Rapid Antigen Test, App
BinaxNOW COVID-19 Ag Card is a digitally-connected rapid test for COVID-19 infection. It was designed to pair with the NAVICA mobile app, which works like a secure mobile boarding pass allowing people to display their test results where people gather such as workplaces, schools and other organizations. Photo credit: Abbott

A conversation with Dr. Michael Mina about a new kind of testing that may be a more effective virus-fighter than a vaccine.

Rarely do we have guests back on this podcast after only three months. But then rarely are we in the midst of a global pandemic that is getting worse by the day. A coronavirus vaccine, the holy grail of this pandemic, is still months away. Labs doing the standard nasal swab PCR tests are once again overwhelmed and taking much longer to return results. All the while, people are dying.

According to Dr. Michael Mina, assistant professor of epidemiology at Harvard’s School of Public Health, there is a better way. A test that we can all do when we brush our teeth in the morning, with instant results. According to Mina it just may save us all. He has been a tireless advocate for this test, which he says is accurate, sensitive, and is cheap and easy to manufacture. 

The catch: it still lacks FDA approval.

The test works on people who are symptomatic as well as asymptomatic, and most importantly, the results are immediate. According to Mina, any test that you have to wait five days for results is “essentially garbage.”

Mina also explains why we have to abandon our fixation with contact tracing and why this rapid test makes it irrelevant. 

Mina says that his ideas are now being taken seriously by public health officials and by the Biden transition team, and was, in a recent CNN interview, supported by Dr. Anthony Fauci.

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Full Text Transcript: 

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Jeff Schechtman: Welcome to the WhoWhatWhy Podcast, I’m your host, Jeff Schechtman. What if everything we know about COVID-19 testing is wrong? If the so-called current nasal swab PCR tests are not the best indicator, especially given how long it takes to get results? Suppose that contact tracing is a bad and unrealistic idea. What if there was a way to have made Thanksgiving something less than a national super-spreader event? What if the solution to the pandemic was not a vaccine, but simply a different kind of test, an inexpensive, at-home positive antigen test? According to Harvard’s Dr. Michael Mina, all of this is true. We had Dr. Mina on this podcast a few weeks ago, but what he had to say was so important, it seemed relevant to have him back. His recent article in TIME about all of this has garnered national attention, and his ideas may be finally taking hold in the medical and public health community, and maybe more importantly, in the Biden administration itself.

Jeff Schechtman: Mina, more than anyone else, may be on the cutting edge of ways to stop the pandemic, even without and/or before vaccines, more remarkable. Unlike Donald Trump, it does not involve hydroxychloroquine, bleach, or the MyPillow guy, but it involves real proven science and public health practices. We’re going to talk about this with my guest, Dr. Michael Mina. Dr. Mina is an assistant professor of epidemiology at Harvard’s T.H. Chan School of Public Health. He’s a member of the Center for Communicable Disease Dynamics, as well as an assistant professor in immunology and infectious diseases. An associate medical director in clinical microbiology in the department of pathology at Brigham and Women’s Hospital at the Harvard Medical School. Dr. Mina is leading the fight nationally and globally for this new kind of testing.

Jeff Schechtman: It is my pleasure to welcome Dr. Michael Mina to the WhoWhatWhy Podcast. Michael, thanks so much for being here. In our last conversation here for WhoWhatWhy, we talked a little bit about these antigen tests and you’ve written about it recently in a story that got a lot of attention in TIME Magazine. One of the things that comes up seemingly over and over again about this is what would this cost, what would it cost to put these antigen tests in the hands of every single American?

Dr. Michael Mina: The idea is that, to get the capacity built to actually have say between 10 and 20 million tests per day, which by my estimations is really enough to get herd immunity across or herd effects, which are like vaccine herd immunity across the population, would cost in the hundreds of millions of dollars to actually build up the capacity to do that. And with the government actually getting behind it, it could happen very, very quickly. A lot of the time that would normally be spent, would be finding real estate, finding things like that. And if the government actually wanted to do this, it could actually move very, very fast for probably well under half a billion dollars to create the factories. And these are very, very simple factories.

