December 29, 2022

In "Thank You, Dr. Jena: Part 2," Dr. Osterholm and Chris Dall discuss the crisis that China is currently facing, the latest influenza data, and what we should expect from this virus in 2023. Dr. Osterholm also interviews Dr. Jena to get an update on the impact that the pandemic continues to have on healthcare workers in the U.S.

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Chris Dall: [00:00:00] Hi, everyone. As another holiday season arrives and this year comes to an end, we reflect on how the world of public health has been challenged this past year. We're thankful to have been able to provide you with this podcast for the last 12 months and with a new and improved recently launched website. Donations from listeners like you allow us to continue to be innovative and maintain a full time, seasoned editorial staff dedicated to producing the freely available news resources that you depend on to support this podcast and our other news offerings, please visit for support. Thank you and happy holidays.

Hello and welcome to the Osterholm Update COVID-19, a podcast on the COVID-19 pandemic with Dr. Michael Osterholm. Dr. Osterholm is an internationally recognized medical detective and director of the Center for Infectious Disease Research and Policy, or CIDRAP at the University of Minnesota. In this podcast, Dr. Osterholm will draw on more than 45 years of experience investigating infectious disease outbreaks to provide straight talk on the COVID-19 pandemic. I'm Chris Dall, reporter for CIDRAP News, and I'm your host for these conversations. Welcome back, everyone, to another episode of the Osterholm Update podcast. It was just about three years ago that we started to get reports about a mysterious and deadly respiratory illness spreading throughout China. The illness, of course, was SARS-CoV-2, and while it spread like wildfire across the globe within a matter of months, China soon seemed to have it under control, with a mixture of strict lockdowns, mass testing and border closures. Three years and more than 6.6 million deaths later, SARS-CoV-2 is less mysterious, but still deadly. And although much of the world has learned how to live with the virus, China having dropped the zero COVID policy it has relied on since early 2020, is just now seeing the full impact of the virus. Of course, we know little more about what China is experiencing now than we did back in 2019, but the reports are ominous. On this December 29th episode of the podcast, we're going to talk about what's happening in China and what impact it might have globally as we assess the current state of the COVID-19 pandemic. We'll also provide an update on COVID in the US, discuss the latest flu numbers and provide you with a prediction for the coming year. And for this final episode of 2022, we'll get an update from Dr. Jena, the only guest we've ever had in the podcast. But before we get started, as always, we'll begin with Dr. Osterholm's opening comments and dedication.


Michael Osterholm: [00:02:41] Thank you, Chris. And welcome back for all of you who are part of the podcast family to another episode. And to those who might be visiting us for the first time, we welcome you. We hope that we're able to provide you the kind of information that you find helpful. Today, we're closing out the podcast for 2022 and anticipating the podcast into 2023. I must admit at the outset that I wish there were a moment that today I could say, we don't need these podcasts anymore. The issues around COVID have been taken care of. We understand how to prevent it. It has now gone away by way of history into a horrible pandemic. But no longer are we concerned about it. I wish I could do that. I can't. And today, we'll explain why. For example, I think one of the most significant events that will take place with COVID throughout the entire pandemic, the three years that we've been in, is unfolding right now in China. And we're going to talk about that more and what that means. And we're also going to look to the future. We will do that carefully. We will do that with a very limited time scope since we really still don't understand what this pandemic is going to look like as it continues to unfold over the days and weeks ahead. But today, I want to start out with a dedication. It's a dedication that we surely have noted in the past, but it's one that never can be noted enough. And that is in light of our conversations with Dr. Jena today, you will hear about the ongoing challenges of being a health care worker with whether it be for COVID or all the other challenges we have in the health care system and how the mental health status of not only the health care workers but the spill over into their families is such a significant challenge right now.


Michael Osterholm: [00:04:31] If you look at recent studies that have looked at health care workers, they are among some of the worst of all occupational areas in terms of mental health status, burnout, post-traumatic stress syndrome, the sense of hopelessness in some cases. And so as a podcast team today, we dedicate this not just to the health care workers, but we also dedicate it to their families, the friends, the people who have had to be part of this whole experience just because their mom or dad or their brother and sister or their son and daughter happen to be health care workers. So this podcast is dedicated to you with appreciation. I know none of you want to be called heroes. None of you ever got into this area to do what would be considered heroic work. You just want to be good health care providers. And so we understand that. But we also want you to know how much we appreciate what you're doing, how you're doing it, and why this cannot continue to be a system that is dysfunctional. And I use that word carefully, but with real certainty. Our health care system today is largely dysfunctional, and I'll talk about that more in the podcast. And you, as health care workers, are the recipient of the challenges that go with that kind of health care system. So this is dedicated to you and your family and friends. Now, on the lighter note, we're going to move over to the light side of the world. And for all of you who live in Auckland, New Zealand, you know that in recent months I have been following your light length as your days have gotten longer and longer. And in fact, just on the 29th of December, you still have 14 hours and 40 minutes and 6 seconds of sunlight. Since the summer solstice you've just experienced on December 22nd, you've only lost 22 seconds of sunlight since then. So you still can enjoy that sunlight. But for those of us, the northern Hemisphere, now is our time to begin to celebrate. The days are getting longer. We can hold out on December 21st. Just to remind everyone, we had 8 hours and 46 minutes and 10 seconds of sunlight, our winter solstice. But by June 21st, we will actually hit 15 hours, 36 minutes and 51 seconds of sunlight. A very different picture than today, and we're moving towards that. So I have hope in the sunlight. And today part of this podcast will be about surely examining our challenges, but it's also about understanding what is our hope. And today in the Twin Cities, we will continue to celebrate the increasing sunlight length that we know is only going to get better every day. And for those of you in Auckland, we know that you will have several months yet of lots of light. And so it's a time for all of us to celebrate.


Chris Dall: [00:07:24] Mike, we're going to focus our international update today on China, because China right now is the biggest story and it feels like deja vu reading stories about overwhelmed hospitals, infected health care workers and patients lying on gurneys in ICU hallways. So I have two questions for you. China has vaccines, so why are we seeing this level of illness in the country? And are you concerned that new variants could emerge from this surge in infections?


