Dr. Michael Osterholm: COVID is Not Done with Us ,Omicron Surge, Future Variants and Building Better Vaccines

Dr. Michael Osterholm

Marianne O’Hare: Welcome to Conversations on Health Care. This week we’re
joined by Dr. Michael Osterholm, Director of the Center for
Disease Research and Policy at the University of Minnesota
whose pandemic predictions have come through since the
beginnin g of the crisis.

Dr. Michael Osterholm : We could have another variant in three or four months from
now that could emerge, that could easily evade the
immunoprotection of what we have right now in our
population or not.

Marianne O’Hare: Now, here are your h osts Mark Masselli and Margaret Flinter
with Michael Osterholm on Conversations on Health Care.

Mark Masselli: In December our next guest was one of the first to describe
the predicted impact of the Omicron variant a viral blizzard. He
said then that we co uld see millions of American infected with
this variant. The blizzard has indeed arrived and so have more
questions and worries.

Margaret Flinter: Dr. Michael Osterholm is the Director of the Center for
Infectious Disease Research and Policy at the Univers ity of
Minnesota which is tracking and analyzing this rapidly evolving
pandemic.

Mark Masselli: Well, it’s good to see you again Dr. Osterholm, welcome.

Dr. Michael Osterholm : Thank you. It’s good to be with you, I appreciate the
opportunity.

Mark Masselli : Tell us what the latest data on Omicron is and what your take
on it?

Dr. Michael Osterholm : Well, as I described earlier and you noted that I thought this
would be a viral blizzard. I really refer to that in two different
perspectives, one is just the ty pe of transmission we would
see. If you look at the course of the COVID pandemic over the
last two years, we’ve had these regional surges that have
come up and down. Some lasting longer, some more short
time periods, but never did we see an entire country or did we
see an entire of the world impacted.

In fact if you look at the WHO numbers for global cases, it
would kind of cycle between about 2.5 million cases a week to
5 million cases a week and then back down to 2.5. This one’s
very different, everybody is in the soup at the same time.
Doesn’t matter if you’re in the northern or southern
hemispheres, it doesn’t matter whether you’re in a rural or
urban area of the country. The only thing that’s really different
like true snow blizzard is that it hit some areas first and then

Dr. Michael Osterholm

hit other areas later, and unbarring from the blizzard is
somewhat slower in some areas than others. That’s exactly
what’s happening right now.

In the United States, all 50 states are -- and the district of
Columbia are in the soup, ho wever, those states first
impacted, particularly the northeast are now beginning to see
the peak number of cases occur and the number start to drop.
The challenge we’re going to have is if we follow what has
happened in South Africa and use that as somewha t of a
benchmark. If you look at what’s happening with Omicron
there the numbers went up very quickly. We all are aware of
that peak, and then it started to come down quickly. Then
people kind of forgot about, well it’s over, well it’s not.

Right now the t ail of cases in South Africa is still, from an
incident standpoint, 25 times higher than it was before
Omicron hit. We’re not quite certain of it is once the big peak
occurs and starts to come down, what will that tail look like? I
think that’s going to be relevant to everyone in the United
States.

Margaret Flinter: Well, Dr. Osterholm you paint a great almost visual picture of
the whole map lighting up simultaneously. In fact I was looking
at one of the maps online today, and that’s what it looks like.
One of the consequences of that is we can’t really help other
regions very much as we did maybe in that first wave in terms
of moving resources around, in particular healthcare
resources.

I know this is something you’re very concerned about with
healthcare wo rkers, particularly acute care just being
overwhelmed and stretched so thin. What are you seeing and
what are you concerned about in terms of standards of care
and access slipping, is that happening? What can we do as the
whole country lives through this p hase?

Dr. Michael Osterholm : Well, as you just laid out very nicely Margaret, the challenge
we have is that in fact the whole country is in the soup at the
same time. There aren’t ways that we can take and move
assets or resources from one region to anothe r. In fact, even
when we take national guard unit individuals from our
communities and put them into the hospitals and long term
care facilities, not that they have great medical skills, but were
taking a lot of other critical jobs in their community. We a re
seeing right now no accessibility to move people from one
region of the country to another for healthcare.