Dr. Michael Mina: So, it’s something that is really well within our means. And then to actually produce them and get the whole program out to the whole country for a year, and a year, we may very well not even need close to a year, it would be around $10 billion, maybe $20 billion, but probably somewhere in that ballpark. And that sounds like a lot of money, but it’s less than 0.1 percent. I believe it’s actually less than 0.01 percent of what the actual cost of this virus is at the entire level. So for less than 0.01 percent of the cost of this virus is having on our economy, we could potentially have a program set up that would actually be able to remove the virus from most communities or greatly suppress it without the need for waiting for a vaccine. And so, I think that cost should really not end up getting in the way here.

Jeff Schechtman: One of the questions that I repeatedly hear when people talk about this and what you’ve written about, is whether or not it’s too late, given that the vaccine seems like it’s around the corner and given how late it is in the process to build up the capacity to do these rapid antigen tests and get them out there in the hands of people. Is a too late, in fact to do this?

Dr. Michael Mina: If we started testing half of Americans tomorrow with a test in their homes that they could use say twice a week. And you wake up, you brush your teeth, you use the rapid antigen test on a Monday and a Friday, and that’s sort of your… That’s what people do. If we could get that many people to do it, half of Americans to use it twice a week, we would get this virus well under control within a month, if we could start it tomorrow. So, we could start it tomorrow in more limited areas, these tests do exist. I have packages of them right here. They do exist. We don’t have them authorized yet for home use, because we continue to require authorization as though they are medical uses and we treat every American as a medical patient, but Americans are not patients, they’re just healthy people living their life who want to get tested and know that they’re safer to go to work or to go to school.

Dr. Michael Mina: It’s not foolproof, but collectively at the population level, it can greatly reduce population incidents and make everyone much, much, much safer. So, a little bit from everyone using this test ends up causing these herd effects. But within a month, we would see a massive drop. We’ve seen it in Slovakia now, and that’s thankfully been sort of reported a bit. Slovakia started this program and within a week, they took exponential growth and turned it into exponential decay of the epidemic. And they have continued to see a dramatic decline in incidents just after a few weeks of using these tests at about half of their country’s population in a very, very similar way to the way that I’ve been describing.

Dr. Michael Mina: And so, we have a tool that can really greatly benefit us. We just have to get the regulatory framework in place to stop treating these as medical problems and allow this test. This is a test that if we were to get these out right now, this is illegal for me to use in my house, illegal for me to use in my house right now. That’s crazy. We could have these that everyone could use just like a pregnancy test. We just have to get the federal government to change a little bit and we all have to feel empowered to do our part in that.

Jeff Schechtman: Michael, the other confusion about these tests, which we hear over and over and over again, is how accurate are they? How sensitive are they? Are they giving false positives or false negatives? Talk a little about that.

Dr. Michael Mina: They are about 99, if not, sometimes some studies have shown them to be 100 percent sensitive when people are infectious, some of the better ones like the Abbott tests. These can be very, very powerful tools that approach 100 percent sensitivity when people are contagious, when they’re a risk to their family members or loved ones. And because of that, there’s been a lot of confusion because people continue to compare them to medical diagnostic tests, which are PCR. They’ll look for the RNA during or after somebody has been infected and contagious.

Dr. Michael Mina: And so, these antigen tests, one of the real benefits of them is that they turn positive when you’re contagious and then they turn negative when you’re not contagious. PCR tests will then stay positive, potentially for weeks more, if not months in some people. And so during that period of time, the much longer duration when people are remaining positive on PCR, they would be negative on an antigen test and so if somebody goes and does a study and doesn’t know exactly what they’re looking for, it would look like these are showing up as false negatives but they’re not, they’re doing exactly what they’re intended to be. In some ways, if your goal is actually identifying infectious people, you could go so far as to say that the PCR is leading to false positives, not for the viral RNA, but false positives for identifying contagious people. And that these are actually the more accurate test.

Dr. Michael Mina: So, we really have to look very, very closely and always define what is the goal of the testing program. And I think that that has led to the lack at the national level, and really at the global level, to a priority define why it is we’re testing, has led to the massive confusion around testing that has ensued. And we just have to define it: is this a medical test, a surveillance test, an entrance screening test, or a public health screening test? And if we make those decisions and we define it very clearly, then we know how to evaluate the test metrics. But to this day, we still don’t really do that. And the FDA certainly doesn’t do it. They assume every test is just a medical device. And so the point is, the tests work. They work really well. They’re being used broadly across the world now. The US is just really lagging behind. And part of the effect of that lag is that we have out of control growth.

