I'll have to talk to the Yale team about
that one. But you know that team has been working on sewage tracking in Connecticut for a long time and they actually use this to predict outbreaks in Connecticut very early on so I absolutely see the value I think college dorms should be doing sewage tracking because it's a great way if you're not going to be able
to test everyone you'll be able to predict outbreaks in populations like that. So it's the perfect setting for something like that.
I think we're through most of these questions and I would love to see if we can't bring it to a bit of a close with just a look into the future. It's so hard for us to get out of kind of what things look and feel like today 456 day wait times very expensive test hard to be able to get them not knowing what to do where to go.
And you know, I mean, let's get you to look into the crystal ball primarily driven by the impact of what tests will bring obviously there could be vaccines that can be better therapies and and all the things the mix as well. But if you were describing a vision six months from the future, we had you wave your magic wand we had all the testing and the testing kinds we want to describe what that world looks like for
people if I was king or president or whatever it might be. I think that a way to tackle this virus, especially from a testing perspective again,
I want to caveat it by all of this will happen with it within the within everything else. We're already doing which is for the time being silenced social distancing and masks but we would have tests that the federal government produces. Well, I think only the Federal Government Can reasonably be the buyer and producer of say 30 million tests today in the United States. I would like to see these rapid antigen test these paper strip test that look like pregnancy test built so that 30 million people could use these every day.
Is to every few days that would means 90 million people could actually be participating in this type of very frequent testing program. You put these tests into the all the hotspots of America. And so anywhere where there's cases that are really emerging you get these tests into the hands of people they brush their teeth each morning, they put in their contact lenses and they and they use a covid test to see if they are transmitting virus that day perhaps and likely a symptomatically if they
they are then they stay home and they stay home for at least five six seven days and and they test a couple of other times to see if they turn negative and that would be enough to stop transmission chains. I don't see these at the outset as your golden ticket into an event or into dinner. These would be actually a way that just like vaccines. They create herd effects. They actually drop population prevalence and that means you don't have to have a hundred percent of people using them every day. You could have 50 percent of people not want to use them at all another.
10% use them incorrectly and if you just get 40 or 50 percent, for example, using them every few days, we'd see major reductions that this value called the are not they are effective of the virus would plummet and that essentially means that the spread in the community plummets. So if we had that kind of testing that takes the burden off of the PCR lab so they can do confirmatory testing for example, even with a one percent false positive rate if you had 20
Million tests going out every in being used every single day by by Americans that brings our number of tests from 900,000 to 20 million and one percent false positives means we'd probably have to be doing PCR and around 200,000 PCR test the data to confirm them and that alone all of this kind of infrastructure would be sufficient to repress the virus and suppress its transmission at the communities that we can actually get people to a point where you're no longer worrying.
If the person next to you at dinner has a covid infection because you'd be in peace time. You'd suppress it so much that there's just the prevalence goes away in the hot spots which makes all of America safer. If you're not worrying about people bringing the virus into your community
and you'd be finding one and two cases instead of 200 into that were 2,000 cases at a time. Exactly. Okay. So how realistic is that Vision? You just gave that that could be the case in a few months.
I think it's very realistic if the these are
Are easy test to build they it doesn't require building huge Labs. It requires maybe Contracting with major manufacturers in China, for example, or even major manufacturers right here in the United States 3M for example has been interested in building these types of tests. They have amazing capacity. They could build huge numbers of them. So it's a simple technology. There's even free blueprints right
online is the scalability of
challenge. It would be a challenge but not an insurmountable challenge. I would say the the pains.
That this country has gone through to get to 900,000 PCR test today far exceed the pains that it would take to get antigen test to 30 million a day.
Okay. So before I decide if I'm gonna vote for you for president, let's here Robbie your vision to when you think about where we can be in a few months as a society. What are some of the elements that you see the hope
with saliva directors that it can change the conversation about testing shortages.