Basically what was already a very tenuous situation in

Dr. Michael Osterholm

maintaining adequate staffing we’re now hanging on by the
skin of our teeth. We’ve seen in the number of areas 20% to
25% absenteeism because of infected healthcare workers.
Remember these are incredible vaccines, they’re remarkable,
but they are not perfect. One of the things that’s happening is
that people who have been fully vaccinated with t heir booster
are still getting infected. It’s a mild illness. They’re not been
hospitalized but they can’t work, and so that’s been a
challenge that we’re seeing.

If you follow the news media you can see story after story
after story about regions implorin g people please try not to
get infected because right now we’re being overrun in our ERs,
in our hospital beds. In addition, we have to be mindful of
what the impact is with supply chains. If you look at the
number of big box pharmacies just in this past w eekend that
we closed because they had no one to work in there. We’ve
had pharmacy shutdown completely. We’ve had those out - of -
state open say it is taking three to five days to fill
prescriptions, oxygen bottles etc. There’s been a real hit on
the healthca re system from multiple levels, not just personnel.
But by far personnel themselves are the key issue.

Let me just close with one number I think that really helps put
that in perspective. We have celebrated the fact that the DOD
has put forward a thousand healthcare workers, a trained
doctors, nurses and technicians to go into our communities,
that’s great. But, right now we estimate that upwards of two
million healthcare workers are off the job because of infection.
That DOD number doesn’t do much to make up for the loss of
the healthcare workers that are currently infected.

Mark Masselli: You know, I was thinking as you were talking sort of add to
that laundry list of challenges or certainly what are we going to
do with our schools. You’ve just written tha t it’s time to
acknowledge reality, and many of the schools will likely have
to close because of Omicron. Obviously, the President’s not
that, Secretary Cardona is not there, it doesn’t seem that the
country is there. What’s the matter with taking a wait a nd see
approach on virtual schooling?

Dr. Michael Osterholm : Well, you know, let’s just come back to what I call a common
sense moment, it’s just reality. The challenges is that right now
this is not about not wanting kids in school. This is not about
the idea that’s just COVID. But when you have 35, 40% of your
teaching staff, your support staff and your bus driver’s out
with COVID, how can you safely hold school? This is just a
reality, it’s not a judgment of whether we should or shouldn’t

Dr. Michael Osterholm

have school. Wo uld we close schools if we were about to have
a category five hurricane? You bet. Would anybody complain?
No.

If there was a regular blizzard, a real blizzard, 35 inches of
snow and 40 mile (inaudible 00:07:04) would anybody
complain about schools being cl osed? No. What I’ve argued
for over the last couple of weeks is just some common sense
to say look at this surge, it’s going to last only three or four
more weeks likely. What we got to do is get through. If you
think you’re going to open your school safel y with such a
reduced staffing level, that’s a mistake. This shouldn’t be a
political point where under in no condition we consider closing
schools.

I’ve heard from many superintendents and teachers who feel
like they’re being punished for closing school, and the
superintendent says how do I do that with 35% of my staff
out? I think this is one of those examples where ideologically
people made decision before they ever had the data to
understand what that decision was all about.

Mark Masselli: The kids in M innesota were walking out today, the high school
kids walked out of school because of the virus.

Dr. Michael Osterholm : Yeah, some of them did. I mean, part of it was the teacher
issues. I mean we’ve had a situation here where they’ve
actually asked parent s to come in and volunteer just to watch
the kids, it’s like a babysitting class. Now, you can say your
school’s open, you’re just politically making a statement.
Minneapolis schools had 38% of their teachers out infected
today.

Mark Masselli: Terrible, te rrible.

Margaret Flinter: Wow, amazing.

Dr. Michael Osterholm : I mean that’s where I fight it hard, and that’s where I push
back hard against the administration and said the President’s
got to stop savoring and keep schools open at all cost. Nobody
would s ay that if it was the hurricane or the real snow blizzard.

Mark Masselli: Absolutely.

Margaret Flinter: Right, right.

