Brian Lehrer: I'm Brian Lehrer on WNYC. We're about to talk to a very special guest from the Harvard School of Public Health, who's got a vision for a rapid testing future for getting us out of the pandemic, maybe even more quickly than vaccines can. We're going to pair this with a call-in for some of you, who are considering how much to get tested all the time. For example, parents of kids in, sorry, I was looking at the wrong note there. For example, how you're navigating the pandemic with testing in your own life. Like how often are you getting tested and why are you getting tested? Is it for your job?

Essential workers are supposed to get tested once a month or is it because it gives you peace of mind to get a negative test once in a while, just because. 646-435-7280, for your questions about rapid testing, but also how you're using testing now. Mayor de Blasio is among those who say everybody should get tested. Are you following that just to be a good citizen? Or when are you getting tested? How often are you getting tested? And why? How does testing change your behavior? Does a negative test make you feel more comfortable going out to dinner and seeing friends?

That's the Donald Trump way of using testing, right? Test negative and party on, but with another white house outbreak in full swing, we know that doesn't always work, or does the feeling of security wear off once you've gone grocery shopping one time? Are you in a mixed generation home? Or does your work entail seeing older or immunocompromised clients or customers? Is that why you get tested on a repeated basis? How are you using testing right now to navigate this time?

646-435-7280. With me now is Dr. Michael Mina, physician and assistant professor of epidemiology at the Harvard TH Chan School of Public Health. He was also a leading expert on the next testing technologies that could bring us back from the crisis, maybe even more effectively than vaccines. Dr. Mina, we're so glad to have you. Welcome to WNYC.

Michael Mina: Thanks so much.

Brian: Want to give us your big vision first? What are you working on? What's the big picture?

Dr. Mina: Sure. The big vision is that cases right now are obviously out of control across the United States. We don't yet have a vaccine. We generally don't as a nation, want to go into total economic shutdown, although that's looking more and more inevitable for many regions. We have for many months now, we've had a tool at our disposal that we just haven't used and that is frequent rapid testing. These paper strip tests. They're small tests that you can use in the comfort of your own home, they can or cannot be connected in some way to reporting to the public health authorities.

We know there's a lot of people in the country who don't want to have big brother looking over them. These are tests that if we get enough people using them, say everyone has a package of them at their home and they use them, they brush their teeth and they use a rapid antigen test twice a week. That's enough to actually start curbing outbreaks, to get this exponential growth of cases to start decaying. To get the outbreaks to start subsiding by letting people know their status. If I am testing and I see that I'm positive, then I immediately pull out my confirmatory test, which Elon Musk apparently did not do yesterday, if you were reading Twitter.

You'd confirm that it's that you're actually positive and if so, then you'd stay home and you test yourself every day for the next, say, 10 days before going back to work. If you're negative, then you do everything else the same. You still, if you're social distancing, you distance. If you're wearing masks, you wear a mask. By giving a lot of people say, half of the population, a constant knowledge of their infectiousness status, we can actually stop the momentum of this virus.

We can bring the virus to its knees without a vaccine, through what I call screening test mediated herd effects. This is similar to vaccine herd immunity, but instead of a vaccine stopping people from spreading to others, it's knowledge of your infectious status, whether or not you're contagious will help you not spread at your loved ones and your family and friends.

Brian: What was the Elon Musk story I missed that?

Dr. Mina: Oh, well, Elon Musk, unfortunately, he tweeted out last night or yesterday and it's got, I don't know, hundreds of thousands of retweets now, that he used an antigen test multiple times in a row and got discordant results. He got two pluses and minuses, and he said, "Something's going wrong here, going terribly wrong." He didn't give nearly enough information to understand what it is? Why he was doing that? Is he actually at the beginning or end of the infection? There's just so little virus that it's fluctuating in and out of a positive status or, for example, we know that sometimes, on just a random day, some people will get a false-positive result.

That's why we always want to confirm testing, especially with things like rapid antigen tests, where we know that one out of 100 or one out of 400 tests can become falsely positive. We always want to have another test right on hand a second rapid test, that's different. A different company, for example, and so if you get a positive on one, you immediately take the other, the confirmatory test that came with the package. But, he's clearly not doing any confirmatory testing and assuming that the screening test positive as positive is not always the best idea, we always want to confirm with any laboratory tests. This isn't specific to COVID.

Brian: We had a public health journalist on the show recently who was somewhat skeptical about this vision of opening the path for a mass re-entry into society because people won't be honest, because people who test positive in too many cases, obviously, presumably in a majority of cases, people will be honest, but in a big enough minority of cases, people either just won't want to go through the hassle of quarantining for two weeks, if they test positive or they have income pressures and they won't want to stay home from their jobs, things like that. This would have a huge hole in it on that basis. What would your response to that be?

Dr. Mina: That person is not thinking through a big enough epidemiological lens. There's a very good answer to that. One of the beauties of this approach is this idea of herd effect. So far the way that most people think is thinking, "We have to stop all of the cases to stop the outbreak." We have to stop this type of thinking. We keep thinking of this pandemic as a lot of medical problems that lead to a public health problem, but that's not actually what's happening.