To access the testing and dropping the price we need affordable testing and we need to have testing accessible to the masses. It's our only way out along with masks. That's it and creating an open source platform for anyone with a CLIA lab to have access to a test. It changes the dynamic. It creates a recipe that labs around the country and around the world can use we had a forward-thinking vision at the NBA and with the Timberwolves in with Yale to not just do something for America but to do something for the
All because other countries are going to be six months a year two years behind here and they're going to be testing for a long time. This virus is not going anywhere. So we need to change the conversation. This is the first step in doing that. It's a low-cost affordable accessible test that will be available to the masses for us. We want to take a step forward as a country and when we talk about this at our first meeting Andy back in may we said this is not for the point guard. This is for the student body. This is for the population to be able to
to get back to school so that we don't have a generational Gap. I know your son is headed to what I think is the best school in the country the University of Pennsylvania this fall and I want him to have the same best great for years that I had while I was there and we want to be able to sorry Mike and I didn't mean to say the Harper's number two, but I love pain hardly gets that a lot. That's okay. We want students to be able to go back to school. We want restaurants to be safe. Again. We want people to be able to go and enjoy a sporting event and for us to be able to do that.
Have to have testing for right now. And and I don't see that going away for the foreseeable future. We're going to have asymmetries and whose immune who's been vaccinated. We have to address these inequities in our country and really come together. And I think the reason I'm proud to work in sports is sports has the best platform for teamwork in a lot of ways people come together to be greater than sum of their parts and we need our country to come together and be greater than the sum of the individuals here to really
try and figure out how we are going to test our way and mask our way out of this and that's going to require us to remember who we lost the personal faces. The people that we have had to not be able to say goodbye to over the last two months. We're forgetting that as we go forward. We have to remember those faces because that's what's going to haunt me for the rest of my life that there's more we could have done. There's more I could have done and I want to keep doing more as I go forward.
Well, those are two pretty compelling cases for president. I'm going to vote for Lana good answer for president and I'm going to go with porcelain popper. You pop it right into the toilet bowl and then it turns a color. So I think that's I think that would sell really well. Thank you guys so much for the time and the vision more so for the hard work and the fact that you guys are both.
Eggs at this you're not going to quit until we get there. I think I just realized that I wanted the in addition to the toolkit today. I wanted to Country to know that while they're sitting bad news headlines and things are scary. Did they really great people working on this problem every day. It's not visible every day. We only we only sometimes see it when it gets to the end and sometimes some of the things get to the end that something's don't but you know, I'm privileged to see the work that you guys are both doing.
And it's really important for the country.
Why Andy? Thanks. Thanks for your vision with all of this to that's you know, your vision of sharing and communicating and bringing together different voices. It's really cool how we've seen scientists and the community come together here, but we need more of it and that's where like I've never met half the people I've worked with I literally have I don't think I've met any of the people that I've worked with ever. I don't know if they walk or wear pants or what but that's what's great. I mean we're doing this all over Zoom.
Imagine how much better we can be after this because we've gotten to know people who are really smart talented committed. I really do think that when we get through this we have a chance to be a better country. If we don't get lost along the way couldn't agree more.
All right. Thanks guys.
Aw. Thanks Andy. Thank you.
Thank you. I hope you enjoyed that show keep the ideas coming. Of course, if you've got a product name for us or if you want to vote for anybody for president, but I thought those two were great and very hopeful let me tell you what's coming up in a couple days Wednesday. We have a new podcast coming out with hooli and Castro. I think it's going to be a great conversation about where we are.
As
a country in the people that are affected in that are going to make things happen and we'll get some Reflections from him and the campaign Trail. We have another episode coming up shortly on the west wing and it's going to be a I won't give it all away. But Pete Souza, who is the White House photographer under President Obama was there The West Wing is up for grabs. Now. It's a real estate lease is coming up November 3rd. So we'll see if the tenant is going to be renewed or a new one comes in. But let's we're going to also talk about what it's like there and how decisions are
Are made and some really interesting experiences there. We also have Rajiv Shah who is the president of the Rockefeller Foundation whose devoting considerable resources and energy towards the notion that we can do better. He has written a very powerful Treatise on what we can trust what we can't anyway, let you all go.
Thanks for listening in the bubble. Hope you re it is highly where production of lemon out of media Chrissy peas and Alex McCowen produced the show. Our mix is by Ivan. Kirov. My son Zack slavit is Emeritus co-host and on-site producer improved by the much better. Honestly. I haven't my wife Jessica Cordova Kramer and Stephanie whittles wax still rule our lives at executive produce the show and our theme was composed by
Dan Millard and over Hill and additional music by Ivan karev, you can find out more about our show on social media at lemon out of media and you can find me at a slavit on Twitter or at Andy slavitt on Instagram. If you like what you heard today most importantly, please tell your friends to come listen, but still tell them at a distance or with a mask and please stay safe share some joy, and we will get through this together. Hashtag. Stay home.
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