How a Harvard/MIT Lab Transformed Into a Mass Testing Center

CHRISTIANE AMANPOUR: Now, our next guest is helping Massachusetts fight against COVID-19. After New York and New Jersey, Massachusetts is one of the worst affected. And Eric Lander is a mighty brain to have on board. As a pioneering mathematician and geneticist, he helped lead The Human Genome Project. And now he’s transformed the renowned MIT and Harvard Biomedical Research Lab, which he runs, into a mass testing facility in just two weeks. And he tells all Walter Isaacson what it’s going to take to scale up the testing that is essential for safely exiting our severe pandemic restrictions.

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WALTER ISAACSON: Dr. Eric Lander, welcome to the show.

DR. ERIC LANDER, PRESIDENT AND FOUNDING DIRECTOR, BROAD INSTITUTE: Great to see you, Walter.

ISAACSON: You wear two hats. You run the Broad Institute, which is a great institute of MIT and Harvard. And you’re also chair of Governor Charlie Baker of Massachusetts’ task force on what to do about COVID-19. Let’s start with the Broad. Back in February, when this was coming down the pike, what did you all decide to do in order to contribute to the effort to fight the spread of COVID-19?

LANDER: Well, as we were shutting — preparing to shut down the institute for most things, one of our infectious disease faculty, Deb Hung, a wonderful physician also who is working at a hospital, called up the head of the large-scale genome sequencing platform. It’s the place where we had worked on The Human Genome Project. It’s an old beer and popcorn warehouse for Fenway Park. And, today, we were sequencing a new human genome every nine minutes. They were going to be shutting that down. And Deb Hung caught Stacey Gabriel on her way to yoga class and told, Stacey: You have everything you need. You have a clinical approval to run diagnostics labs, because we were doing that, and you have large-scale automation. Could you turn this into COVID testing? Three days later, the team had COVID testing up and running. They needed about a week to get the formal approvals and protocols in place. And then they launched.

ISAACSON: Isn’t this something that — we normally expect the government to be in charge of testing. And yet all these academic institutions feel they have to run into the breach.

LANDER: Well, look, it’s great that we have institutions in the country able to do it. It’s true, it would be great if it was really coordinated right now, but I think, in the absence of more coordination, it’s wonderful to see institutions stepping up to the plate.

ISAACSON: If you were to coordinate it better, what type of things, what type of data, what type of standardization would you use to coordinate better the national testing effort?

LANDER: Oh, goodness. I mean, look, in fairness, there are a lot of complexities with spinning up national testing to a high level. The first was just getting those swabs, the nasopharyngeal, long swabs you stick way back up somebody nose. They were in short supply. And when you do that, you need to be dressed up in the protective equipment, PPE, as they say, and there were shortages of that. And so, at the beginning, places, like hospitals and others, really were confining testing to the most severe cases, because they had to treat it like a super scarce resource. Then, at the same time, institutions were trying to spin up more capacity. And many of them were starting without a real playbook. It would have been great to have coordination on playbooks, so best practices, cooking tips, coordination of supply chains. But it’s sort of rumbled into place slowly. And I think people are beginning to share a lot more. And we have a lot further to go. Today, the whole country is doing only about 150,000 tests a day. And at the Broad, we’re doing about 4,000 a day. We could increase to 10,000 a day with a couple days’ notice. But we need to be doing a lot more than that. And there isn’t yet a plan for doing it.

ISAACSON: One of the things that Broad did was step in and decide to do the nursing homes all over the Cambridge and part of the Boston area. Tell me about that.

LANDER: Well, we began talking to the state about how important it would be to do not just firefighting at nursing homes that were known to have frank outbreaks, where people were dying, but trying to do fire prevention by figuring out which nursing homes had high infection rates, and then ideally surveil every nursing home in the state for the residents and the health care workers. So, the state was beginning to prepare a plan to do that. And we reached out to the city of Cambridge and proposed to do all nursing homes and assisted living facilities and all the homeless shelters. And, remarkably, the city mobilized quickly, and we were able to launch such a program, and, within a week, we had made a pass on every resident, health care worker, homeless person in all of those facilities. And it was eye-opening, because in the nursing homes, infection rates were sometimes 25 or even 50 percent, lower in assisted living facilities where people living separately. But it then opened everybody’s eyes to the fact that we had to be surveilling lots of nursing homes. And so the state of Massachusetts has opened the lens, and is now sending out teams to do surveillance at many, many nursing homes.

