Larry Brilliant Says Covid Rapid Tests Are Bad for Public Health

Second, the longer this virus continues, the more variants we’re going to have. We don’t know exactly what forms a variant, but for sure one factor is immunocompromised people who have the virus puttering around longer in their system—not for 17 days like me, but for months. The body can’t clear the virus completely. You’ve created ideal circumstances for reassortment, recombination.

Another issue is that we don’t have a good handle on numbers because we never got testing, right?

What if I said to you that antigens, those rapid at-home tests we all use now, were bad for our public health? It’s stupid that antigen tests were approved without the requirement to report positive cases.

How would you enforce that?

Through technology. It’s not that hard to build the technology to do automatic reporting. There’s now a class of at-home molecular tests that can already do that. They’re almost as good as PCR tests.

Aren’t those more expensive?

The only thing that makes them expensive is the lack of scale. Right now we can get antigen tests for as little as $5. If you’re doing a billion molecular tests, you can bring the cost down as well.

When those molecular tests go to the FDA for approval, they say that all positives should be reported. That makes them much better than antigen tests, which are great at the back end of the disease when you’re trying to determine if you’re still infectious. But they’re terrible for the first two days, when the rate of false negatives is so high. Between the false negatives and the fact that they don’t report into public health, antigen tests are dangerous to the public health.

Would you ban them?

I would regulate them.

On to vaccines. The one we have works against the original version of Covid, which no one gets any more. So why didn’t we have a “warp speed” effort for a specific vaccine directed toward the newer variants?

We sort of did. Both Pfizer and Moderna are about to release vaccines specific for Omicron. You seem to be asking why we don’t have a warp speed for BA.5? We call that process whack-a-mole.

So the new vaccine will do a better job protecting us from getting it?

I hope so. You will have more immunity to Omicron. But BA.5 itself doesn’t necessarily honor a previous infection with Omicron. The vaccine will, though, better prevent you from being hospitalized or dying. But we should start talking about BA.2.75. It seems to be the next car in the train. And it’s coming on really quickly.

We’re already on to the next one?

It’s already been detected in several states. We’re just getting more variants.

There’s a controversy over whether people who are due for a booster should take it now or hold off until this new vaccine shows up in the fall.

I’m very cautious. I don’t want anybody to get it in the next two or three months before you can get the new vaccine. [Note: White House officials have said that anyone immunocompromised or over the age of 50 should get a second booster if they haven’t done so already.]

If you went back to our first conversation, in March 2020, it seemed unlikely we would be talking two and half years later and still facing huge numbers.

Why are you surprised? I wrote an article called “The Forever Virus.”

Will we ever get back to Before Times? When we don’t have to be careful and we can eat indoors and go to a Broadway show without a mask and feel safe?

That’s two separate questions. Will we ever get to a point where there’ll be no Covid? No. There will always be Covid.

Will we ever get to a point where we go to a Broadway show without a mask? Yes. We’ve probably had coronaviruses infect the world in a pandemic-like way before. And then the virus went into the retirement home for coronaviruses, and we called it a “cold virus.” And they kind of rotate. That’s why you can get two or three colds a year. They feel the same to you, but they’re different viruses. And that’s because the immunity that they give you is only good for about a year or two.