Straight talk with Michael Osterholm

Transcript

Eric (00:00):

Okay. Hello, this is Eric Topol and this is a rare privilege for me to interview my favorite epidemiologist, Dr. Michael Osterholm. He is the Regents Professor of the University of Minnesota. He's director of CIDRAP, which is certainly one of the leading entities around the world for public health. And, we've been friends for the last few years, which we'll we'll talk about. So, welcome Michael. Such a great privilege to have you today.

Michael (00:31):

Well, thank you, the honor, really is mine. As I have shared with you and others know very well--you have been a real mentor to me and many others during this pandemic. And, I could never repay you adequately for all that you've helped teach me throughout these last three years. It's been immeasurable.

Eric (00:49):

No, if you're too kind, I think it's much different. The opposite way. I've learned so much from you because this isn't my area, as you well know. I thought we'd start with, of course, right now things are relatively good for the pandemic in the United States and mostly around the world, with relatively less cases, less hospitalizations and deaths. But obviously still people are getting infected. And maybe you can tell us about the recent case that you went through that would be enlightening.

End of the Pandemic?

Michael (01:28):

Yeah, I think we're all trying to understand when the pandemic ends. And, as we've discussed many times before, we'll probably know that about a year after it ends, then we'll say, yep, that was the end of it. Don’t for a moment think that at the end means that there won't be cases. You know, for every infectious agent that we think of when causing a pandemic, they still come back, whether it be influenza, or potentially coronaviruses. They will, they will continue to circulate. It's a matter of how many cases occur, how many people die. And I think that's an important point. There isn't really a definition for when a pandemic ends. It's, I guess it's just when you feel like it's over. And clearly the world has come to that conclusion already. You don't need a, an epidemiologist or a politician to tell 'em that the pandemic's over that they feel that we're still seeing about 165 deaths a day in this country from Covid.

(02:24):

So it's hardly gone away completely. But we do have to acknowledge it. Most of those deaths are older individuals, people who have not been vaccinated recently with bivalent boosters. And in that regard, we could surely even reduce the illnesses further. I don't have any faith right now in the surveillance systems that have been set up to look at cases around the world. We've pretty much dismantled that. We are not testing people that we results in reports being made to public health agencies, whether in this country or anywhere else in the world. So I really look at two other things. One is deaths. And even they're realizing that still is a challenge in terms of how complete death reporting is due to covid. But then the other thing we're looking at, which has been really, you might say, public health revolution during the pandemic, and I say revolution cause it's really changed things.

(03:19):

And that is the issue of wastewater surveillance. And we've been able to ascertain in many areas of the world, in fact, with using wastewater surveillance, a much better sense of how much virus is in the community. And so, just in following with your very thoughtful comment about case numbers dropping, that's exactly what we're seeing in most locations in this country too. We, for example, here in the Minneapolis St. Paul area, have seen a dramatic decrease in wastewater activity in the last two months. So I think we're in a place right now where I can hope it'll only get better. On the other hand, you know, I have a lot of respect for this virus, and frankly, we all ought to have a lot of humility. We don't know if another variant will emerge that with, given how much immunity we have in our population will somehow break through that and cause increase in surgeon cases or whether this will become kind of the norm and we'll see less and less.

On Getting Covid

(04:16):

Now, you asked me about my case. Yeah. I have to say that, I speak about this with, with really some trepidation in the sense that I was not gonna get this. I had and very faithful throughout the course of the pandemic, where in my N 95 respirator when I went out and about, I had been fit tested. In addition, when we finally did socialize in our home, we had a, what became affectionately known as the Osterholm Home Rule. You could not have had known contact with someone of the, with Covid in the five previous days. You could have no symptoms yourself on the day of, and you had to test negative bilateral flow test within three to four hours of coming. And we would entertain small four, the six party, parties, and it was going wonderful.

(05:07):

And then on March 10th, the night of March 10th, a colleague from work came over with Fern and myself. Three of us had dinner. We went down our elevator in our building here, which were 31 stories up. No one else is in the elevator. And then we proceeded to go to a very small music venue where we wore N95s. We were some distance from any other people, and we were there for an hour and 45 minutes. And, literally two days later, almost 48 hours later, all three of us developed symptoms. None of us converted for another 24 hours. And then at that point, we all three tested lateral flow positive.. We all three took Paxlovid. I took it and was starting to feel better after that fifth day.