Jeff Schechtman: With respect to the existing PCR testing, now that we’re seeing such explosions in the virus, we’re starting to see the PCR testing backed up again with significant delays. What’s the consequence of that within the context of the possibility of using these rapid tests?

Dr. Michael Mina: And we’re starting to see four or five, six, seven-day delays, which frankly makes these high quality PCR laboratory tests complete garbage, completely useless if you’re waiting for five days to get a test result back, it’s not even worth getting the test. These, on the other hand, give you results in five to 10 minutes and you can do them in your house without waiting in any line right after you brush your teeth.

Jeff Schechtman: You’ve been talking about this for quite a while now. A lot of it has seemed like whistling into the wind. Suddenly though, there seems to be real advocacy for the kind of rapid antigen tests that you’re talking about; are you heartened by this?

Dr. Michael Mina: I’ve been heartened to see that Anthony Fauci and Debbie Birx and other people have really begun to advocate for them as well. And Fauci, he was on CNN yesterday saying that he would now really like to see every household have access to these types of tests and that he thinks that that’s one of the best approaches that we can go forward with to tackle this virus. So, I think that the message is catching on, the research is certainly there. We have a preprint that’s out that will be getting published eventually and that has laid out this whole idea of test frequency, the speed of the test, the frequency that somebody can use the test is so much more important when it comes to public health and the individual sensitivity of each test to catch molecules.

Dr. Michael Mina: And that’s why this whole testing program works and that’s why it could get us truly out of the mess that we are in. And I say mess, but really I should be calling it like I’ve been doing lately which is calling it a war. This is killing thousands and thousands and thousands of Americans every single week and we should be treating it as though it is something that is causing thousands of deaths every week.

Jeff Schechtman: Do these tests work on both symptomatic and asymptomatic patients?

Dr. Michael Mina: These tests work as well for symptomatic and asymptomatic. The really important thing to know is that testing itself or rather the viral load it’s not a binary thing. So the point is these tests only care about the virus. They don’t care about the symptoms. And that’s why it’s so important to distinguish medical from public health. If you’re a doctor, you might be interested even if somebody is asymptomatic, you might be interested just to know that somebody has the virus inside of them, even if they’re not transmitting, for whatever reason, maybe they have some other heart condition and you’re just really concerned that if they even just get exposed but if they don’t have enough virus in their system to turn one of these positives, then they’re very, very unlikely to be transmitting. So, that’s why we really have to distinguish. That’s why I make the case that these are transmission detecting tests. They detect you when you’re high enough to transmit.

Dr. Michael Mina: And so, if you’re asymptomatic and you have enough virus to transmit, they will detect you. If you’re asymptomatic and you have such a low amount of virus, which is why you’re asymptomatic, but you can’t transmit, then they may or may not turn positive, but that’s okay because you’re not contagious. And so, we have to stop thinking about transmissibility as a binary and recognize that there are whole gradients of transmissibility. When we look at the amount of virus that somebody has in their body, we generally tend to put it on a plot of CT values and we’ve all heard about these CT values now. Well, for anyone who recognizes sort of how plots like this work, there is something called a logarithmic scale and a linear scale.

Dr. Michael Mina: Normal life, the way that our brains think, is a linear scale. But a logarithmic scale, it like compresses everything or it expands everything, so one to 10 looks the same as 1 million to 10 million in terms of size. When people are infectious or when they have virus in them, if we place… We’ve been looking at a lot of these like log scales where it looks like a CT value from 35 to 30, it looks similar to the same CT values like 20 to 15. But actually, 99 percent of somebody’s viral load will happen when they’re really, really high virus. And then even if they’re still positive with the antigen even for a little bit longer, they have such a low amount later on that they’re just not very, very likely to be transmitting. So it’s a very, very, very short window when people have trillions of viruses and then it comes back down to thousands.