We have a public health problem that's causing a lot of individual medical problems and the reason I say that is because if you start to think from a public health and whole pandemic perspective and think about the whole outbreak, you stop caring about the individual cases as long as you can get the average rate of transmission across the whole population below one, meaning that on average, when you average everything out, the people infect fewer than one additional person. The whole way that this plan would work, in the first place is that you only need a fraction of people to be participating.

You could have half of the people completely disregard the results. They get a positive, they go to work and the program can still work, it's all accounted for. In the same way, that we know that vaccines-- We've probably all heard about herd immunity and what's the fraction of the population that must be vaccinated to get the outbreaks to stop transmitting, we know that that's not a hundred percent. You only need to get the vaccine to say 50% of the people and that-- It takes the momentum out of an outbreak.

It's a little bit hard to explain the mathematics of why it happens, but it's, the, the real point here is that those skeptics who say, "Well not everyone's going to take it seriously and people still have to go to work things like that," they're not understanding the epidemiology of how outbreaks move, which is in this case, you just have to get the average across the population below one, so you could have half of the people just choose not to participate at all and it can still work to very rapidly slow down and stop outbreaks.

Brian: Dr. Michael Mina, from the Harvard School of Public Health, with us as talk about testing, his vision for a rapid testing nation. We'll get to your phone calls in just a minute on how you're using testing today, and what you would like to ask him. Two other things before we get to those phone calls. One you write that we could've gotten this done months ago, for essentially pennies. Really, we could be living in this home antigen test strip. I guess when you say test strip, it's saliva-based, you don't have to stick a swab all the way up your nose, and that we could be doing this already, really?

Dr. Mina: Oh, absolutely. This technology has been around for a long time. It's actually the same technology as an at-home pregnancy test. Many countries are using these. We are not currently because we have regulatory hurdles and we've had an administration that has been entirely unwilling to act appropriately to fight this virus. Many countries are now using these test strips.

Not in the massive numbers that I think we need to really use this as a control mechanism, but even Slovakia right now, for example, is doing a massive trial of this. They're testing over half of their entire population once a week, for a number of weeks. What they saw is just in the first week alone, they halved the incidence. Cases went from going upwards to dropping in half. That's not surprising. That's exactly what we would expect.

Brian: What do we need? Do we need some political kindling or something like that to start this fire? Should I ask Mayor de Blasio, and he's coming on after you? If there's a way the city can set up a rapid test regime? If New York starts to crawl out of the fire this way, then other places will, how does this get started?

Dr. Mina: We need pilots. We need to show that this works in the United States. That people will use this in their home, especially if the result is there. A lot of people will use it just because they want to know if they are contagious with a virus that they might not know they have. To get the political will on board, we have unfortunately had a White House that has had no political will, no will at all to fight this virus. So we haven't seen it move forward. If we want to do this program, we do need to build up more capacity. Right now we could build probably across all the different companies, maybe around two million tests per day, but to really make this work, we probably need somewhere between 10 to 20 million tests each day that people in their homes would use. Which isn't a lot. We could do it.

Brian: Do you have a commitment from the Biden administration. I know he uses the words rapid tests to launch a meaningful pilot program like you refer to quickly?

Dr. Mina: I do not have any commitment like that from the Biden administration. I know that that the President-Elect has been discussing this as one option that's on the table.

Brian: Let's hear some people's testing stories. Maria in New Jersey, you're on WNYC. Hi, Maria.

Maria: Hey there, can you hear me?

Brian: I can.

Maria: Okay. My first time calling. I work in a factory type of place. We have the factory and also offices. Recently one guy in the factory tested positive so the boss brought a testing team in to test everyone. There's about 50 people that work there. Out of that, I think four or five tested positive. Nobody had any symptoms. I take care of my 90-year-old father and also a brother who has issues as well. As soon as I heard that there was one person positive, I did not go back to work. I went and got myself a PCR test.

Brian: This is working for you. It sounds like to be able to maintain that family contact and maintain your job testing three times in two weeks.

Maria: This is just since these positives happened at work. Now I'm nervous. Only my boss has been very good about me staying home and taking care of my family so that I'm very lucky and blessed to have that.

Brian: Dr. Mina, what does her story represent in terms of how people can use currently available tests and the limitations of that?

Dr. Mina: There's so much in just that short story. This describes why we need to-- On the one hand, why we need to support people who can't go to work because this virus is transmitting. We have to have Congress appropriate the funds to make sure that everyone who is staying home so that they do not get the infection or transmit the infection onwards has income so that they can try to themselves not be part of the transmission chain.

That's absolutely critical for any of these programs, any test or control program. What it also represents, she said, none of them had symptoms. That's the problem with this virus. That's why symptomatic surveillance and random surveillance isn't going to work. We need frequent testing of individuals and likely on their own terms to get them to do it, meaning at home and easy. If we don't, then what happens is this virus transmits silently among many, many people.

