Lockdowns, focused protection or rapid tests: the pandemic strategies compared
Jay Bhattacharya makes the case against lockdowns and for focused protection of the most vulnerable, Michael Mina argues that cheap rapid tests used at home were a powerful tool and explains why the US lacked them, and Francis Collins discusses rapid tests and getting out of the pandemic. Comparing the strategies that were argued for is a practical way to think about the next outbreak.
What three pandemic strategies did the three Lex Fridman Podcast guests argue for? Show answer
Jay Bhattacharya argued for focused protection of the old and chronically ill, Michael Mina for cheap rapid tests at home, and Francis Collins for vaccination first with boosters, masking and distancing.
What is Bhattacharya's rule of thumb for COVID risk by age? Show answer
For unvaccinated people before Delta, the infection fatality rate is around 0.2% at age 50, doubling for every seven years older and halving for every seven years younger.
What two ideas does the Great Barrington Declaration rest on, according to Bhattacharya? Show answer
The steep age gradient in COVID risk and the devastating harms of lockdowns. He considers both uncontroversial.
What does focused protection look like in practice, in Bhattacharya's examples? Show answer
Grocery delivery for older people and a hotel room where an exposed young person can isolate away from a grandparent, while businesses, schools and places of worship stay open.
Why does Mina say a less sensitive rapid test can beat PCR for public health? Show answer
The virus can grow from zero to a billion in a day, and people are infectious for only three to seven days while PCR can stay positive for 30 to 70. A fast test catches people when they can actually spread it.
Why did the United States lack cheap rapid tests, according to Mina? Show answer
They were evaluated as medical devices against PCR as the gold standard. A perfect contagiousness test would show only around 20 percent sensitivity against PCR, far below the 80 percent the FDA asks for.
What fix does Mina propose for approving rapid tests? Show answer
One executive action designating tools used for public health testing in the emergency as public health tools, so the CDC could evaluate them on the right metrics.
What is Mina's arithmetic for why imperfect testing still suppresses outbreaks? Show answer
The goal is only to get R below one. If 100 infected people infect 95 instead of 140, after about four weeks there are around 20 cases instead of about 600.
What is Francis Collins's full plan? Show answer
Vaccinate the 64 million hesitant US adults, vaccinate kids, boost those due, keep masking and distancing indoors for now, and speed vaccine access in low- and middle-income countries.
What was the RADx program? Show answer
An NIH program, funded with a billion dollars, that Collins says worked like a venture capital firm with a shark tank of experts. He says most home tests on pharmacy shelves came out of it.
What two things does Bhattacharya say he got wrong? Show answer
In March 2020 he assumed a vaccine would take a decade or more, and in January 2021 he thought the vaccines would stop infection.
Why does Bhattacharya say the denominator matters early in an outbreak? Show answer
In the 2009 H1N1 flu, early fatality estimates of 3% to 4% fell to about 0.02% once antibody studies showed how many people had been infected.