Dr. Michael Mina: And the difference there is enormous. Most people have $1,000 in their bank account, nobody has a trillion dollars in their bank account except for Amazon and things like that. And so, that difference is what we’re talking about within each person, so transmissibility and the amount of virus people have is not just a binary thing, it’s like truly the order of difference between me and Jeff Bezos, it’s even a bigger difference than that in terms of wealth. So it’s really important to us to keep in mind that if you’re negative, even if you have live virus in you and you’re negative on one of these, the important thing is that you’re very low risk to actually be transmitting because you just have such a low amount of virus compared to somebody who’s really likely to be transmissible.

Jeff Schechtman: Just to be clear, do these tests actually exist now? Is there a supply of them anywhere?

Dr. Michael Mina: Oh yeah. Well, so we actually have a decent amount of these out in the population right now that are just totally not being used. We have like a whole store of Abbott BinaxNOW cards that are just not being used. And we have some of the BD Veritor and Quidel tests are not being used. Now, there are some of the older tests, some of the newer ones like Abbott and others are performing quite a bit better. But we have quite a lot and they’re not being used; we never created guidance around it. We never created strategy — we were using them for the wrong reasons. We’re just kind of sending them around. I like to think in the same context that I often think of this as a war, we’re just like sending guns around and hoping that some soldier maybe picks it up and uses it appropriately but without any direction.

Dr. Michael Mina: With tests like this, we have to create strategy. We really have to create strategy about how to use them appropriately. We have to give instructions, we have to get nursing homes to understand, “Hey, this is the role of an antigen test, and this is the role of a PCR test and these are the downfalls of a PCR test, these are the downfalls of an antigen test.” We haven’t even done that much due diligence to help nursing homes and such figure out how to really use these. And so this has been a real problem and I think that if we were to create the guidance and create the guidelines and create the strategy around how to use these, we would see them become much, much more useful. We’d also start to see PCR testing not be backed up so much because we could start actually replacing some of that PCR testing with rapid testing, make it more convenient for people, make it quicker.

Dr. Michael Mina: And overall, you ended up getting an increase in the whole system’s efficiency because you start to de-clog, if you will or unclog the PCR laboratories. So I would say that very few of them are being used, because there’s been no strategy. And what that means and it goes so far beyond just not having a strategy if we… Because we don’t have a strategy and the right messaging, people start to very, very quickly lose any trust in the antigen tests like this because they don’t understand, they haven’t been told that, “Hey, on the back end of an infection, when you just are PCR positive with RNA, there’s a whole long period of time when you don’t have viral infection anymore, you don’t have contagious virus.” But most people don’t understand that. I’ve been trying to explain it to a lot of people but that’s not common knowledge.

Dr. Michael Mina: And so if we don’t make it abundantly clear when we give a nursing home these tests that, “Hey, that you might see discordance between your PCR and your antigen test, and a lot of times that’s okay, and this is how you deal with it.” Then people lose trust in these tests extremely fast. And that has been what we’ve seen. And it’s really just a messaging problem. We just haven’t instructed people on what to expect and how to use them appropriately.

Jeff Schechtman: It’s become increasingly clear, particularly by the travel patterns that we saw over the past few days, that people did not adhere to the CDC guidelines, that people traveled over Thanksgiving, that a lot of people got together for Thanksgiving, even when suggested not to. What is your sense of how much worse things are going to get as we come out of this holiday weekend?

Dr. Michael Mina: Well, we’re in the worst case scenario, more or less, I guess it could be a little bit worse. We have uncontrolled growth of the virus, of course. And so, this has been an extraordinarily long year. And so, we haven’t exactly given the population reason to see a light at the end of the tunnel, except maybe by continuing to harp on a vaccine being a month away. We’ve been saying that for many, many months. So, I see this as a failure of policymakers. I see this as a failure of us as epidemiologists and scientists and doctors, and everyone else who has been speaking to the American public. And it’s not because they’re going against public health orders, it’s because people are living their lives and we can’t fault people for doing that at this point. It’s really hard for the average individual who doesn’t understand anything about infectious diseases to know what the heck to believe anymore.