Michael Osterholm: [00:07:51] Well, first of all, Chris, as you've described the situation in China, it in fact, is that and more, I believe that the next weeks to months in China will be among the darkest days of the pandemic. And I'll share with you why I believe that to be the case. What we're seeing in China is, in fact, I think, an example of the very worst in governance by any government in the world. What they're having happen right now is something that could have and should have been anticipated. As you may recall last January Zeke Emanuel and I wrote an op ed piece, New York Times, stating that what is happening now would happen if, in fact, the Chinese government did not take major steps to increase vaccination with more effective vaccines than they currently have, that the health care services were improved before they let, in a sense, as virus ripped through the population. They didn't do that. They literally continued to enforce zero COVID policy with no subsequent planning for what would happen if they removed it. And then, because of pressure from the population, realizing the economic issues that were present with these lockdowns occurring and extensive geographic areas of China, they just let it go. I can't imagine a more irresponsible action by a government of any government. And surely during the course of the pandemic, any government than what China has done now, they could have and should have anticipated that this was going to happen and there was so much that they could have done beforehand over the course of the last 12 months to greatly increase current immunization levels with better vaccines. They didn't do that. So, Chris, right now, China does feel like deja vu all over again, except this is a much more extensive situation. This is not just Shanghai. This is not just Wuhan. This is not just Hong Kong. What we're seeing right now is hospital hallways lined with patients seeking care and rampant infections among staff. And this is part of the growing norm in the country. I have had frequent contacts in the last two weeks with individuals in China, both from the business perspective and the media and getting reports on a daily basis of just what is happening. It is simply dramatic. So let's just be clear. Any time a system reaches the point that the Chinese system has, it is an unmistakable tragedy. However, with that being said, the true size and scale of China's outbreak hasn't exactly been all that clear due to less testing and the overall lack of publicly available information. Most of what we're hearing about now is coming from people who are getting information out from China, whether it be videos or web postings, etc. These are not part of the government. And I don't know how much longer will even be able to get these out of the country. At this point, the China's National Health Commission just formally announced that they're no longer providing daily updates. Indeed, the updates will only be made available once a month through the Chinese CDC. Absolutely irresponsible. So from that perspective, any comprehensive understanding of what's going on there, at least officially has gone by the wayside. Either way, when you consider that the official death toll in China since they moved away from zero, COVID on December 7th remains in the single digits, I think you can understand how unrealistic this particular number is. That does not relate to anything that we're seeing in actual activity in China. According to Chinese health officials, the virus is only considered the cause of death when it results in acute respiratory failure. In other words, it's a very, very narrow definition that doesn't account for many other conditions that COVID can prompt. That fact, combined with less frequent testing in the dismissal of deaths that occur outside of the health care setting, has essentially guaranteed that any death toll from China, as reported by the Chinese government, is absolutely unreliable. The same point was shared last week by senior officials of the W.H.O.. So clearly there is a disconnect separating the government data from reality and more. I talk to colleagues on the ground in China. I'm watching what I think is by far the most dynamic transmission of the virus since the pandemic began this past week in a study done in Beijing. The R naught, the number of people that any one individual is likely to infect, reached 16. Early days of the pandemic it was at two or three. This puts us in the same class as measles virus. This is a very dynamic situation. We've actually talked to business officials in China who have said that they have watched the numbers double every 1 to 2 days in terms of the number of their employees who are actually home sick with COVID. So clearly, there's a major disconnect separating the government data from reality. And in some respects, that's always been a challenge. It's why I've shared repeatedly that I have almost no idea what the case numbers mean anymore, whether you're talking globally or even here in the United States. In fact, if you look at the most recent global average for daily cases, it stands at 542,000. Meanwhile, a recent report from Chinese health officials featured estimates that around 248 million residents of China might have been infected with COVID between December 1st and December 20th. Now, how accurate is that? I don't know. But if it is, it would equal out to more than 12 million cases a day in China alone during that time. Yet the official global tally featured almost none of those with death. It's a similar situation. Globally, the daily average sits just shy of 1,900 deaths, the highest it's been in nearly four months. Yet the number doesn't account for the outbreak in China, which on paper has reported a total of eight COVID deaths since December seven. Absolutely not the case. Meanwhile, on the ground, as I've shared with you before, the reports of the challenges continue to flood in. I talked to a reporter yesterday who had firsthand knowledge of individual families who have had to wait 3 to 5 days before an ambulance would come and remove the dead body of one of their family members who had died from COVID. Funeral homes and crematoriums right now cannot even begin to keep up with the influx of the bodies. So the data doesn't match up at all with reality in terms of what's being reported. China is clearly demonstrating that first hand. But as I've noted, the stories and accounts from on the ground, whether it's from journalists or social media, from business contacts, shed light on what's happening. And it is a very, very dark situation. For example, hospitals throughout the country, including cities like Beijing and Shanghai, health care workers have shared accounts of packed emergency departments, much of which has been verified through video footage. In some facilities, 80 to 90% of the staff are currently infected. Yet in many instances, they're still expected to work. We have a report of one surgeon who was made to do surgery yesterday, even though he is moderately ill with COVID. Otherwise, to help cope, some facilities have postponed non-emergency procedures and retired health care workers have been asked to assist. Even that is not enough. The system is being overwhelmed. Regardless, all of this is happening against a backdrop. In which very few of the staff have had experience or training in treating patients with COVID. So to do a complete 180 and what probably felt like a moment's notice isn't easy. In fact, I would say it's irresponsible. And the challenges go beyond just staffing in a number of places, including the Hubei province. The supply of oxygen and fever medication has been completely outstripped by demand. Other medications like COVID have been authorized for use in China, but appears to be extremely limited in terms of availability. Given these conditions, one of the directors of the country's National Health Commission expressed publicly that the health systems in multiple regions are approaching a breaking point. So although it's only been a matter of weeks since China moved from zero COVID, you can see that the situation has grown more and more challenging by the day. But why is that the case, given they have vaccines? Again, I come back to the piece of zinc and I wrote in January. I hardly believe for a moment that just because Mike Osterholm and Zeke Emanuel write a piece in New York Times, it should change the world's view of anything. But there is more than adequate information that was available to the Chinese government that said, if you suddenly tear this zero COVID policy Band-Aid off the population, something that we said was never going to work anyway. But if you just do it immediately without other preparation, you will have a tsunami of COVID cases in China. What's happening? So let's take a look, though, quickly at the vaccine situation. For starters, we have known that the vaccines currently available, including the mRNA vaccines, don't provide complete protection against infection. And of course, when Omicron emerged, the effectiveness was further reduced. In addition, when you factor in the passage of time, with the peak protection declining in the months that follow a dose, i.e. when an immunity, you can see situations where the virus takes off. Even in a population with a relatively high vaccine coverage. The same thing is true in terms of recovery from infections. So even though 90% of the Chinese population has received at least two doses of vaccine, it's not going to stop the virus from spreading. More notably in the six months prior to the actual lifting of the zero COVID policy, less than one half of 1% of the population received a dose of vaccine. So this is really, really a challenge. Now, fortunately, vaccines do make a difference in terms of reducing the risk of severe outcomes. Well, as I've talked about many times, the vaccines that China has elected to rely on, CoronaVac and Sinopharm are both inactivated vaccines and the protection they offer is lower than we've documented with others, like the mRNA vaccines. As a result, the third dose, which you already know is important with the mRNA vaccines, is even more vital for those who have only had two doses of the inactivated types. Well, right now in China, there are 85 million individuals, 60 years of age and older, who haven't received a third dose and repeat that 85 million individuals, 60 years of age and older who have not received a third dose and many whom had their first two doses more than 6 to 12 months ago. In fact, 21 million of these individuals or at least 80 years old. So that could surely have an impact in terms of severe disease and death, especially when you consider that more than a year has passed since most of these people in this group likely received the second dose. That said, even a third dose of CoronaVac or Sinopharm is crucial. There's still some evidence that suggests it's inferior to other types. For example, a study that was published in the Lancet medical journal earlier this month out of Singapore found that elderly residents who received three doses of the Chinese vaccines were twice as likely to develop severe disease and 50% more likely to be hospitalized compared to elderly residents with three doses of mRNA vaccines. So although both vaccine types surely can reduce the risk of serious outcomes, there was additional protection among mRNA recipients. And although comparing relatively low rates might seem insignificant, even a slight difference can become a big noticeable issue. When you're dealing with a country that has 1.4 billion residents. Otherwise, I want to make it clear I'm not at all against the vaccines that China has been using. They no doubt can provide important protection against this virus. I just think the data demonstrates that China would have benefited even further had it authorized other kinds of vaccines and that they made sure that people were currently vaccinated not one year or two years ago. On this note, I just want to conclude by pointing out that 8 million Chinese residents who are 80 plus years old have yet to receive a single dose of vaccine. Again, let me repeat that 8 million Chinese residents who are 80 plus years old have yet to receive a single dose of vaccine. And much like we saw in Hong Kong, that's a glaring vulnerability. In fact, if you look at Hong Kong's data, which includes case fatality rates from the past year, broken down by age and vaccination status, you can see that 14.5% of unvaccinated individuals in the 80 plus age group who became infected with COVID died from their infection, 14.5%. Now, if you apply that same fatality rate to mainland China and the 8 million residents who fit these criteria, you could expect almost 1.2 million deaths if everyone were infected. So in summary, I think China is dealing with an extremely infectious virus that's quickly spreading through the population. And we're seeing it take advantage of some vulnerabilities that exist as a result. I think it's safe to say we'll see continued challenges to their health care system and significant levels of severe disease and death for some weeks to come. Otherwise, the approaching Chinese New Year, which is slated to begin on January 22nd and involves hundreds of millions of people traveling to their hometowns to spend time with family and friends could also have a major impact as well. Finally, in terms of the variance, each time this virus replicates, it's almost like another ticket for the evolutionary lottery as being purchased. In the grand scheme of things, the odds that a virus will mutate in a way that allows it to win the lottery are very small, but there's always a chance. And of course, the more tickets that are purchased, the better the odds are that you'll see a winner. So from that perspective, the outbreaks in China are surely providing many more opportunities for this virus to replicate. And as I've said many times in the past, I've always been concerned about what the potential variant might be on the horizon. That being said, beyond the standpoint of additional opportunities for this virus to replicate, I'm not entirely convinced that China has any unique characteristics that would somehow make it a special breeding ground for new variants. It's just a lot more transmission. One of the challenges we have is the population sets them apart from most of the rest of the world, and they haven't experienced a nationwide surge prior to this point. So now we can expect to see a virus that may have an R not of up to 16 spreading very quickly among 1.4 billion people in a very short period of time. Everyone needs to look at what might this mean, what is the stability of the Chinese government. In fact, if these large metropolitan areas literally begin to collapse with health care? We already saw the kind of public outcry when the zero COVID policy was actually put in place. Will there be more when people are dying in their homes without access to any health care? And how about the supply chains? We have to understand that with zero COVID policy, we had challenges and this is zero COVID policy closures on steroids. The whole entire country is now challenged to even keep essential workers on the job, let alone those who may be supporting supply chains. So let me just say, I don't know where this is going to go, but I can tell you it is absolutely bad. It is very bad. And it has implications for the rest of the world, not just the fact that it's a disaster unfolding in China, but between the variants, between what it'll do to supply chains and the economy. It is going to be a game changer. So overall, I think it's critically important that as a world we keep supporting and conducting the kind of genomic sequencing and surveillance work that's necessary to monitor what the virus is doing in China. I don't have a lot of faith. We will get information from China on these variants in a timely way. I hope I'm wrong and I hope that China understands and does support the kind of activities that will rapidly increase, if at all possible, the vaccination levels in the country that they are able to make more drugs available like COVID, that they can shore up their very fragile health care system at this crisis moment and that they do partake in the kind of activities around virus surveillance. I know they already have their hands full. The unfolding situation in China has every possibility to redefine this country like nothing has done in many, many, many, many, many years.