ISAACSON: One of the bottlenecks seems to be the need to use nasal swabs, to stick these long swabs back into the nasal passages all the way to a person’s throat, while the person doing the testing is in full protective gear. It’s not something that I think people are going to want to do all that often. But if we need widespread testing, we are going to have to test people pretty regularly. Is there a way out of this mess?

LANDER: So, people are beginning to look at saliva. Viral loads are detectable in saliva, as well as in these deep nasal swabs, and they’re a lot easier to get. So, a number of groups, including ours, have been getting people to spit in a tube — they make the special spit tubes — and comparing them to the levels that are found in the nasal swabs. And I think we will see over the next couple of weeks people being able to bring up saliva. Then you could actually imagine, if you wanted to, testing everybody every day, in theory. At least there wouldn’t be a bottleneck with the saliva. The testing downstream becomes a bottleneck, but the collection doesn’t become a bottleneck. And I think that will be very important. But every step of this chain has to get simplified.

ISAACSON: The Broad Institute put up a paper to share that shows how you could do perhaps a next-generation test, one that directly detects the RNA perhaps with just a little pinprick of blood. I know Berkeley and others put up a similar one. They’re called things like detector and Sherlock. Explain what you think those next-generation tests might be, why they might be better and when they’re going to come.

LANDER: Right. So, there’s a wide variety of needs for testing. There’s some places in the United States where you might need a 15-minute test, because you have got somebody in a hospital, you’re concerned that they are infected, and you have to treat them as a COVID case, which requires lots of PPE and other things. And so you want to quick answer. There are some things where you need an answer in 24 hours, and it would be great to collect 50,000 samples across the city, get them run overnight, and get answers back. But there are a lot of settings in the world that are very resource-poor. I think all of us are tremendously worried about what will happen in Africa. The spread initially was slower in getting to Africa because of less international travel. But in a very resource-poor setting, we’re going to need tests that are able to work in simple ways. Some of these tests, based on a technology called CRISPR, which you and I both know and love and involves genome editing and all that, those CRISPR-like proteins can be repurposed to detect the RNA of viruses. And some of these things have been converted into simple paper strip tests, for example, that could be done anywhere. Now, I don’t think it will necessarily be the optimal way to do it in large scale in a city like Boston. But I do think there will be a really important use for these kinds of Sherlock tests in many settings, some in the United States, certainly in other places abroad. So I think it’s really important in all of these to say there’s not one uniform solution. We need a whole portfolio even of these testing solutions.

ISAACSON: The governor, Charlie Baker, of Massachusetts, a Republican governor, wants a dashboard to figure out, when do we reopen the state? How do we reopen? Tell me what you’re doing to help him make these decisions.

LANDER: You know, the problem for any virus is one thing: reduce R. R is this replicative number. If you have one case, gives rise to three cases, nine cases, 27 cases, 81 cases. And a month later, you have 250 cases, for example. If R is bigger than one, it keeps growing exponentially. Everything we have available today is designed at reducing R, so it’s less than one. A governor needs a dashboard to say, what is the state of the state today with regard to COVID? And what tools do I have? If you’re going to reopen, you better have a certain amount of testing, you better have a certain amount of contact tracing. It’d be really good to make sure that everybody’s wearing masks, and then that you’re monitoring, are you bringing down R. Are you keeping it down? That’s what happened in Wuhan. The R was big and it kept growing exponentially. They did social distancing. It kind of flattened out. Then they really went with aggressive contact tracing. It went down, so low that the virus fell exponentially. Now, we’re not Wuhan. We will do things differently in Massachusetts and different states. But we need a portfolio of strategies for every state that’s reopening that says, how do we keep R down?

ISAACSON: Do we even know what R is at this moment for, say, Massachusetts?

LANDER: No. And the reason we don’t know is, you would, in principle, measure it from the number of new cases each day. The problem is, we don’t have an accurate case count, because we’re only testing people with the more severe symptoms. It is a lab problem and an information problem.

ISAACSON: So, what is preventing us, as a nation, from getting more tests out to the public?