That person hadn't been detected, and I'm not sure what made that one individual first detectable, but she could have unknowingly got it, contracted the virus and even if she was asymptomatic, meaning no symptoms, could have transmitted to her 90-plus-year-old parent and that could have been a deadly decision. This is why we need to, A, get the virus under control overall, but also why we need to give as many people in the country the possibility to be knowing their infection status on their own terms as frequently as they can.

Brian: Here's Margaret in Danbury, I think sitting in a car at a covid testing site. Hi, Margaret, do I have that right?

Margaret: Yes, you have that correct. Hi, Brian. Thanks for having me. This is my first time getting a COVID test. I do live in Connecticut. I live in a very rural part of Danbury. This first COVID test has been difficult. I got here at nine o'clock, but it proved to be a three-hour wait when I got here. They immediately put up traffic cones, they're not letting anyone else in. It's a very gross rainy day. The reason why I am getting tested for the first time is because my work has had two scares in two weeks. No one's been positive, but we've all had to miss a week. No pay. It's very difficult times. I'd like to ask the doctor a question. How often or how frequent can you get a test after getting exposed? Like how soon?

Dr. Mina: It's a really great question. It really depends on what your access to tests are. If you have one shot at goal, if you will. You only have one opportunity to get tested. Then a good timeframe to get that test after you know you've been exposed is probably around six days. Though in the first few days, is an incubation period where the virus is getting situated in your body. It's not transmitting to other people in those first few days, but it's also not testable. It's not in enough abundance to get picked up by the test.

Once it starts growing, though, then you can start picking up. How long it takes to start growing in that way, really varies. Some people it's as long as 14 days, but that's very rare. Most people will start to become detectable within the first five or six days. So what I would recommend first if you know you've had a high-risk exposure, you want to quarantine yourself, you want to try to not mistakenly spread it to others. Then you probably want to try to get a test. Again, if you have just one test opportunity, then try to get it probably around day six or so would be a good time to maximize the likelihood that you find the virus if it is there.

Brian: Margaret, I hope that's helpful. Thank you for calling in. Hannah in Brooklyn. You're on WNYC with Dr. Michael Mina. Hi. Is this Hannah in Brooklyn? Hannah once. Hannah twice.

Hannah: Hi, sorry.

Brian: Oh, there you are. Hi.

Hannah: Hi. Thank you for taking my call. I'm a physician in one of the big New York City hospitals and they are not doing any asymptomatic testing on any of the employees or trainees. They haven't at all in the entire course of this even though we work incredibly hard. In fact, I'm actually on quarantine right now because my daughter had a fever and so we went to an NHC testing site, actually, had a great experience there, but my husband tested positive so we've been quarantining for that reason, but has been very difficult to get any asymptomatic testing through my employer.

Dr. Mina: This continues to astound me, at my own hospital here in Boston. At almost all hospitals in the country, we are not routinely testing our physicians or staff. Meanwhile, we have major outbreaks that continue to spread through these hospitals oftentimes with physicians and staff and nurses and others, part of those transmission chains. I can't even begin to understand why the places that have the testing capacity available are not using it to keep their employees safe and to keep their patients safer. I am a big advocate for all hospitals that can. Any hospitals can't should try to get there to get frequent testing as a part of work these days.

These are people who are often dealing with sick patients and moving through cancer hospitals, children's hospitals, everything. We need to keep everyone safe, including the physicians and staff themself. I believe pretty firmly that we have opportunities, especially in the hospitals that have labs. We could be pooling samples, take 50 physicians have them all swab their own noses and stick their swabs into one tube and do all 50 of those swabs at once. You can really be efficient with this type of testing and these settings, but so far in the United States we're barely doing any of it and I just can't understand why.

Brian: We're almost out of time. We have under a minute and we have Mayor de Blasio standing by next. I'm thinking still about the color from Connecticut in her car in a three-hour line to get a test this morning. We're hearing stories like that all over the place. Why at this point in the pandemic, when officials from liberal Democrats to conservative Republicans have said, "We've got testing ramped up now," why are these things still happening? I'm hearing so many stories like this?

Dr. Mina: We don't actually have the type of testing that this epidemic demands. We are fooling ourselves if we think we do. We can't just have it all bottleneck through these drive-throughs, it's going to turn people off. They're sitting in their car, they're wasting their time. We need to ramp up a different type of test. We can't shove everything through these laboratory-based PCRs. We need to bring the test to people's homes and we just haven't seen any strategy with testing to this day.

I think a kindergarten soccer team coach has more strategy for getting those players on the field than our president and our country has had in terms of how we're using testing. We have not had any strategy and it's just jumbling everything up. A little strategy goes a long way in this pandemic and we just need a plan.

Brian: Dr. Michael Mina, testing expert from the Harvard TH Chan School of Public Health. This was fascinating. I hope you'll come back with us. Thank you so much.

Dr. Mina: Thanks a lot.

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