Dr. Michael Mina: Is this virus going to keep going on for years? Is it going to stop tomorrow? Is it going to stop in February when vaccines kind of start to be seen? When is this going to stop? And we haven’t exactly given hope to people that we have it under control. Probably what that means is we will see more people die than otherwise would have. We’ll see more people get infected. So, we are really in a pretty bad place, but I’m at a point where I really don’t want to say that people aren’t behaving in the appropriate way for public health, because public health hasn’t exactly done the people well at this point. We continue to use failing practices. We’re not meeting the people. We’re not trying to figure out how to work with where the people are. And that is 90 percent of public health, or 99 percent of public health, should be meeting the population and not taking a paternalistic approach and just telling people what they have to do.

Dr. Michael Mina: If people are rising up against what would otherwise be considered best public health practices, we need to take a reset. We need to say, “Well, there’s a million reasons why this could be going wrong.” It’s politics, it’s other pieces of information that have to do with medicine, all kinds of things, but we have to reset and we have to say, “What should we be doing different?” And we still haven’t done that. We just keep beating the same drum over and over and over again. I’ve tried to put policies forward, or plans, rather, forward that could lead to policies that would be different. That would take the average American in mind and give them tools to help themselves to be able to feel empowered. We haven’t done that in general as a populous at this point. So, with these tests, if everyone could have taken these on Thanksgiving morning, it would probably make Thanksgivings across the country, much, much, much safer. So, I think the end result of all of this is going to be that we will see a Thanksgiving break or a holiday accelerate cases even more than they’ve been accelerating.

Dr. Michael Mina: It might claw back some of the gains that have been made in some places, if there are any places that have really made big gains, there’s not a lot of them in the country. And we should expect to see a bump in probably mortality and disease and hospitalizations throughout December as a result of Thanksgiving. And then the same thing will likely happen in Christmastime. I think that if we really wanted to make Christmas much safer, we could start today. We could start today to figure out how to get testing in place, rapid tests at people’s homes, start producing them, work with international partners since we didn’t build up the capacity enough in the country yet. We have millions and millions, tens of millions of BinaxNOW cards we could use strategically and make Christmas at least a little bit safer, if not a lot safer, if we actually treated this like a war, actually got the US government fully on board with doing so. But otherwise, I think we’re really kind of in for a hard December and January.

Jeff Schechtman: Michael, you said that some of these tests exist in the marketplace right now. Is there the possibility of getting some of them out there between now and Christmastime?

Dr. Michael Mina: They’re illegal. They’re literally illegal right now to use. There’s no other reason, we just haven’t prioritized it. We haven’t prioritized a different way to look at this pandemic and the approach to it. We could — it’s not a manufacturing problem; if we really want to get these tests built in a way that we want, we could do it. We can build stealth bombers and we could build, I don’t know, all kinds of weapons in World War II on assembly lines very quickly. We could build up these factories if we wanted, we actually threw the weight and might have the US behind building these factories on our soil. We could do that in a heartbeat. This is not hard, have the US army build it all. China was able to build hospitals in two weeks, we could do this.

Dr. Michael Mina: I think the only reason we’re not doing it is because we’re not doing it. And Fauci yesterday on Chris Cuomo’s show said something that I was so happy to hear. He just said, “Let’s stop thinking about it and let’s do it.” In response to a question very similar. And that’s really all it comes down to. If we want to mobilize this country, we can. We have this, like, we’re literally just talking about getting a tube of pieces of paper out to every other household in America; that might sound daunting, but it’s not. We have Amazon going to practically every house in America. We have the US Postal Service going to pretty much every house in America, or every house in America.

Dr. Michael Mina: And so, we just have to act, we have to want to tackle this virus. And so far, we haven’t wanted to deal with the virus as a country. We have wanted to sort of deal with it in ways that are not working and then not think creatively about how can we actually come up with new ways that are working and put those into action. And so much of it is certainly at the highest levels of politics and government. The inaction is literally killing Americans.

Jeff Schechtman: We hear over and over again with respect to testing that it kind of goes along with contact tracing, that they go together kind of like a horse-and-buggy. To what extent is contact tracing meant to be, or not meant to be a part of these rapid antigen tests?

Dr. Michael Mina: My colleagues will, a lot of them will disagree with me. But I get the feeling that that’s because a lot of people just aren’t maybe bold enough to buck the trends, but contact tracing isn’t working. We keep putting a lot of effort into it, for sure. But I actually think the insistence on contact tracing and making that a key cornerstone of our response is part of the reason we’re in the problems that we have right now. We have to recognize, we have to adapt if we want to tackle a virus like this, we really have to adapt and we have to recognize when something’s working and when something’s not. I have yet to see any evidence that contact tracing does more than just barely dent the epidemic. And Massachusetts is a great example. And in Massachusetts, we have some of the best contact tracing in the country.