Dr. Michael Osterholm : This is short lived, this is not the next school, this is not the
next -- get us to February and I think we’re in a very different
place.

Margaret Flinter: Well, obviously during this period of time with the massive

Dr. Michael Osterholm

surge across the country we’re concerned about all people but
the most vulnerable patients in particular. One group I know
you’ve commented on are the immu nocompromised patients,
and you’re saying they really need to get their fourth vaccine
dose. Why is that so important for this group right now?

Dr. Michael Osterholm : Well, let’s be really clear because there’s been some
information come out on the last da y suggesting fourth dose
may not work. We already have a recommendation in this
country based on data that already exist that supports a fourth
dose for those who are immunosuppressed moderately or
severely, that’s about 7.2 million people in this country. That
one is not even up for discussion, get that fourth dose.

The data that came out in the last day from Israel on the
laboratory studies, looking at the immune response in healthy
people, people who are otherwise not immunosuppressed
suggested that the level of protection from that fourth dose
may not be sufficient benefit to warned that it’d be used.
However, the studies are still going on actually looking at
clinical cases much like we did with the third dose. I think
within the next month or two month s we’re actually going to
have substantially more data on does the fourth dose really
protect you in a way the three doses did. I mean we need the
facts, we need the best data.

We also have to face reality. Reality is, is that if that means we
have to have a fourth dose, are we going to keep giving doses
every six months to so many people in the world? It’s not
going to happen. I think we are going to come to a point
where if in fact that fourth dose does appear to be necessary
or can be helpful of asking o urselves what is our model going
forward? How are we going to do this if we can’t even get four
doses in people in the high and middle income countries, what
is the chance we’ll ever do anything like that in low and middle
income countries? I think right n ow the bottom line message,
if you’re immunosuppressed please get that fourth dose
because it surely can have a benefit.

Mark Masselli: You know, you and Dr. Manny (PH) you both served in the
Biden transition team and some have really called your writing
a s striking critique of the administration. We’re about two
weeks out since the article appeared. I’m not sure if you’ve
been invited to dinner at the White House. But tell us what the
response has been and has anything changed in your own
thinking?

Dr. Mic hael Osterholm : Yeah, it’s one of those situations, Mark, where people have
tried to make this as an adversarial situation. We’ve had a

Dr. Michael Osterholm

second row seat in all of this being part of this team, not a
front row where basically you have to keep your eye on the
ball 26 hours a day and even sleep with one eye open. We’ve
had the luxury of not having to do that. What we were
attempting to do is actually in a very positive and collaborative
way say, you know, you have to continue to deal with this
firefight right n ow, but we have to figure out how we’re going
to deal with this in the future. We can’t keep going from the
surge to surge to surge, crisis to crisis to crisis.

What our efforts were was to help provide a framework for
the administration to consider going forward. They have been
very supportive of our efforts. We’ve shared all this
information with them before we’ve ever published. I actually
still do get invited to the meetings and the calls. None of us
has gone to dinner yet. But the point being is I thin k we’re in a
very positive step forward because we have to figure this out,
you know, what are we going to do?

I know no one wants to hear this, but you know as you know a
year ago I was saying that I thought the darkest days of the
pandemic could still be ahead of us based on the variants.
Once I saw alpha and beta and gamma, I said wow this virus
has that potential to continue to throw 210 mile an hour
curveballs, which of course Delta and Omicron did. Well, there
is still that chance we’re going to have another one that could
be just like Omicron or worst where it evades immune
protection where either from vaccines or a natural infection.
What we wanted to do is set out an approach that says, well
we got to be ready for something like that. But what if, i n fact,
that doesn’t happen again, and we start to see this become
part of the seasonal milieu of respiratory transmitted disease.

Remember, Influenza on average year kills 50 to 70,000
Americans in this country, how does that fit in with COVID?
Our papers were really about looking and reaching forward
with the idea that we need to learn to live with COVID, and
that’s what we have to start figuring out how to do.