(05:59):

And then I kind of crashed and at that point, I got a second, , five day course of Paxlovid and started to feel better. And, I'm you know, was very happy to have this behind me. However, over the course of the last 10 days, I have really had significant fatigue. You know I'm not one that sleeps a lot But, I can tell you there are multiple times in a day where I'm doing something like even doing what I'm doing right now where I just feel like I just need to fall asleep. It’s been really a challenge. The other thing that happened, which was in retrospect a little bit more concerning than I realized at the time, there was a period at about day 10 to 14 into my illness, I started losing my memory on many, many things of, you know, importance.

(06:53):

I couldn't, for example, tell you what was that drink that is: a champagne, orange juice combination. I couldn't find the word mimosa if my life depended on it. If somebody asked me who was in sleepless in Seattle, I had to think about now the movie who was in it. I couldn't remember. And I mean, in retrospect, I wasn't that concerned thinking, ah, it's not that bad. And it was actually quite remarkable. This lasted about two and a half, three weeks. And now I think, I think at least according to those around me, I have gained most of my memory back. But now I have the fatigue picture. So, as much as I don't know where I picked up the virus, all three of us picked it up. And as much asI feel like I have survivor's guilt right now in the sense that, you know, I'm not that concerned about getting infected in a public exposure given I probably have some pretty good protection, at least for a few more weeks. But nonetheless,  I think this potential fatigue issue is really a challenge.

Eric (07:52):

Yeah. The things that you're bringing up with this, like for example, I know you had had, the initial series and three boosters including the bivalent. Was that sometime in September last year, or,

Michael (08:04):

Yeah, it was seven and a half months before,

Eric (08:07):

Yeah. So,

Michael (08:07):

So, so that was, and I tried to get it at six months in the second. But in Minnesota we actually have a registry. And so it's not just your white card that, you know, you could do it. And it wasn't, I was trying to do something illegal, but you know, this vaccine's just sitting there. So I tried to get another bivalent at six months post my first one, and of course I was turned down. And then, five weeks after that I got covid.

Eric (08:33):

Yeah. And, and then of course, just recently the FDA and CDC finally came to the conclusion that for people of our age group and immunocompromised, they certainly have the option that you've advocated for. And unfortunately, you weren't able to get at that time. Although I suspect the protection, you might comment on that, Mike, that there is some protection infection for the first few months after a booster.

Michael (09:00):

Yeah. Yeah, absolutely. I mean, I think the studies that we've seen so far, at least, and particularly from those from other countries where they have remarkable follow up on databases, there is some initial evidence of protection in those first weeks against getting infected and even potential transmission. But that wanes unfortunately, quickly, and it's likely B-cell related immunity. And then I think as we all, at least believe the T-cell immunity, which we're still all trying to understand and characterize, probably kicks in and gives us protection against serious illness, hospitalizations and deaths. But as you and I have looked at even then, at six months out, you start to see some potential waning of that. And I think that's why we have a real challenge right now. I've said many, many times, we can't boost our way out of this pandemic. And I meant that not because some of us wouldn't be willing to get a vaccine every six months, but the vast majority of the population would not. And we've even seen here with the first bivalent booster dose, which we know has provided good protection against serial serious illness, hospitalizations, and deaths. Look at the very small proportion of the [age 65+] population that have taken that less than 40%. So  it's a challenge that how do we get people to keep getting vaccinated? A lot of people say, I'm done. I'm, I'm done with it.

Eric (10:22):

Right, right. Unfortunately, especially those who are at high risk. It's really unfortunate. Now, one of the things you've done recently among many things, you covered the status of the pandemic today and some liabilities for the future. And you've been working on the future with the blueprint that you put together from people, experts around the world to try to map out, optimally managing this pandemic’s future, preparing for the next pandemic. Could you give us the skinny on that?

Michael (10:52):

Well, actually this was a report that is relabeled the Covid Wars put out by the Covid Crisis Group, which was a loose affiliation of 34 individuals who had agreed to help out developing basic materials with the hope that that would lead to a post pandemic commission, much like the commission we saw after nine And then the person that headed that up actually was the person who did head up the 9/11 commission also. And there was support from several foundations for this. When it became clear, after almost a year of trying to pull together lessons learned challenges to what we know and don't know, the US government was not gonna support, another commission either at the, in the legislative side of the government or in the executive branch. Both of them basically said, well, we're not really interested.