Dr. Michael Mina: We have some of the best operations with partners in health and other groups. We have some of the best testing, some of the fastest testing, and the most expansive testing programs in the country, but even here… And we said that contact tracing can only work when cases are really low. And so, what we’ve seen is that we had cases really low. We had some of the best contact tracing in the country, and we had some of the best testing in the country in terms of turnaround time, and even still contact tracing failed. And so, it continues to boggle my mind, why we continue to try to use this strategy that is just not working? Now, is it bad if it’s not sapping any additional resources away from other potential avenues, then great, every case counts. And we know that contact tracing captures a fraction, a small fraction of actual cases.

Dr. Michael Mina: And so, it can be useful along with everything else, but if it’s using up any of the resources that could go to other more efficient programs, or if it’s distracting us from thinking up more efficient programs, then I would say that it’s probably not worth it to really be putting a lot of energy. And we all said it’s strange. We all said that contact tracing doesn’t work when there’s a lot of cases. Every epidemiologist I feel said it, we’ve always known it, yet we don’t do a good job at listening to what we know. We keep thinking that we don’t know anything about this virus and we just keep beating our head against the same wall and expecting that our headache will go away. No, it won’t go away, it will get worse. And so, we really have to try to look around and take a very critical view of what’s working and what’s not working.

Dr. Michael Mina: And I would say that right now, with cases out of control, ramping up contact tracing is spinning our wheels. We know that there was a JAMA paper a couple of weeks ago that looked at contact tracing in San Francisco, another good place for contact tracing. Of 800-plus people that were positive and contact-traced, they only found about 120 additional cases. So that’s good, every case counts. But we know that of those 800 people, they probably went on to infect something like 1,100 or 1,200 people on average. And so it’s great that they found 120, but they maybe missed 1,000. And of those 120 that were discovered, it was probably too late, they had probably already transmitted the virus yet another round. And so, we’re always behind. And so, I think we really have to take a very hard look at what our policies are. Where are we placing our resources? And decide is contact tracing and isolation, really the best thing to rally around as a cornerstone of our response, or should we think of new and creative avenues to use testing more efficiently?

Jeff Schechtman: One of the important things to keep in mind about this testing is that it has been tried, that it is being tried as we speak, most notably Slovakia and as I understand it soon to be Austria. Talk a little bit about the results in those places?

Dr. Michael Mina: Slovakia is certainly the first one to initiate it. We really came up with the idea of this mass frequent testing back in May or June. The preprint out first. And then it really gained traction. Other research groups made similar models that showed similar results. And since then we’ve been advocating for it pretty widely. And I’ve been personally advocating it to a lot of these other countries, to their leadership. And so Slovakia is kind of the first one to take hold and try it. And it’s been wildly successful so far. Austria is going to try it soon, I believe. And but yeah. And then the UK is piloting it and each country is doing it a little bit different than the next. And so we have to see… This will give us the variety, gives us a good opportunity to try to see is one way working better than another way, but it will really have to be kind of country specific what people are willing to do.

Dr. Michael Mina: For example, in Slovakia, they’re able to get people to come to a site, sites set up all across the country and test outside of their home. I think in the US, generally people are not going to be interested in sort of participating if it’s not extremely convenient. Heck, I don’t even know that I would, if I had to walk two blocks down the road to get one of these tests, I’d say, “No, I’m good. I stay in all the time anyway.” But if it showed up at my doorstep and I had a box of them, like I do, then I would use them, and so I do when I’m doing certain things. And so, I think that we’re going to see different countries do it differently, but so far Slovakia is really leading the charge. I would have really liked for America to lead the charge.

Dr. Michael Mina: We call ourselves an innovative country, we clearly are not in this regard. And at some point, our leaders have to realize that they are leaders and I think our leaders in this country have really felt like they’re followers without realizing that they’re in positions of leadership. And I’ve personally been on a number of calls with leaders in the country who say, “Well, we don’t really know how to do it. We can’t do it, our hands are tied. FDA, this and that.” And I think at some point, real leadership is saying enough is enough, and we have to figure out how to lead. And so, Slovakia is doing that and it’s going exceedingly well.