Chris Dall: [00:24:20] Mike, what about other parts of the world? Are there any countries or areas that you're keeping an eye on?


Michael Osterholm: [00:24:27] Well, Chris, with this virus, we have no choice but to keep our eye on the entire world. And although we are surely singularly focused right now on what's happening in China, we are monitoring other locations in the world that are also seeing challenges. For example, the Western Pacific is probably the most noteworthy region in terms of activity right now. Cases and deaths remain elevated in Japan and South Korea. In fact, the surge in Japan is basically guaranteed to become the deadliest since the start of the pandemic, with a current average deaths of about 290 to an all time high reached in early September 2022 was 293. In both countries, Japan and South Korea, BA.5 remains dominant. So that activity is surely a challenge. Hong Kong is lighting up again, while you may consider them part of China. Many have separated them out because of their previous surge activity. Cases there have been growing since early November, when they were only at 4,800 a day and are now at 19,130. And that same time, deaths have also climbed from single digits to now 43. As of now, overall, they're still well below their all time high that they hit this past March with 65,000 cases and 290 deaths a day, but still ranked number one in the world right now in terms of per capita case numbers. Finally, there are signs of growing activity in parts of South America. Countries like Argentina, Bolivia, Chile, Paraguay and Uruguay have reported increasing case numbers, but some delays and reported in a lack of sequencing data in these places make it very difficult to know how to interpret what is happening. If we look at the UK, we've seen a 36% increase in hospitalizations in just the last seven days. Deaths have basically been roughly the same for the past seven days with a 1.6% increase. France, on the other hand, is now up to 160 deaths a day. They were only at 46 deaths a day in September. So, again, the case numbers are going up. In short, what this is really telling us is we're far from over with this pandemic, as much as the world wants to be, it's not done. And we have to be mindful that in any one day we could see activity emerge again in any of these countries. And in light of what's happened in China, we should never lose that focus. Imagine last January when we wrote that piece in The New York Times and I had tried to lay out the disaster was about to hit China. People would have thought I was actually a wing nut. Probably you probably do anyway. But the bottom line is, is that we as a world never really fully imagined what this situation would look like in China. But we need to continue to focus on what the rest of the world might look like, given the immunity we have in the population, the effectiveness of vaccines, and what this virus continues to do to change. That's hard information to hear. People don't want to hear it. They want to be done. But all of my years in epidemiology tells me we are not done.