(11:48):

I think that's been a major mistake. But this report, which is now out, does address a number of the shortcomings that we have experienced with this pandemic. And again, you know, in a world where it's so partisan and everyone wants to blame someone for something, this was not meant to blame. This was meant to be what we classically call a hotwash, where we go back over an experience to learn from it. What could we have done differently? How could we have done it? What did we do right? How do we have to make sure that that's in place in the future? And so this plan is, is about that very thing. Now, at the same time I'm writing another book, much like the one I did, deadliest Enemies Our War, againsts Killer Germs in 2017, when I laid out what a pandemic might look like.

(12:38):

And this one is really to address what do we need to learn from this pandemic for the next one? And I go into a bit more in certain topic areas, than our report did much more in depth as it relates to vaccines, public health actions, lockdowns, all of those things. And so I hope that in a, you know, a few months that'll be available so that not only does it lay out what the challenges were, but, you know, given my public health experience of 48 years and having been through these, what do I think the lessons learned should be?

A Major Prediction and Being Called Irresponsible

Eric (13:17):

I can't wait to read it. I mean, the roadmap, though, that you've pulled together, was really extraordinary. And of course, it addressed the things like pan-coronavirus vaccine and, and so many others that we can, pursue hopefully, and be also templates for the future. Now, I want to go back now since we recovering kind of the current future status, but back in March, 2020, you wrote that there would be, this is March, 2020, there would be 800,000 deaths in the next 18 months from Covid. Talk about an oracle, I mean, obviously no one would ever wanted that to see that, be actualized, but how did you, how did you know that, Mike? How did you know we were, we were in that, in, in store for such a dreaded outcome in an imminent period of time?

Michael (14:13):

Well, you know, let take a step back to December of 2019. You know, our center has a very active news team that basically covers infectious disease news from around the world. Even though it's inside of CDRAP, there's a thick wall between it and me, from an editorial standpoint, so I don't have any control over it. But they notified me that they were picking up information that last week in December, out of Wuhan about this emerging outbreak of unexplained pneumonia. And,  you know, at that point we stayed on top of it. And of course, my first thought was, could this be a, a flu situation with an emerging flu pandemic, or was it just more coronavirus? You know right after 9/11, I spent three years as a special advisor to then Secretary of Health New Services, Tommy Thompson.

(15:06):

I split my time between the University of Minnesota and the government. And it was during that time that I actually participated actively in the first SARS outbreak that occurred, with regard to the US involvement. And then in 2012, I had been serving as an advisor to the royal family of the United Arab Emorys. And when merged first emerged on the Arabian Peninsula, I went over and worked, on that issue. And then in 2015, when MERS exploded, literally in Samsung Medical Center in South Korea, I was asked to come and I went to over to Seoul and help with that outbreak. So I had a, a pretty good feeling, I thought, for coronaviruses. And of course, influenza is something that I had been working on for 40 years. And so initially I was saying, I hold up, boy, I hope this is a coronavirus, because we know how to control that.

(15:55):

They're not, it's not that infectious. Even though the case fatality rates may be between 15 and 35%. Well, as you know, by the end of that first week in January, we had the data saying, yep, this was a coronavirus. But it was at that time that we had contacts in Wuhan and in Hong Kong, and we were basically getting information out. And then of course, following up with our colleagues in Singapore, the old flu network that was suggesting that this was a very different kind of coronavirus. This, there appeared to be substantial transmission among those who were asymptomatic as well as those who were symptomatic. And as we saw more and more transmission, outside of, of Wuhan, it reminded me of great deal of what we saw in 2009 with H1N1, where there in the month after it was first discovered in Mexico, it was subsequently found in 128 different countries in just one month.