Margaret Flinter: Well, speaking of learning things from COIVD, if you spent any
time in vaccin e clinics or testing clinics over the last couple of
years, one of the things you really got a sense of was we were
making a vital service available to people regardless of cost,
regardless of insurance status, regardless of citizenship status.
From your a pproach, is there a lesson in all of that about how
to address other public health or preventive care concerns?
Can we use this as a lesson to make things better in health and
public health going forward?

Dr. Michael Osterholm

Dr. Michael Osterholm : Well, I think to me, Margare t, the number one lesson that I
think has been so important in this is that it’s kind of like
hosing your driveway uphill. You can go up and up and up one
spot or you can keep going back and forth and back and forth,
that’s what everyday public health is a bout is hosing your
driveway uphill. Suddenly if you get distracted into just one
small section of it, everything runs back down.

When you look it from a global standpoint and even in our
own country, the kinds of negative implications that we’ve had
becau se of a lack of diagnostic services, access to healthcare.
Even for cancer patients, surgeries that were postponed. We
have seen a degradation of overall health in the world that is
really remarkable. What it really points out is we can’t afford
to focus o n (inaudible 00:14:32) driveway. If anything what it’s
going to call for is major new investment just to catch up
again.

I look at HIV, I look at malaria control, I look at childhood
immunizations, I look at cancer screening, we are falling way
behind in a ll of those. We’re going to be paying a price for
years to come. We have to rebalance the public health and
medical care balance sheets right now so that we can
understand we have to do COVID, it’s not an option, but you
can’t do it only in exclusion of al l these other issues. To me I
think that message rings really loud and clear that if anything
else COVID has proven just how important these other
programs are.

Mark Masselli: Margaret talked about having approach and you’re perhaps
the only public health official to sort of enrolls for President
George W. Bush, Donald Trump and Joe Biden. Tell us about
the difference in the styles and approaches you’ve observed,
and how this play out in the healthcare arena.

Dr. Michael Osterholm : Well, Mark, actually I’ve had the fortune to serve roles in the
last five presidential administrations including now this one.
I’ve always come in as just the private in the public health
army. It’s not an ideology issue, it’s not a political issue, how
can I help out. I had the g ood fortune, you mentioned George
Bush, I served as a special advisor to Tommy Thompson the
secretary of HHS for three years after 9/11 while also at the
University of Minnesota.

I was a science envoy for the State Department during the
Trump administratio n which I actually traveled around the
world talking about pandemic preparedness. I think the one
thing that I have to just continue to emphasize. There are
some really incredibly dedicated brilliant people in our

Dr. Michael Osterholm

governments that don’t change their priori ties just because
political parties changed in the White House. Good public
health is good public health, and working with these people
have been remarkable. I mean, I can tell you I had a wonderful
experience during the Trump administration work I did for the
State Department, now helping out with this administration.

I think we so often focused on that small group of elected
officials overseeing this program, and what we fail to
sometimes remember is that just like with our military that
these soldiers th ere day in and day out without regard to
political party, and that’s what I always remember is the
commitment and the efforts that they were making to go
forward.

Margaret Flinter: Well, that’s a very important view to remind people about.
You have been on e of those people sharing your expertise in
so many areas, and one of them you’ve referenced Influenza a
while ago and I want to just go back to that for a second.
January, typically a very high peak season for impact of
Influenza, we’ve had some reports o f Influenza combined with
delta or Omicron to create an even more dire situation. What
are you seeing around the country with this?

Dr. Michael Osterholm : Well, right now I think we’re at a point of -- it surely could get
worse, but it may actually be lev el after coming down. This is
the H3 and 2 virus which unfortunately have a relatively poor
match with the vaccine this year. But we haven’t seen the
major increase in Influenza particularly in kids which in the
past years has been an indicator of just wid espread
community transmission. I think it’s still early to tell, I wouldn’t
want to write this season off as having been mild or even
moderate in terms of occurrence. Influenza can change in a
dime.

But I think it also points out the fact that the older I get I think
the more vulnerable I am to learning. One of the things you
have to do with Influenza is have a real sense of humility and
learn, because it control curveballs at you just like COVID’s
doing and it is a very significant public health challenge . I
mentioned earlier 50 to 70,000 deaths a years. I’d say right
now we’re fortune in that we’re not seeing more of it, could
be an interaction with COVID and that reason why we didn’t
have any of it last year. But I wouldn’t want to count out that
we’re d one with the flu season for this year yet.