Chris Dall: [00:27:38] Here in the US, the seven day average of COVID-19 cases is around 73,000, with a daily average of around 40,000 hospitalizations and over 400 deaths. So we seem to be at an even higher high plains plateau than we were in the fall. Do you see that continuing over the next few months, Mike, or might it get worse? And how concerned are you about the XBB variant which has caused surges in other countries and appears to be picking up steam here in the US?


Michael Osterholm: [00:28:06] Well, to follow up on my previous comments about what's happening internationally, let me just say that again, we're part of a global viral world. And so the kinds of things we see happening in other countries with COVID surely have to be considered here. But let me just start out by saying, when you look at the national picture as a whole, it doesn't seem that the COVID situation has changed much over the past two weeks. Yes, hospitalizations are up 3% now at about 420 hospitalizations a day. Deaths are down about 4%. And case numbers, which cannot be trusted, as we've talked about many times, are down about 1%. Test positivity is up 14% compared to two weeks ago. That supports the fact that true case numbers are surely higher than the number of cases being reported. Well, this seems like a similar story we've been discussing for weeks. A more granular look at the COVID situation is necessary to capture what is really happening and what might be around the corner. Let me just provide some context, though, to understanding where we're at. Let me just remind you that we're looking at about 420 deaths a day. That's almost 150,000 deaths a year. As I shared in previous podcast, is this a significant number? Well, the number one cause of deaths each day in this country for cancer is lung cancer. And there we average about 350 deaths a day. Many of them are older individuals, much like we see with the COVID deaths today. And I don't know of anybody who would say that we're done with lung cancer. We've got it taken care of. And yet here we are seeing deaths substantially higher for COVID. So from a context standpoint of the shifting baseline analysis, where, again, comparing 420 deaths a day to what was 2,000 deaths a day earlier in the year is surely an improvement. It's surely better. But in fact it still is a real challenge. And I just have to add, I know this is a repetitive statement that for some of you say, just skip it, But I can't. These 420 deaths a day are somebody whose mother and father, somebody's brother and sister, somebody's son and daughter, somebody's aunt or uncle, somebody's best friend. These are not just numbers. And we have to keep remembering that that this is unacceptable in terms of where we're at right now. If you look at the ten states with the highest hospitalization rates per 100,000 population, seven of them are in the northeast, including Washington, DC. This is really concerning, Chris. We've had a shifting sub variant picture in the Northeast is now at the center of it. For the past couple of months we've been focusing on BQ.1, BQ 1.1 subvariants which rose to dominance together, but there's now a new subvariant in town. This new sub variant, XBB, now makes up 18.3% of the new cases in the US. BQ.1.1 makes up 35% and BQ.1 accounts for 27% of the new cases. Interestingly, and with some challenge, XBB is already dominant in the Northeast where remember it's home to seven of the top ten states with cases including highest hospitalization rates. While we can't say for sure that XBB is causing the rise in hospitalizations, it would not be a far-fetched assumption. New York was the first state to see XBB become dominant, and during the rise of XBB, there was a significant increase in hospitalizations, particularly among the elderly. With this in mind, I'm concerned that that might be the direction we're heading. The perfect storm is brewing in the US, and I'm afraid that these higher plane plateau numbers that we've had throughout most of the summer into the fall really will not be maintained. With friends and families gathering, people traveling, the very picture shifting. There's no telling exactly what will happen next. But I have a feeling it's not good. The XBB subvariant is quickly becoming a dominant variant across the country, and if the trends we've seen in the New York and Northeastern states region holds, we will see a concerning few weeks and months ahead. And it's at this time, I have to re-emphasize again the way we're going to most effectively deal with this is please, everyone was eligible for a bivalent booster dose. Get it now. It is not too late. In addition, please get your flu shot. We'll talk more about flu in a moment. But it's not too late to get those flu shots. Will both of these vaccines keep you out of the hospital? Will they prevent you from getting serious illness and even preventing you from dying? Not in all cases, but the protection is remarkable. The numbers continue to come in and you have a threefold higher risk of dying, particularly as an older person if you've not been vaccinated than if you have. I will take those odds any day of the week.


Chris Dall: [00:33:03] So, Mike, you just mentioned flu. What are you seeing in the latest US flu data?


Michael Osterholm: [00:33:09] Well, Chris, as you know, I've been critical of how I think the public health community in general and the media as a whole have handled the issue of this concept of tripledemic. Clearly, influenza is a very significant challenge year after year after year. I've spent almost 35 years of my career cutting my teeth on influenza in all aspects of the epidemiology and vaccine work. So make no mistake, I am very, very concerned about what influenza can do. But as I have suggested in the last several podcasts, I think we miss the call on influenza this year. Now, before you think I'm saying it's not a problem, let me be clear. Any time you see an increase in influenza like activity in a community, it's a challenge. But just as what we saw in the winter of the southern hemisphere, our summer months is what we're seeing here now there in Australia, in South Africa, in countries in South America, we saw this very early season onset of influenza, and this is where the misunderstanding occurs. What we mean by that is that, for example, in the United States, we actually follow influenza by surveillance Week, with week one being, of course, the first week in January, week 52 being the last week in December. And what we've seen for the first time is activity in week 41, 42 and 43, very early, not like we would typically expect to see it in the early fifties and in the first 1 to 5 surveillance weeks of the next year. And people kept saying, “Oh, this is the most activity we've seen in 20 or 30 years.” And therefore, “Oh, this is really bad.” Well, what we're seeing right now is what we saw in the southern hemisphere countries is very early increased incidence in kids with H3N2. Something we don't usually see is more H1N1. And then a very abrupt end to the actual surge in cases. And in the end of the flu seasons there, it turned out to be an average flu season. It's just occurred early. I think we're going to see exactly the same thing here. It's going to have been an early flu season, unlike what we've seen in many, many years. When you look at cumulative number of hospitalizations, when you actually look at influenza like illness surveillance, when you look at the kinds of virus isolations in our community and our public health laboratories. When you look at all these things, this is at best going to be an average flu year. So I want to just bring that point up, because there has been this misconception that this was a very different flu year. And there's a reason I'm bringing this up not to say, “Ha ha, you know, it's not all that bad.” It has been challenging. But for two reasons. One is what it was the root cause of the challenges that we had in our health care systems. And what I don't hear talked about by almost anyone is that we have basic reduced our health care system in this country to respond to surge capacity to almost zero. There have been several media stories that fortunately have tried to explain the fact that we've had such a reduction in the number of beds that are currently in our hospitals, particularly pediatric beds, because of reimbursement. We've seen a major loss of health care workers. We see 30% of our hospital beds today occupied by individuals who should be in long term care or stepdown care. But that's not available. So they have to stay in the hospital using up resources there. We've seen our emergency rooms literally become major mental health holding areas, particularly for adolescents. We've seen them overrun by other than emergency issues. In a sense, the system doesn't have the capacity to respond to almost any surge of some nature. And so, yes, when all these reports were coming out about how overrun hospitals were, they were. But it wasn't because we had a big increase in influenza cases. The same is true with RSV. To the extent that, yes, it was increased, it went up fast and it came down quickly. The one area in this country where we are most vulnerable is in pediatrics. Pediatric beds have been reduced at even a much greater rate than adult beds. And so the point that we need to address is why did that happen? We are going to see more average flu years challenge our health care system and we are not dealing with it. We have a 1968 Medicare financed health care system in this country that is broken and is not going to provide us with this surge capacity we need. So that's an important message. That's what we should be focused on. And very few people are. They'd rather focus on, oh my God, how bad it is with this surge. The second reason why this is important is if you have multiple respiratory transmitted viruses in a community, we're still trying to understand this concept of interference. Does one virus dominate in a way that holds back other virus transmission? And when you think of COVID right now with both RSV and influenza dropping dramatically in terms of case numbers, I think that is not good news for COVID. Not that I want to have flu or RSV in the community either, but I think it could surely provide an enhanced opportunity for SARS-CoV-2 virus transmission. So let me just say, at this point, I suspect that for the next few weeks, we're going to continue to see the influenza numbers drop. We're going to see RSV drop and does mean it can't come back. I'm the first to acknowledge there could be a secondary surge that we see that has happened in some flu years. We did not see it in the southern hemisphere this summer. It didn't. When it got done, it got done. The last point I was going to say is I think we need to go back and reexamine how we report out on flu numbers, particularly deaths. Most people don't realize that the number of deaths reported in the United States is actually based on a statistical model. Now, that statistical model is largely based on the fact that flu disproportionately hits the older age population, particularly with age three and two. That's not happening right now. Yes, it's there 6.1% of the nursing homes in a surveillance system in this country reported at least a single case. But I also think that when you have a season where it's primarily kids, primarily age three and two and kids, the death numbers may not hold. And I think this is going to be a challenge for us in public health to go back and reexamine our models, to say when you have a flu season like this, is it also representative in such a way that we report out 9,000 deaths, etc.? What does that really mean? And I'm not so sure that I think those numbers really reflect what's been happening.