(16:52):

And, and it looked like this is what this coronavirus was doing. And so on January 20th, actually our center put out a statement saying, get with it world. This is the next pandemic. It is a coronavirus acting differently than MERS and SARS, my worst fear was that the case totality rate may be as high as that. Well, over the course of the next few weeks, we got more in better information about what was going on. And there was just such a denial at the time. In fact, I went to JAMA, and to the editor's and said, can I do a perspectives piece on why the world has to wake up quickly? This is going to cause a pandemic. They not only turned me down, but the following week they ran a cartoon in JAMA, one pager on one column looking at Covid, and Coronavirus is on the right kind column looking at influenza.

(17:43):

And they came to the conclusion, don't get distracted by this coronavirus thing, it's about flu. Wow. And so I think at that time, there was such denial that was going on. So when I first made this statement, I actually did it by the kind of the back of the seat estimate. You know, I'm not a black box guy. I, in fact, I find black boxes often, they sort of press the hell outta you with their sophistication. And what they don't tell you is they have no clue what they're talking about. So I just basically did a back to the envelope calculation and not even realizing vaccine might or might not come into place. So, you know, I have to be honest and say it was in some ways luck.

Eric (18:29):

Yeah, I don’t know, I think it's a lot of wisdom and mixed with that.

Michael (18:33):

You know, I want to add one, I want to add one of the thing though, Eric, because the thing that I will most remember probably in this pandemic is not all the hate mail that I received from so many as the days went on and even death threats. It was the feedback I got in that month of March from colleagues who thought that I was over the top that I had finally, you know, scared the hell out of people one too many times kind of thing. And it was amazing to me, as much as we're critical of the politicians and what happened, and we surely should be, there were many of our colleagues who were equally in a state of denial not wanting to believe that this was really happening.

Eric (19:15):

Oh, absolutely.

Michael (19:16):

Yes. So I think that's what I'll remember is, it's one thing to have some anonymous person tell you, you know, that you should be dead. It's another thing to have one of your colleagues say you're irresponsible.

Organizing the “Party Planning Group”

Eric (19:29):

Yeah. You're not kidding there. And you know, especially with you because you know, everybody who's listening has seen you innumerable times on, you know, CNN, MSNBC, Meet the Press, and, various news networks, and they know you come across with humility, unlike many other experts where, you know, you say we just don't know. And also the master of metaphors, as far as I can tell, like the eye of the hurricane and so many things like that. But the other thing I wanted to get into historically is something that brought us together that a lot of people still, it's been written about, but a lot of people still don't know. So back in the summer of 2020, you said, I'm gonna organize a group, a group that eventually became known as the party planning group that we meet every Friday morning for an hour or so. And we talk about, well, there's a pandemic and related matters. So you again, had this idea to bring this group together. And could you talk about that, because it's amazing here it is. You know, two and a half years later we met today, we are, we're continuing to meet, tell, tell everybody about whether that group, how, how you first saw the need for it. And perhaps, you know, what do you think it's accomplished?

Michael (20:43):

Well, first of all, let me start out with two caveats, number one, and thank you for your comments. But I realize the older I get, the more vulnerable I am to learn . And so I want to surround myself with people that can teach me. Okay. The second thing is, is that humility should be considered a requirement today of trying to deal with pandemic viruses because we have to acknowledge, we don't know what the next major curve ball is going to be. You know, I can remember a, a a light bulb moment for me early in January of 2021 when vaccines were now flowing. But recall you and I together, we wrote a piece on this. So Alpha variant emerging out of Europe. And remember up until then, that time, we kept being told that, well, these variants, the sub variants are really just nothing more than rings on a tree.

(21:36):

They're just telling you how old the virus is. And with Alpha, we had clear and compelling evidence, oh no, it had a lot to do with functionality, how infectious it was, et cetera, and that that could very well change the complexion. And I remember very well, being on Meet the Press in January of 2021 and saying, I thought the darkest days of the pandemic were still ahead of us because of the number of people who were not vaccinated. The fact that this viruses was going to continue to change. And of course, again, I caught a lot of heat for that Nate Silver, who gutted me in public media for irresponsible. And of course, as you know, the vast majority of deaths occurred after that time. Right, right. But now to back up to your point and why I think some of the things that I was able to learn occurred was in the summer of 2020, a colleague of mine who, very near and dear came to me,  said that there is someone in the senior level of government that right now is making some major decisions, but really has no one around him he knows he can trust.