Mark Masselli: Since all the variants have Greek letters, it seems appropriate
to think a little bit about Greek mythology as Americans are
looking for its scientist to be a little likely Oracle of Delphi.

Dr. Michael Osterholm

You’ve been so right in so many of these predictions about the
virus. Where do you think will be by spring or summer or
winter, and I hope you don’t mind being refer to as the oracle
of Omicron.

Dr. Michael Osterholm : Well, I am going to give you a very truthful answer that is
correct, okay? It’s somewhere between little to nothing or it’s
really bad, and it’s somewhere in between there. I think this is
where, again, Mark, the humility comes in, we don’t know. All
these statistical models are beyond four weeks, th ey’re all
based on pixie dust. I see these organizations out there putting
these out, and you can seen in a moment by just looking back
in November, December, January now, who could have
predicted this in October, early November.

What I look at is I hope f or the best and I have to plan for the
worst. If it’s less than that then we will be in much better
shape. I think that people don’t want to hear this, but the idea
of herd immunity went out the window for me over a year
ago, and it’s because we don’t have sustained immunity with
this virus, and it’s not, not unusual as well we’ve seen it with
other coronaviruses.

Look at how many of the people right now are being re - infect
with Omicron who have been vaccinated, who had boosters or
previously were infected with a previous Delta variant. What it
really points out is, is that we could have another variant in
three or four months from now that could emerge, that could
easily evade the immunoprotection of what we have right now
in our population. Could be just a s transmissible or not, maybe
we won’t see that.

I think right now the scientific community has to have that
dose of humility and don’t try to predict what we can’t. I’ll just
say that right now we’re not done with Omicron. We’re surely
not done with COVID yet. We may, as population, get done
with this pandemic, but the virus isn’t done with us. Knowing
that that’s why we have to learn how to live with it.

Our group was very involved in overseeing the writing of and
bringing the experts together to come tog ether with a plan on
the influence of vaccine roadmaps on our website. This was an
international effort with WHO, major foundations and it was a
roadmap for how we’re going to get better flu vaccines, the
universal vaccine. Well, we’re now embarking on a s imilar
process for pan - coronavirus vaccines. I do believe that in the
next few years we’re going to see vaccine 2.0, 3.0 maybe even
4.0 that could provide us more durability, more protection
against variety of variants.

Dr. Michael Osterholm

I think therapies are going to huge. Imagine if we did this
interview back in early 1980s and we were talking about HIV,
that was a death sentence then. Look at it today where
therapeutics are available, it is a manageable chronic disease. I
think the therapeutic contribution to reducing the impact on
our communities is going to be huge. What we need to do is
get in place a global plan for rapid testing, identification of
people infected and the distribution of these new
therapeutics, that could be like HIV in a way even without a
vaccine. We had both vaccines, better vaccines and
therapeutics. I think we can definitely pull COIVD to a place in
our communities where it’s not scary, it’s not interrupting
everyday life.

Margaret Flinter: Dr. Osterholm leads the University of Minnesota Center for
Infectious Disease Research and Policy which works to prevent
illness and death from targeted infectious disease (inaudible
00:22:35) through research and a translation of scientific
information into real world practical applications policies and
solution s. Dr. Osterholm we appreciate so much you’re
returning to Conversations on Health Care today for this
important talk, and thanks for joining us on this edition of
Conversations on Health Care.

[Music]

Mark Masselli: At Conversations on Health Care, we wan t our audience to be
truly in the know when it comes to the facts about health care
reform and policy. Lori Robertson is an award winning
journalist and Managing Editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim
to redu ce the level of deception in US politics. Lori, what have
you got for us this week?
th
Lori Robertson : The U.S. Supreme Court heard oral arguments January 7 in
two challenges to the Biden administrations attempts to
expand the use of vaccinations. In the fi rst case National
Federation of Independent Business versus Department of
Labor, Justice Sonia Sotomayor overstated the number of
children with COVID - 19 who are in serious condition. “We
have hospitals that are almost at full capacity with people
severely ill on ventilators.” She said, “We have over 100,000
children in serious condition and many on ventilators.”