Chris Dall: [00:40:11] Mike, you're not normally given to making predictions, but in our pre podcast meeting, you talked about a prediction you wanted to make for the coming year. So what is that prediction?


Michael Osterholm: [00:40:22] Well, as you know, Niels Bohr, the famous physicist, once said, you know, prediction is very difficult, especially when it's about the future. Now, that's been attributed to Yogi Berra and others. But if you go back, Niels is the one that really said it first. And so I fit very much into that category. Recognize the difficulty of prediction. But the prediction I want to make is one that is not necessarily going to be well received. But it's important because it should allow us to consider what must we be doing in the weeks and months ahead. And this prediction is that there is more than one surprise left up the sleeve of the SARS-CoV-2 virus, just as we're seeing in China right now, this unbelievable transmission thrust. People might have said six months ago that never happened. You know, they'll control it. And look what's happening. So my prediction is be prepared for new days with COVID. And I don't know what that means yet. I don't believe we'll go back to the large surges that we saw in the earlier days of the pandemic. But I also think we're going to have some surprises. And that means we have to keep an open mind. We have to be constantly asking ourselves, what do these data tell us? What we can't do is get locked into, well, this is the way we've always done it. So this is what will happen again. Look no further than just the discussion I had in influenza. How people all latched on to a concept that, Oh, this is a much worse flu year without understanding. No, it was a different flu year, but it wasn't worse yet. And so we have to keep in that mind also open for COVID. I don't believe we'll ever go back to restrictions, closing schools or anything like that. Don't think that will happen. The public won't allow it. But we may find ourselves challenged with increased hospitalization needs, ICU care, etc. So my prediction is expect the unexpected. It's going to happen.


Chris Dall: [00:42:26] As some of our listeners might recall on Episode 66 of the Osterholm Update, which aired on August 26, 2021, Dr. Osterholm spoke with Dr. Jena, an intensivist at a Twin Cities hospital, about her experience treating COVID-19 patients in the intensive care unit. During that interview, Dr. Jena, the first and only guest we've had on the podcast, told Dr. Osterholm, quote, "No amount of medical training can prepare us for what we're seeing in the ICU. Between the acuity of the illness and the sheer number of patients, we're dealing with situations we never imagined," unquote. But that wasn't all. She also talked about the anger and distrust that was being directed at her and her colleagues by patients and their families and the demoralizing effect he was having. Today, we've invited Dr. Jena back on the podcast to reflect on that experience and to talk about what the ICU is like now with COVID 19 now competing with other respiratory viruses. Dr. Jena, before I hand the interview seat over to Dr. Osterholm, I'd like to welcome you back to the Osterholm update.


Dr.Jena: [00:43:31] Thank you.


Michael Osterholm: [00:43:32] Well, thank you very much, Dr. Jena for being back with us. It is a real honor to have you. It's hard to believe that here we are recording Episode 121 for December 29, 2022. And you were with us way back in August of 2021. A lot's happened since then. At the same time, while a lot has happened, a lot of things have stayed the same. And today we really want to touch base with you and to get a sense of reality, both in terms of what's happening in the medical care delivery side of the house and just the sense you have in the community of what's going on with COVID and how people perceive it. If we look back over the course of the pandemic and we see that through 2021, we had recorded approximately 825,000 deaths in this country from COVID, a number that seemed unfathomable at the time. And yet in the last year, we've also recorded almost an additional 300,000 deaths. So this pandemic is far from done in many ways. And as we today we'll be talking about on this podcast, what's happening in China. We're all wondering what is the next turn in the pandemic, What will be the next curveball that will get thrown at us. So today, though, I want to start out with really some, I think, very basic questions that get back to who we all are individually. And I have to say thank you again for being with us. Thank you for your willingness to share what is, in some cases, difficult information to share. And I want to start out by just saying, how are you and how is your family?