LANDER: It’s a whole set of things. We need to ramp up much larger testing labs, labs that have capacities, not to do 1,000, 10,000. We’d ideally like to see testing labs can do 100,000 samples a day, for example. I think that’s totally doable with automation. But it also means that supply chains have to be there to be able to supply them. So, the manufacturers that make the reagents, the chemicals to do that, or, frankly, even to make the machines that you put in those labs need to be ramping up, and they are ramping up. But there’s a whole bunch of pieces that are — and then you need folks who can run those labs. And then you need systems to collect samples, just plain old logistics, shoe-leather. Do you ask everybody to come into a clinic if they think they’re infected? Do you have mobile testing sites? Do you go out to them? Should some of this be done at work sites, where we’re protecting our front-line workers, and every day or a couple of days or something, they can be giving spit samples? You need to bring in place the logistics of how you’re going to identify who needs testing and how you’re going to get it to them and how you can do it at the requisite numbers. And I’m watching — at least in Massachusetts, I’m watching the state come together, I think in a bipartisan way, across the academic world, medical world, the commercial world, to think about just, how, do we ramp up all those pieces? We’re all frustrated we don’t have the pieces today. On the other hand, we’re pleased that, in the state, we have a lot more testing than we used to. But we know we’re just en route to where we need to be to feel — for the governor to feel comfortable that he and his team have all the information they need, and can stay on top of these things.

ISAACSON: When we started this strategy of sheltering at home, everybody said we had to do it because we wanted to flatten the curve to give some breathing room to hospital workers and all, and by flattening the curve, we’d be safer. You have said that we’re now starting to flatten the curve.

LANDER: Yes.

ISAACSON: So, how do you tell the governor, now we need to reopen things?

LANDER: Well, I think the question — look, it’s not my job to tell the governor it’s time to reopen things. I think what scientists can do is help the governor know what tools are available to know and what capabilities have to be in place, the dashboard of information, what you want to monitor. The governor, I’m sure, is going to want to be monitoring daily rates of infection across the state in many sentinel communities, in addition to the lagging indicators, like death rates or new hospitalizations. I’m pretty sure the governor, because Massachusetts has been the most forward-leaning state on contact tracing, is going to want to be sure that he’s got contact tracing able to follow up on every single new case, so that the curve has come down to the point where every case could be followed up in two days, and all those contacts could be tested. It’s a bridge. The curve starts coming down, you have these other tools to limit the spread. You’re substituting distancing for other tools. And the government — governor has to have the information flow and has to have those tools in place, because, if you don’t, it’s just going to go back up again, not instantly. Exponential things go down, and then they start coming up, and then they come up, and then they go really fast. And so you don’t want to just start seeing that. You want to be monitoring that and keeping it down. So, I think that’s what a governor has got to do. And I think what’s incumbent on the scientific community and industry and academia and hospitals is to make sure the governor has the information and the tools to deploy as part of an overall strategy.

ISAACSON: You talk about the overall strategy for opening up carefully. I remember sitting with you in the stands of Fenway Park, drinking a beer, whatever. Do you think we’re able to get back this year to big gatherings, like going to Fenway Park for the Red Sox?

LANDER: Well, I sure would love to have a game at Fenway Park. It’s one of the great pleasures of living in the city, best ballpark, I think, in the United States and best team in the United States too many years. But I’m not really sure that we’re going to have an in-person game at Fenway Park, because if you ask about opening, you ask about R, well, small gatherings, you have a small number of people you could transmit to. Fenway Park, my recollection is the seating is 35,000 people in a pretty compact space going to get beer and popcorn. It’s a fantastic way to spread virus. And so my guess is that we’re not going to open up really dense, big events until the end of the strategy, because it takes only one wonderful, as they say, super spreader to spread coronavirus in the grandstands at — in center field at Fenway Park, and that’s really disastrous. So I think we have to think about this as opening up, so we get our businesses back. We will have workplaces that are wearing masks, workplaces that are practicing distancing, but they are actually meeting, but just not huge meetings. And then, as we gain confidence that we have the dashboard and we have the tools, we will open up a little bit bigger. And, at some point, there will be a fantastic first pitch thrown out at Fenway Park.

ISAACSON: Dr. Eric Lander, thank you for being with us. And stay well.

LANDER: Pleasure, Walter.