(22:42):

Would you ever talk to him and, and provide what information you can to kind of give him a sense off the record? Well, I thought, you know, actually it would be better cuz there's a team of people I think that could be more helpful. I'm one, I'm one voice and I surely don't proclaim to have the only voice. So I actually literally went to my might say, magical list, who are the people that I most respected and admired, and who did I trust? And trust was huge. Trust was huge. And as you know, you're on that list. it's now been publicly stated. Peggy Hamburg. Peter Hotez, Bruce Gellen, Pennny Heaton and, Ruth Berkelman. And you know, we, we meet on every Friday and our discussions are incredibly, incredibly thoughtful.

(23:39):

They are honest and there's a trust in that group. You know, what we share stays there. And I, I so appreciate that. And so from that perspective, that will continue and I will continue to learn from all of you. And I think if it was any one lesson that came out of from this pandemic is just the value of having that kind of collective brain trust that can come in, ask questions. Many times we didn't have the answers, but we surely got the questions out, which then gave us opportunities to learn the answers. And the fact that we could do it. And you and I both knew that our comments were gonna stay within the context of that group.

Eric (24:20):

Yeah. And we had to keep it anonymous with this name of party planning group just because we didn't want people to know what this was.

Michael (24:29):

Yeah. At that time, it was interesting. I have to tell my administrative assistant was out one day during that time, early time period. And someone else, was sitting in and they saw in my schedule an hour blocked off for party planning. And it was right at the holiday season. So there was an assumption made in my, in our center that I was just planning this big holiday party and that nobody knew about it yet and said party planning. And that rumor got spread got, was spread throughout the entire center. And I had to self-correct, you might say and explain we can still have a party, but that wasn't what this was about.

Eric (25:07):

Yeah. Well, it, it's been an amazing ride and it continues, but, you know, we were there from well before, there were vaccines all the way through to the current time. And you can imagine all the different things that have been happening in the background and that we were discussing, exchanging ideas, communicating with the public health agencies, the White House and all sorts of other issues along the way. So it's been a privilege for me not just to have this conversation, but over these last two and a half years to work with you on that. It’s been extraordinary and to learn from you and our colleagues. Well, this has been so much fun for me, Mike, I I just am struck by your ability to weave together, you know, the, the wisdom you've drawn from all these experiences over four decades of working in this space with the ability to be humble and know that, you know, you're not the smartest guy in the room.

(26:07):

No one's the smartest guy in the room that you want to have other people, you know, whether, wherever they come from, like for example, when you put together the Roadmap and you brought together, you know, people from all over the world, to think, to exchange ideas about how we can do better for this and future pandemics, because undoubtedly we're gonna be facing those. So maybe, as we wrap up, could you just give us your sense, there's obviously climate change, there's all the things that have been done to the environment and this pandemic, which we all want, wish to be, you know, put aside, the virus will be here for many years to come. But what are your expectations since unfortunately your predictions have come too close to real, about the next pandemic. Will it be influenza? Will it be in the next few years? What are your thoughts about where we're headed?

Michael (27:05):

Well, you know, Eric, let me just start out and say thank you for your very kind comments. I think one of the things I learned at CIDRAP a long time ago is the very name, the Center for Infectious Research and Policy. And I knew very early in my career that well designed, well conducted even very important research means nothing if you can't translate that into active policy that makes a difference. At the same time, policy, if it's not informed by good research can be dangerous. And so I think what you're highlighting here is how we try to bring groups of individuals together to merge research and policy together. And you just talked about the Coronavirus vaccine roadmap, where 54 of the world's leading experts, including you, participated in that. And we developed a very, very specific, outline for a roadmap of what needs to be done to get us to new and better coronavirus vaccines, and ones that basically, will be hopefully broadly protective for any future coronavirus activity that occurs.

(28:12):

So I can never say enough about the ability to bring shareholders together. Collective wisdom will win every time against a wisdom. And I think that that's one thing I learned in terms of where we're going. You know, I, I have to just think back into human history. And when you think about the fact that in 1900 average life expectancy in this country is about 43 years, and today, even with the pandemic, it's about 76, 77 years. For every three days we've lived in the last century and 20 plus years, we've gained one day of life expectancies that takes us all the way back to the 80,000 generations to the caves. And I think what we haven't fully understood is, is that we lived in a world where infectious diseases had major impact on why we didn't live to be as a median age, life expectancy, up into the seventies, but rather, into the forties.