Jeff Schechtman: There are lots rumors swirling around that many people in the Biden administration are looking seriously at this testing. Do you have any specific sense of whether they’re embracing this, whether this is something that they’re going to follow up on?

Dr. Michael Mina: I do believe from everything I know, that there is building support in the president-elect’s administration, or at least in the COVID, the people who are talking, we saw Fauci and we saw Debbie Birx start talking about it. So now we have two very, very prominent people who I think are feeling more emboldened given election results, the way that they are, and are really saying that this is something that they are starting to support. So now we have Birx and Fauci very publicly supporting it. And I believe that this will be something that Biden’s campaign and that his administration will take very seriously and they are starting to take it seriously. It’s one of his top priorities is to get rapid testing out to the people. And so, I do believe that there is a strong will to do this.

Jeff Schechtman: Michael, I think it’s fair to say that the general sentiment in the country right now is that everything is going to be fine. We’ll get through this surge. The vaccine is coming, it’ll be here in a month or maybe two months, and that that’s going to solve everything.

Dr. Michael Mina: I think it’s a really bad idea to bank just on these vaccines. This is the same behavior though that we’ve seen. There’s a reason why I often say that for the whole of this pandemic, the vaccine has always been one month away. Right now is no different. Sure, we might actually get a vaccine to a few people, or even a million people by the end of December. But that doesn’t mean that this is going to be the game changer that we need to stop spread anytime soon. And I think all signs point to this not becoming widely available at least until early spring of 2021. We’ll start to see it ramp up more and more, but remember, 7 billion people may need this vaccine. Now we can allocate it very well, we can allocate it efficiently if we can get it to the elderly individuals first, along with the first responders, then that’s the most beneficial way to use this potentially.

Dr. Michael Mina: We don’t know, though, if the vaccine is going to have really durable long-term effects, we have no idea. We just don’t. All of the vaccine results we’ve seen so far have been the short-term effects of the vaccine. When the cells that produce the antibodies, the temporary cells that produce the antibodies are still floating around, but those die off after two or three months. And so it could be that all of these efficacies that we’ve seen in the 90th percentile, those are maybe really high compared to what will turn out to be at month four, five, and six, and seven. And so we have to be really careful about how we’re considering these vaccines. We also don’t know, is it really going to do well in the people who need it most? Elderly people don’t tend to respond to vaccines well. My hope is that people will respond well to the vaccine, that they’ll get immunity, that they’ll get enough protection, at least that they don’t die if they get infected. But there’s a lot of unknowns. And so, this is a massive catastrophe that we’re dealing with.

Dr. Michael Mina: And anytime we have something like this, if anyone is thinking that there’s one solution, that’s really dangerous thinking. And as we’re seeing, it’s another one of these things like people glommed onto it, just like contact tracing and said, “Okay we’ll put all of our energy into these two things.” That was probably a really bad idea. And, of course, it was a bad idea for vaccines. These were never going to be available this year in any widespread way, but people made policy around it thinking that maybe it would be. And so, I think we should probably not bank on it. Hope for the best, but really plan for the worst is very apt here. And I think it only makes sense to do that.

Jeff Schechtman: Thank you, and thank you for spending time with us here on the WhoWhatWhy Podcast. And thank you for listening and for joining us here on Radio WhoWhatWhy. I hope you join us next week for another Radio WhoWhatWhy Podcast. I’m Jeff Schechtman.

Jeff Schechtman: If you liked this podcast, please feel free to share and help others find it by rating and reviewing it on iTunes. You can also support this podcast and all the work we do by going to

Related front page panorama photo credit: Adapted by WhoWhatWhy from Eric Mesa / Flickr (CC BY-NC-SA 2.0).


  • Jeff Schechtman

    Jeff Schechtman’s career spans movies, radio stations and podcasts. After spending twenty-five years in the motion picture industry as a producer and executive, he immersed himself in journalism, radio, and more recently the world of podcasts. To date he has conducted over ten-thousand interviews with authors, journalists, and thought leaders. Since March of 2015, he has conducted over 315 podcasts for

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