According to the latest data from the U.S. Department of
Health and Human Services, there were about 4700 children
th
hospitalized in an inpatient pe diatric facility on January 10
who had laboratory confirmed or suspected COVID - 19 that
includes those in observation beds HHA noted. As of early

Dr. Michael Osterholm

January there has been a concerning surge in children
hospitalized with COVID - 19 particularly among the very young.
th
The American Academy of Pediatrics wrote in a January 4
report that it was uncommon for children to have severe
illness due to COVID - 19 but more data was needed to assess
the severity caused by new variants and the long term impacts
of the pandemi c on kids. But Sotomayor’s statistic on the
number of children experiencing a serious condition was way
off, assuming she was talking about hospitalizations which the
context of her comments suggest.

The Justice was correct that cases of children hospitali zed with
COVID - 19 are at a record high so is the number of infections.
The American Academy of Pediatrics reported that weekly
th
data ending January 6 showed the cases among US children
nearly tripling over the course of two weeks. The seven day
average of hospital admissions for those up to 17 years old
th
was 830 children on January 8 .

A particular concern is the rise in the rate of cases among
children ages four and younger who were admitted to
hospitals and were infected with the coronavirus. Children
th at young are not yet eligible for COVID - 19 vaccination. The
Supreme Court sided with the business group blocking a
federal requirement for vaccinations or weekly testing at large
employers in the US. That’s my fact check for this week. I’m
Lori Robertson, Managing Editor of FactCheck.org.

[ Music ]

Margaret Flinter: F act C heck.org is committed to factual accuracy from the
country's major political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fa ct that you'd like checked, e - mail
us at www.chcradio.com w e'll have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on
Health Care.

[ Music ]

M argaret Flinter : Each week Conversations highligh ts a bright idea about how to
make wellness a part of our communities and everyday lives.
People living in Sub - Saharan Africa have tougher odds at
overcoming diseases, and the problem is not just the lack of
access to healthcare providers, access to vital lifesaving
medicine is out of reach for many who are sick.

Gregory Rockson: Africa has some of the highest drug prices in the world
similarly because it’s a free pricing market. You can take a

Dr. Michael Osterholm

single medicine and two pharmacies next to each other will
sell that same drug at widely different prices.

Margaret Flinter: Gregory Rockson is the founder of mPharma a nonprofit
organization that’s seeking to address inequities in drug prices
in Africa and the supply chain that often puts these lifesaving
drugs out o f reach. mPharma operates in four African
countries. It decided to tackle the problem by redirecting the
supply chain that forces small independent pharmacies and
clinics to source their own drugs.

Gregory Rockson: We realized that if we could begin to bri ng together all these
independent pharmacies and remove the pressure that they
have to face in sourcing their own drugs, we can begin to
address the issue of medicine availability and affordability.

Margaret Flinter: Rockson says they help improve the drug procurement supply
chain by collecting data on actual drug sales which allows
healthcare entities to avoid over or under stocking, and it
reduces their vulnerability to fraud and corruption.

Gregory Rockson: Not only are we taking ownership of the supply chain, we are
also providing the financing to patches the inventory. We offer
them a simple value proposition, pay only when you dispense
the drug to the patient. We actively help them manage their
inventory.

Margaret Flinter: mPharma was a 2019 recipient of the Skoll Foundation’s
Entrepreneurship Award. mPharma a nonprofit entity that
utilizes reliable data on drug usages, eliminates fraud and
waste in the drug supply chains, makes lifesaving medications
more readily available to some of the world’s most v ulnerable
people. Now that’s a bright idea.

[Music]

Mark Masselli: You’ve been listening to Conversations on Health Care. I’m
Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Peace and health.

M ar ianne O’Hare : Conversations on Hea lth Care is recorded at WESU at
Wesleyan University, streaming live at www.chcradio.com ,
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