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
 
