Mina: We’re not going to have these big pandemic sort of waves across the whole country. As we move into November, we’ll probably see a resurgence of cases again. But it’s not going to be this massive overwhelming tidal wave of cases. It will be putting out little fires one after another. These tests will help us do that.
MarketWatch: Is the U.S. relying too much on PCR tests right now?
Mina: We have this strange infatuation with PCR in the U.S., to the extent that we are not authorizing tons of potentially much more accessible, much cheaper rapid tests. One of the most damaging things in this pandemic is putting so much weight on the PCR test. There was a time when test results were delayed 10 days, and millions and millions and millions of people got tested or were waiting in line for a test that would come back 10 days later . Every single one of those tests was 100% useless, as far as slowing transmission.
The White House is still putting a lot more effort into setting up contracts with PCR laboratories. It’s a massive mistake. I helped start what is now the country’s highest throughput PCR laboratory at the Broad Institute. I don’t have anything against PCR. But when it comes to meeting a population where they’re at — we want tests that people can just do on their own time.
MarketWatch: Should PCR tests be reserved for diagnosing before treatment?
[Editor’s note: Gilead said it’s up to prescribers to decide who is treated with Veklury, though patients previously had to have a positive test before they were treated with the therapy. The monoclonal antibody therapies, developed by Eli Lilly & Co. <COMPANY_REFERENCE SYMBOL="LLY">LLY</COMPANY_REFERENCE>, Regeneron Pharmaceuticals Inc. <COMPANY_REFERENCE SYMBOL="REGN">REGN</COMPANY_REFERENCE>, and Vir Biotechnology Inc. <COMPANY_REFERENCE SYMBOL="VIR">VIR</COMPANY_REFERENCE> and GlaxoSmithKline <COMPANY_REFERENCE SYMBOL="GSK">GSK</COMPANY_REFERENCE>, require a positive test, either PCR or antigen, before initiating treatment.]
Mina: It could be, but I would say if it’s going to take a few hours to get your result back, why not do a rapid test first? If it’s positive, then you have your answer in 10 minutes instead of three or 10 or 12 hours. Sure, get a PCR test if you want, but you can start treatment immediately. If it’s a negative, and you’re wanting to give remdesivir, and you want to be sure that the symptoms truly are COVID-related, then get the PCR test. We keep being in this boat of thinking, it’s either this or that, but a rapid test is so cheap and so easy.
There’s another class of tests, which I think are going to be important. There are the rapid molecular tests, and they’re not necessarily as sensitive as a true lab-based PCR. But they’re more sensitive than an antigen test, and they give you results in a half hour or so. Every school nurse should stock 10 of these new rapid molecular tests, and have them on hand for when a kid comes in. You don’t want to have to take a swab and send the kid home. Take a swab right there. Let the kid sit in the chair for 30 minutes. And then you have really accurate almost lab quality results in a half hour.
There’s no real need for PCR testing in a laboratory anymore, unless you’re at a hospital.
MarketWatch: With vaccination rates increasing in the U.S., how does that change the way that individuals and organizations should think about testing?
Mina: That’s where I think everyone’s getting confused. CDC hasn’t helped on this front. What do you do if 70% or 60% of your workforce is vaccinated? We have truly entered into a new era of use, which is no longer to suppress outbreaks that are burning. That boat has sailed. In a lot of companies, and a lot of schools and universities, everyone was testing very frequently, in order to either stop outbreaks from continuing to spread or the risk was so high that they on a daily basis wanted to prevent new outbreaks from taking hold. That’s what we saw in the colleges all year. That actually worked really well.
But in the context of 60% to 70% vaccinations and seasonal declines in cases, we are seeing less need for that type of proactive testing. How companies and society should start to think about testing now is reactive — but effective reactive — testing. We don’t want reactive testing.
Even if it is something as simple as everyone who works at company X, have five tests at your home. Well-funded companies can do that. And if we have an outbreak, maybe we do it floor by floor, wherever your potential contacts are. If you have a potential contact who’s positive, test yourself for your own sake and your family’s sake. Test yourself at home for the next five days before you come to work. It takes 30 seconds to do. You don’t have to stockpile thousands of them.
Maybe it will get to a point where we believe who cares if you’re vaccinated and you get infected? We will hit a point in this pandemic where we’ll have the luxury of being able to say exposures can actually be seen as a benefit. If you’re not getting sick from it, and you’re already protected, then you can consider it a natural booster.
That’s how our bodies naturally work. That’s how kids work. They start with runny noses, By the time they’re five or six, they no longer have runny noses. By the time they’re 30 or 40, those same little people have grown up, and you or I can go and we can walk into a daycare full of these little coronaviruses and not get sick. Not because those coronaviruses can’t sicken us but it’s because we’ve been naturally boosted potentially hundreds of times in our life. There’s something to be said for getting to a point in a pandemic where you have enough people who are protected that the vaccinated people say, this isn’t so bad. I just got exposed. I didn’t get sick at all. Until we get to that point where we’re not sickening other people around us, like if we walk into a nursing home, we can’t take that approach. We have to be a little bit more reserved.
We’re not all Superman and able to run into a roomful of SARS-CoV-2 and say, I’m getting super boosted here. That’s a bad idea. But I do think we’ll get there eventually. It’s an important piece to remember that humans have to live with viruses like this. Our end goal shouldn’t be zero cases. It should be zero deaths. Those are different things. And they will demand different levels of testing.
MarketWatch: It sounds like what the U.S. needs to do is move past this kind of like one-size-fits-all-for-every-American approach and figure out ways to be more specialized about who gets a test, what kind of test, and in what scenario?
Mina: That’s exactly right. One size does not fit all. We have thus far just taken pretty much the least scientific approach to testing in this pandemic we could have possibly taken. Had we rolled out different types of tests earlier, in September, we could have stopped the massive outbreaks of the winter and saved hundreds of thousands of lives. We didn’t do that. But I do hope that we’re learning slowly. We will move past this unscientific approach to testing.
This Q&A has been edited for clarity and length.
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