Dr. Jena: [00:45:06] Well, right now I'm tired. I just finished a night shift in the ICU, but overall, I'd say I'm doing pretty well. I've been working really hard over the last year or so on my mindset and attempting to remain optimistic throughout this. I've come to realize that over the past two and one half years it's been very traumatic for myself and my colleagues were really burned out. In addition, many of us are suffering from PTSD. I was talking about this with my partner a couple of weeks ago, who was also a doctor mom, and we were discussing. One of the challenges we are all facing right now is that we work in a job that's very traumatic at baseline and has been even more so over the last two and a half years. But then we are expected to go home and live our lives like normal outside of the hospital. And that's a really challenging balance. Most people I know have moved on from the pandemic and are living life more similarly to their pre-pandemic life. But I think a lot of health care workers have yet to do that. I've had people say, “Well, you signed up for this”, but I didn't sign up to practice medicine in a pandemic. I wanted to help people get better from serious illness and help patients and families move through some of the most challenging times of their lives. I didn't sign up to practice medicine and a broken system with resource scarcity and staff leaving health care altogether. And that takes a toll on us who stay either because we choose to or we need to. I was also talking about PTSD with a nurse colleague recently, and she happens to be a military veteran as well. Having served in Iraq, we were discussing the similarities between PTSD after coming home from a war and the PTSD we are experiencing during the COVID pandemic. Many people can at least imagine that there's a significant PTSD associated with being a soldier in a war, but don't realize that there are many similarities when working in an ICU. This has actually been studied, but it's not widely known even by people who work in health care. And my family is doing pretty well. We seem to be getting hit with every upper respiratory tract infection that comes our way right now, except COVID, fortunately across my fingers, which is exhausting. But it's been nice for all of us who have to be able to see family and friends more frequently when we're doing well and feel safer about that. My kids are young enough that they don't really know life in any other way, so they're quite tolerant of events getting canceled, school shifting to online learning, wearing a mask and getting their vaccine boosters when they're due. But it's certainly a toll on all of us. And I think we're still in the process of figuring out how we will emerge from our pandemic life. My husband and children have been active over the last couple of years in helping people get vaccinated, too, and my husband's helped with the pharmacy of volunteer doing paperwork at all hours of the day and volunteering in the pharmacy. But we are finally now starting to do family activities that don't involve vaccine clinics only.


Michael Osterholm: [00:48:00] Thank you for that. Very thoughtful and frankly very moving explanation of where you're at and how you're doing. I have to say, though, when you think about the intensity of what's happening with you and the ICU, the entire health care system right now is very fragile at the very best. I know that there has been a lot of attention paid to recent hospitalizations with what has been called by some the tripledemic, a term I find not helpful. But if we look at the rates of hospitalization for influenza, they are not any higher than they have been in any normal flu year. It just occurred earlier. If you look at RSV, those numbers are up. But from a hospital standpoint, it's clear that this has just added to an overwhelming need for care that health care facilities around the country are just not prepared to do on a routine basis. So based on just where you're at, how are you? How is your health care system? And I don't mean to pick on any one hospital here, but just in general, how are we doing in terms of trying to respond to the care that our communities need?


Dr. Jena: [00:49:11] Well, as you said, we've been very overwhelmed with COVID over the last couple of years, but we've sort of moved from being overwhelmed with COVID patients to being extremely understaffed and unable to accept patients into the ICU due to staffing issues. So the stress of not being able to take care of patients like we want to is still there. There's also the problem of the inability to transfer patients to long term care facilities because of the lack of staff, which means that patients board in the hospital for a long time awaiting a safe discharge plan, then that delays patients coming out of the ICU once they're a little bit better into a general hospital bed and then keeps beds unavailable for patients to be admitted from the emergency department. They then board there, which completely overwhelms the emergency department, and they are challenged with managing both extremely sick patients and a much higher than normal number of patients. We've also been dealing with a lot of upper respiratory illnesses, as we all know about, especially if you have kids. During the high numbers of COVID hospitalizations. The children's hospitals are taking some of our youngest patients when we had a bed shortage and we are now offering to take teenagers that we can manage in the adult hospital to offload some of the volume at the children's hospitals. Fortunately, this seems to be improving a bit, however.


Michael Osterholm: [00:50:28] Well, when we look at where we're going from here and we don't know where we're going, I think as we have discussed in the past, much of society is over the pandemic. They're done. It's over with. But at the same time, we're still averaging 430 to 450 deaths a day. To compare that to another kind of measure that people may relate to, the leading cause of death on any one given day in this country for cancer is lung cancer at about 350 deaths a day. So here we're sitting above that. We're looking at potentially 15,000 new deaths next month. In thinking about that, how will health care providers continue to continue to do what they're doing? If we don't see an end date, we don't see it's going to expire on this date, the pandemic will be over. What are we doing to help you? What is the health care system? What are what are we in the public doing to help you maintain that kind of action day in and day out, even when you are experiencing post-traumatic stress?


Dr. Jena: [00:51:33] In short, I'm not sure. I've been working on my own wellness journey by attending retreats and conferences that focus on wellness and lean on my partners a lot. And we have a good support system. But I do worry about my colleagues. One group that has been extremely important to me throughout the pandemic is the Minnesota Physician Moms Group, and we've joked that the relationships that have formed there have been one of the few good things that have come out of the pandemic.


Michael Osterholm: [00:51:58] Well, we're all obviously very interested in hearing about the Minnesota Physicians Mom Group. As you know, I have a very personal interest in that, given that my daughter is a member of that group. And one of the things that I learned a long time ago, if you want to get something done, give it to a very busy person. They'll get it done. And I look to what your Physician Moms Group has done from helping to schedule vaccinations, moving vaccines around when they were very hard to get to outreach to all the things that you do and tell me when you consider what has happened with the Physicians mom group, what does that tell us about what we need to do today to support health care workers who are not moms or fathers or sisters or brothers? What do we need to do to help provide across all of health care a model much as you yourself have helped invent and that you have carried out with such incredible, incredible importance?


Dr. Jena: [00:52:54] One thing I've learned with these other physician moms is that we just really need to work together, which we've done really well. We've gotten to know each other really well throughout all of this because we have had to share resources both at work and also in our personal lives through some of the difficulties throughout the pandemic. We share information about where beds may be available or where the patient might get the best specific care that they need. We've also, as you mentioned, organized vaccine clinics from the ground up and have partnered with some amazing physician groups in the community and pharmacists to get vaccines rolled out to some of the hardest to reach groups. I'm really proud of what we've done with grit and determination, and I truly believe this work has saved lives. So I think just figuring out how to work together and really lean on each other and organize outside of the hospitals and our care systems has been has been really helpful.


Michael Osterholm: [00:53:55] If you had a message for the public health community, that group that should be trying to do everything to keep patients from ever ending up in your ICU, what would be the message that you would want to share with them today about what they can do to be most helpful?


Dr. Jena: [00:54:12] Well, I certainly hope that people will continue to get vaccinated and that we can more quickly vaccinate some of our most vulnerable, like those living in care facilities specifically. I also hope that we can truly learn from this pandemic, that we can be humble and realize that we are all vulnerable and do better when we actually work together to teach our children to think critically, to question in a way that seeks to understand and to be able to feel okay with uncertainty and being uncomfortable.


Michael Osterholm: [00:54:41] So if you had to get a message to all of your fellow health care workers right now, and I've already laid out less than positive news about the fact that the pandemic continues. And with regard to what's happening in China, we don't know if we're going to see another new variant come spinning out of there that could actually cause us to go through another cycle of surging cases here in the United States. How do you talk to your other colleagues about where you're at, what you've got to do? It's almost like running a race for which you can't ever see the finish line.


