so i think of rapid daily tests in two camps
so you have the nespresso camp and these are these are going to be
machines that you have to go out and buy and you have to buy capsules that are
proprietary to that instrument and yeah they could probably be
connected to the web, but they're a big machine
and that is immediately going to limit its distribution and utility
but it will probably do a really good job relatively speaking
but what i really want to see for these tests is is not an espresso
model - that's good if we get them cheap but i just don't believe we can get them
cheap and distributed in the in the tens or hundreds of millions
i want the the instant coffee version that every single person around the
world can easily get that there's no frills they're not
connected to the internet there's no buttons
but it does the job and the job, in this case, is to tell you if
you're detected as positive so both of these things can
exist today but the FDA is really pushing for this model over here the
Nespresso model. I love that coffee analogy because the
cheap coffee still has plenty of caffeine in it,
it still does the job. That's exactly right and in fact it probably has
more caffeine a lot of times and and you know the
frequency that you use it, you could drink 18 cups of
cheap instant coffee a day for relatively no price and you'll end up
getting more caffeine than you would if you
drink one cup of Nespresso. This is a tool that's sitting in front of us
right now that the government and the feds and everyone should be putting
billions of dollars into ensuring that every person has these tests in their
home and recognizing that this is a way
forward. So the companies that could develop these tests right now
won't for regulatory reasons and the companies that are saying
okay we'll go by the by the regulatory book
and try to do this, they don't have a test that is going to necessarily pass
muster as a diagnostic test, and again we
don't want these as diagnostic tests we really want them as public health
interventions that can serve to practically in a couple of
weeks rapidly transform epidemics and diminish
them. Saying that these are not sensitive
completely misses the point the important thing to recognize to
really make sense of this we have to think of the biology
that underpins these infections and the biology of what happens with the virus
when it grows inside of you. The virus starts at anywhere around
let's say 10 viral particles per milliliter per swab that somebody gets
it will start growing and then by the time it gets to about a thousand
particles per swab the pcr tests the really good
sensitive pcr tests that are expensive and hard to get
they will start to detect the virus at around let's say a thousand
but the important thing is these rapid tests might not detect
a signal until the virus gets to say a hundred thousand
so for most people they would think oh that's not good i would rather the test
that detects that a thousand instead of a hundred thousand
but actually the important thing here is to know that most people when they're
transmitting this virus, their viral loads by the time they're
transmitting are up at a million or a billion or even for some people a
trillion and then it will sort of persist for
weeks potentially or months even in some people at very low RNA levels
so it's after people are well beyond their transmissible period
that we're actually seeing the loss of sensitivity of these assays
these rapid tests will kind of be a filter
to only be able to view people who are actually
transmitting infections and the good thing is that they'll
they'll tell you at the time that you take it whether you're transmitting
and that will allow you to make decisions that will tell you okay i
don't want to go to school today i don't want to go to work today
i don't want to go into this restaurant and so it will start to very rapidly
stop the transmission chains so we don't have to go find everyone
who has any virus signal in their nose at all
we just need to find the people who at this moment in time
are at greatest risk for transmitting and this is
where i think frequency of testing becomes so much more important
than the sensitivity because if somebody's taking a test every single
day by the time the virus passes a
hundred thousand you'll detect it on that day
versus if you're just using a PCR test every three weeks
you know that you're very likely to miss whole infections since most of them are
asymptomatic. I think we have a few opportunities in
life to truly change the course of of an epidemic that's killing
potentially eventually millions of people on earth
and continuing to infect millions of people just in the united states here
and i think that there's an exciting groundswell of
support and i encourage people to get as
involved as they can because as much as you'd be supportive of
helping to push vaccines through if the government wasn't
already pushing that very hard i think we should all be considering
this with the same urgency that these things need to get pushed through
as much as any vaccine and it's just not
as readily palatable by the politicians and everyone and so i think
the more support we can get the better