(29:13):

And I think what we're facing today is a world that's moving us back to those, numbers not forward. For example, if you look at just the situation right now of world population, 8 billion people on the face of the earth you look at, you know, what's happening with mega cities around the world. You know, I, remember early in the days of HIV aids making a trip to Kinshasa, which no longer is of course, where it was a large rural city. Today it's 18 million people. When you look at the median age of Africa, it's 19 years. When you look at what we've done with human population and how we have reached out to every corner of the world seeking food, bush meat, et cetera, I, you know, Ebola has been a problem likely for many, many, many decades. But when it was in very rural, isolated villages of Africa, you know, if 25 or 30 people got infected and died, no one even knew about it.

(30:19):

Now, today with the organization of Africa, you can see widespread  transmission quickly in these areas. And this is true for all parts of the world. Think about avian influenza and the need today to feed 8 billion people. We have relied on  birds on, on the fastest that as an animal species is the fastest conversion of energy to protein on earth. And so look at the billions of birds we're raising, which now provide for a new reservoir for flu viruses. I can go down the list, look at how climate change is moving, in terms of precipitation levels and temperatures that now move mosquito populations to places of existence we didn't see before. And then added transportation in. Think about all of history to World War II, the four serotypes of Dengue virus existed in four different regions of the world. It wasn't until First World War II that now they all exist virtually where each one exists.

(31:19):

Why do we have Dengue hemorrhagic fever? It's because of that. And so I think that the final piece I would say is yes, pandemic's gonna happen again. We are going to see more of what we've just experienced. And frankly, it could be a lot worse. We didn't see 15 to 35% mortality rates like you might with SARS or mers, but instead we saw just high transmission levels. There is nothing to stop the next coronavirus from being transmitted like SARS -CoV-2in killing like MERS or SARS. Mm. And so I think we have to be mindful of that. And the final last thing, I would just paint this is our climate change issue in infectious diseases. It's antimicrobial resistance, it's amorphic, people all know it's there, what to do about it. And we are watching ourselves literally devolve back into a pre pandemic era of antibiotic resistance.

(32:14):

Meaning that, you know, before our grandparents were around, people died often from common in, you know, cuts, bruises, et cetera, because they didn't have antibiotics. Look what's happened since that time, they've played a huge role. Sure. And now we're gonna watch that. You know, we're wildly that. And then last one, at least, I just have to say misinformation, disinformation on vaccines is huge. I think that we're gonna continue to see increasing challenges with populations around the world, no longer willing to take childhood immunizations or even other adult immunizations just because of the disinformation. So when you add that all up, it's job security, unfortunately, for a lot of us. And that's a sad commentary. It's real, yeah.

Eric (32:58):

Well, and as you pointed out so well, just before we got started with AI, it has a potential to amplify the myth and disinformation to unprecedented levels. And it's already so, you know, horrific as it is.

Michael (33:13):

You know, it's bad enough that I can just say that there are times I read articles in newspapers, and I'll get halfway through a quote and I'll say, who the hell said that? According to Osterholm? And of course, what? ,

Eric (33:28):

Right. There you go.

Michael (33:30):

What are we gonna do when you and I end up on these bots? You know, we're there Is Eric Topol saying, saying to the world, you know,  I was wrong. Vaccines aren't any good. Yeah. And people are gonna see that, and it's not you. Right?

Eric (33:44):

Right.

Michael (33:44):

A lot that concerns me a lot.

Eric (33:46):

No, it, it was deep fakes and now it's going to another ultra level of that. It's pretty scary actually. So with all the things that we've been talking about, whether it's a potent virus or a tech like AI is becoming with generative AI we've always gotta look at both sides of this and, and be prudent, to put it mildly. Well, this has been fun. And I can't thank you enough. I I, I would like to talk to you all day, but we've got a got a lot in there in a half hour, and I know we'll get a lot of interactions from the folks that are listening. Mike, thanks.

Michael (34:25):

Gift to all of us. You're a gift to all of us. Thank you.

Eric (34:28):

Oh, thank you. That's much too kind.

Get full access to Ground Truths at erictopol.substack.com/subscribe