Dr. Jena: [00:55:15] I think we need to be open and honest with each other about how we're doing and check in with each other because this work is really hard. As I said at baseline, and it's been even more difficult now, we've had to be very innovative and flexible. And so I think that's very important. We are constantly assessing what's working and what isn't and changing to work within the resources that we have. We've throughout the pandemic have had to adjust what we're doing based on recommendations about COVID treatments. For example, as the data evolves and changes, we address our own staff shortages when we're sick or get stuck somewhere because airplanes aren't flying. To make sure that we're covered so that the ICU is well staffed. And because we have no wiggle room for holes in the schedule. I work in a large tertiary care center where we normally get a lot of patients transferred to us for a higher level of care. However, we are frequently at high capacity right now and that limits our ability to transfer patients in from some of the smaller hospitals and the more rural areas to help with this problem. My group has created a telemedicine program and these exist in other hospital systems as well to help with the doctors in the smaller hospitals to manage these patients when they're unable to transfer them to us. This lack of resources puts a huge amount of pressure on the physicians in these small hospitals who would not normally take care of such patients. So I'm incredibly honored and grateful to work with them, and it's been a really great connection between us and these community hospitals and the more rural areas.


Michael Osterholm: [00:56:52] Do you see any hope right now for people addressing the fundamental challenges in health care, where you have up to 30% of your patients in house because you can't move them out to long term care or step down, You have emergency rooms that are overrun and are now serving as basically holding areas for many with mental health challenges where you have such staff shortages. Do you see anything being addressed on a basically a national level, particularly at the institutional level, more than what physician moms can possibly do, even though they are incredible? There's only a limit to what you can do. But I wonder from your perspective, do you see at all the system being addressed that has helped get us to this place?


Dr. Jena: [00:57:41] I am worried about the rates of burnout in those who work in health care, and I'm worried about my colleagues and the burnout we feel. I feel that this is going to be the next public health disaster for decades to come, and we need to do something about it now. I don't know what that answer is, but I think a lot of things have been happening from the ground up to help make that better. We also need to focus on prevention of disease so we don't overwhelm our health care systems again. So people want to stay in health care and don't leave. This should be a lesson to us. Acute disease lays bare years of neglect of prevention. But what will it take to be proactive? I'm not sure right now.


Michael Osterholm: [00:58:23] Do you have any sense that the patients you're seeing today and their families are approaching the carrier giving in a different way? I know last time when you were on in August of 2021, I think for many of our listeners, what was so challenging was to hear you talk about the anger and the displaced, concerns about the care onto your shoulders when in fact you were there saving the lives of their loved ones. How is it now? What's it like?


Dr. Jena: [00:58:55] I think a lot of our patients and their families have a very basic understanding that the hospitals are very busy and they see everyone working really hard when they're there. So I would say almost 100% of the patients who in their families who are able to actually talk to me because a lot of my patients can't talk to me, say, I know you're really busy and I really appreciate all you're doing. And we hear that a lot more right now because I think people do feel fortunate to have a hospital bed right now and feel grateful for the care that they're getting because they know how busy we are. They know how burned out many people are. And many people have to transfer from a couple of different hospitals before they finally get to us. So I think the attitude has changed a little bit and people are a little bit less angry. Of course, that's us taking care of a different subset of disease right now to with fewer COVID patients in the hospital. But I think people are seeing it a little bit.


Michael Osterholm: [00:59:54] Among those patients that have COVID. Are you still seeing the major push by some for treatments like ivermectin, unconventional treatments that have been promoted early on in the pandemic, or have we kind of moved past that?


Dr. Jena: [01:00:08] We have had some patients recently ask for that. It doesn't come up very often anymore. But recently we did have a patient ask for ivermectin and hydroxychloroquine, which I hadn't heard in a long time. But we also have a lot fewer patients, so maybe that's part of it.


Michael Osterholm: [01:00:25] So, I think one of the things that is a challenge for us is what I call shifting baselines. When we were experiencing 2,000 plus deaths a day in this country. There was one standard of life, whether it be for care or whether it be for expectations, outcomes, etc. And now we're at 420 to 450 deaths a day, and it may seem like a great improvement was already discussed. That's still a challenge on the system that you didn't have three years ago where we had this number of deaths. If we continue to see this number or even an increase in this number, will that create any new changes in how you're providing care or you're just going to keep basically trying to take this care rubber band and stretch it as far as it can go and hopefully it doesn't break? What would be different if we continue to keep this number or even higher in the days ahead?


Dr. Jena: [01:01:21] Well, I certainly hope that we can get more staff to come back to our hospitals so that we feel less of a resource crunch and that we can all work less over the next year or so. So I can be home a little bit more with my kids and so that when I am home, that time with my family is more quality and I'm not stressed out and anxious and worried about getting COVID when I go to the grocery store, that sort of thing. I certainly wish that I could just make COVID disappear, but I realize that that's not a realistic thing. But I really hope that we can figure out a way to work together in our community and be kinder to each other so that we can all start to figure out a way to move through this post and into this post pandemic life, whenever that will be. I hope that we can get more staff at the hospitals, that we won't feel the crunch of resources as much, that we can all enjoy going back to work and feel proud of the work that we're doing. And I do feel proud of the work that I'm doing, but I just it carries a lot of stress and a lot of anxiety. And I, I hope that that can improve throughout the next year or so.


Michael Osterholm: [01:02:39] Well, let me just say on behalf of the podcast family, there's a large number of people out here. I know that they would all want to right now just give you a big hug and say, thank you. I've said this to you before, and I'm sure our listeners will chuckle when they hear this, but I have no plans to ever be in an ICU. But by God, if I am, I want you as my doctor because I know that I'll be in very, very good hands. So I just want to take this opportunity to thank you, thank you for who you are. Thank you for what you do. Thank you for all the sacrifices you've made for so many. And thank you for your clarity of purpose and how you are continuing to do this day after day after day. All I can say is, is that as a physician, mom, you represent the group very, very well. But more importantly, as the medical community, you are the face that we all want to see when we need the kind of care that you yourself are so uniquely able to provide. And so thank you. And I know you don't do your job for thanks. I know you didn't get into this business for things. You got into it for all the reasons that are about saving lives, etc. But on behalf of a grateful nation, I do thank you very, very much. So hopefully we aren't going to ask you to come back a year and a half from now again to talk. Not that we wouldn't want to have you back, but hopefully we won't have that need. Hopefully the pandemic will be over by that time and we can move forward. So thanks a lot. It means a lot to have you with us and we appreciate you so very, very much.


Dr. Jena: [01:04:12] Thank you very much. Thank you.


Chris Dall: [01:04:16] Mike, that was great hearing from Dr. Jena. And just a reminder to our listeners that we love hearing from you. So in the New Year, keep sending us those beautiful places and your questions to Mike what are your take home messages for today?


Michael Osterholm: [01:04:35] Well, first of all, I want to thank Dr. Jena for being with us. That was very special. She is an incredibly busy individual trying to be a state of the art intensive care physician, a mom, a wife, a community activist. And she does it all so well knowing full well that it's a challenge. So let me just say that it's a real honor and privilege to have her with us. And so thank you very, very much, Dr. Jena. And we wish you and all of your colleagues the very best in this new year. In terms of the summary points, I think number one. And maybe you could call it number two and three is that China is the biggest and no. One we have right now. It very well may be the darkest days of the pandemic since the pandemic began, just because of the sheer size of the population and their lack of preparedness and the infectious of this virus. So we just have to stick with it. We have to stay on top of it and understand what it means for the rest of the world. But at this point, trust me, this is going to be one of the most crucial moments in the entire pandemic to date. Number two is I just said with my prediction, expect the unexpected with COVID here in the US and around the world. But having said that, there are some very important recommendations. Please get vaccinated, get your booster dose for COVID, get your flu vaccine. It's not too late yet, but the time is wasting and you could be a case tomorrow. If you do develop COVID, make certain you have access to slow that if it's possible for you to take it from a medical standpoint. Please use that drug. It can dramatically reduce the likelihood of developing severe illness, hospitalizations and deaths, and it can also reduce your likelihood of getting long COVID. If you're in a public space or where you may be exposed to the virus, and particularly if you are at increased risk for serious illness wear your N95 and wear it tight. Don't listen to the idea of masking. I think one of public health's worst moments has been how they've handled recommendations to the public on masking. Very, very few people really understand the nuances of N95 and why it has to be worn a certain way. This is really an important situation in terms of protecting yourself, I have to say, you know, I'm knock on wood, I continue to remain COVID free. My partner does. And we are very careful about being in public settings without our respirators, we wear them. Finally, I would just offer a moment of practicality, which surely is getting the test of time may fail tomorrow, and if it does, I'll report back to you. But if you want to get together with friends and colleagues, family, follow these rules. Number one, you can have no exposure to a COVID, No. One case. And the three previous days before you get together in this event, this activity, any potential exposure rules you out. Number two on the day of the event, any symptoms, including sniffles, any kind of allergy like symptoms just qualifies. You're out, you can't get together. Number three, test with the home test kit in the 4 to 6 hours before the event and you have to be negative. Now, will this guarantee that someone is not going to come into that setting and transmit the virus? No, I can't say that. But so far I have enjoyed an increasing number of holiday contacts and increasing number of friends and family together in a way that this worked so far. Even though I know in our community right now there is widespread COVID transmission. I can honestly say that none of the people who have participated in these activities have turned up as cases. So get vaccinated. Make yourself available for slow. But if in fact you get infected, wear N95 in public places and use a screening method I just talked about that may very well keep you from getting COVID. And finally, the last piece I want to leave you with is. I choose at the end of this year to reflect back and say it's been a tough year, particularly when you look back at the early days of Omicron in January. But when I look forward to the next year, as much as I do expect the unexpected. I look to that year with hope. I hope that we can, as a world, come to some level of control, of some level of living with COVID that we can, in fact, say that the pandemic is ending. Now, that may be a pipe dream, but I believe in hope. And I think that right now that's where I see us at.


Chris Dall: [01:09:39] And do you have a closing song or a poem for us today, Mike?


Michael Osterholm: [01:09:43] Yes, Chris, in light of my previous answer, I do have a song and it's one that is in a sense about hope. It's about dreaming, and it's one that I want to start the new year with. I'm going into this new year with hope. This particular song, which is very near and dear to my heart, has been used twice before. In episode 35, the last mile to the last inch on December 10th, 2020 and Episode 78 Breakthrough and Boosters on November 18, 2021. The music and lyrics were written by Paul Williams and Kenneth Asher and performed by Jim Henson as Kermit the Frog. The 1979 film The Muppet Movie. I'm sure you now know what the song is, is the Rainbow Connection. The song reached number 25 in the Billboard Top 100 and remained in the top 40 for seven weeks. The song was nominated for Best Original Song at the 52nd Academy Awards and the American Film Institute named Rainbow Connection. The 74th Greatest Movie song of all time. Notably, it was actually recorded by 31 additional artists, including the likes of Barbra Streisand, Kenny Loggins, Johnny Mathis and Judy Collins. That tells you, I think, a bit about the staying power of these words. So here we are. The Rainbow Connection. Why are there so many songs about rainbows and what's on the other side? Rainbows are visions. They're only illusions. And rainbows have nothing to hide. So we've been told in some shows to believe it. I know they're wrong. Wait and see. Someday we'll find it. The rainbow connection. The lovers, the dreamers and me. Who said that every wish would be heard and answered. Wished on the Morning Star. Somebody thought of that and someone believed it. Look what has done so far. What's so amazing that keeps us stargazing. And what do you think we might see? Someday we'll find it. The rainbow connection. The lovers, the dreamers and me. Have you been half asleep and have you heard voices? I've heard them calling my name. What brings the sweet sound that calls the young sailor? I think they're one in the same. I've heard it too many times to ignore. It is something that I'm supposed to be. Someday we'll find it. The Rainbow Connection. The lovers, the dreamers and me. Thank you again for being with us for this podcast. As always, we welcome your feedback, how we can improve it, how we can make it more meaningful to you. I want to thank the podcast staff for helping us assemble all this information and to be able to provide you with the latest in what we know about what's going on with this pandemic. I also just want to leave you with the sense of a happy, happy New Year and hopeful for the future. These are challenging times with regard to COVID. Is it a problem? Is it not what's happening? What's not happening? But I think the bottom line message is we're not done. But there's so much we can do to reduce its risk. So thank you so much for being with us. Thank you to all the health care workers and their families and what they have had to sacrifice to make it possible to treat us. We're all thinking about what's happening in China and so many individuals who are now so severely impacted by COVID who by none of their own fault have been put into this situation. And I want to commit to the fact that a year from now, we will do everything we can to make this podcast not needed, that it's beyond the information needs of anyone in the community because we've handled COVID. So have a happy New Year. Be kind. Be kind. If there's anything you can do for a New Year's resolution this year. Dedicate yourself to doing one kind act a day that you otherwise wouldn't do. Be kind and be thankful. The fact that we are together here, I'm very thankful. We so appreciate you as the podcast family. Happy New Year.


Chris Dall: [01:13:59] Happy New Year, everyone. Thanks for listening to this week's episode of the Osterholm Update. If you're enjoying the podcast, please subscribe, rate, and review, and be sure to keep up with the latest COVID-19 news by visiting our website This podcast is supported in part by you, our listeners. If you would like to donate, please go to The Osterholm Update is produced by Cory Anderson, Meredith Arpey, Elise Holmes, Sydney Redepenning, and Angela Ulrich.