January 12, 2023

In "Shutting Down Misinformation," Dr. Osterholm and Chris Dall discuss the state of the pandemic in the US and around the world, China’s struggle to keep up with its dramatic rise in COVID cases and deaths, and the vaccine misinformation that is spreading on social media.

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Chris Dall: [00:00:06] 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 Dahl, reporter for CIDRAP News. And I'm your host for these conversations. Welcome back, everyone, to another episode of the Osterholm Update podcast. And Happy New Year to the podcast family. As we begin this new year, the pandemic storyline is taking on a familiar feel. Many people in the US and other parts of the world are ready to be done with the virus, but the virus continues to let us know it's not done with us. The latest reminder of that fact is the Omicron subvariant XBB.1.5, which World Health Organization officials say is the most transmissible version of the SARS-CoV-2 virus yet. The world may be in a better place in terms of managing COVID-19, but the virus is ability to keep collecting mutations that help it evade our immune defenses suggests this pandemic may have a longer tail than any of us had hoped. And with the virus now exploding in China, the threat of future variants remains ever present. On this January 12th episode of the podcast, we're going to talk about what's happening in China, the US and other parts of the world as we assess the state of a pandemic now entering its fourth year. We'll also look at what we know and what we don't know about the XBB.1.5 variant. Answer a question about suggested links between COVID-19 vaccines and variants. Address some COVID-19 vaccine conspiracy theories and share a beautiful place from one of our listeners. But before we get started, as always, we'll begin with Dr. Osterholm’s opening comments and dedication.


Michael Osterholm: [00:02:00] Thanks, Chris, and welcome to all of you to today's podcast. In particular, I want to welcome back our podcast family. You know who you are. You are a part of a very special relationship that we here at CIDRAP and our podcast team have with you. And I'll talk more about that in a moment. I also want to welcome those who might be with us for the first time. I hope that we're able to provide you the kind of information that you're looking for that's actionable, that has some meaning to you. We surely will be covering a number of topics today. And in the light of my comment I just made about the podcast family. I just want to share with you that over the holidays and into this new year, I had a lot of opportunities along with our podcast team, to reflect on what it is that we do with each one of these podcasts. And it was clear and compelling the importance that you, the podcast, family play in these podcasts, your emails, your letters, your cards, your feedback, your support, your thoughtfulness, your hopefulness. And in many instances, you're just straightforward, critical comments about what we can do better all reflect on the very best of truly being a family. And I realize that most of you will never meet each other. You will not know who you are. You will not appreciate the fact that you share in something that we do here together. But I want to let you know that you do know you're part of that family. You're part of that group of individuals that feel, think and hope in a similar manner and for all the right reasons.


Michael Osterholm: [00:03:42] And it's for that reason that today we dedicate this podcast, the entire podcast team does to you the podcast family. We can never say it enough. We can never say it with enough conviction. We can never say it with the heartfelt feelings that we have for how much we appreciate the podcast family. This podcast today is dedicated to you. Now, on another very bright note, let me say that today here in January 12th in Minneapolis, Saint Paul, we will have 9 hours, 4 minutes and 44 seconds of sunlight. We are gaining one minute and 35 seconds every day. And in fact, since December 21st, when this we only had 8 hours and 46 minutes and 13 seconds of sunlight, we've gained over 18 minutes. Now, we appreciate that our dear friends and colleagues in Oakland are still lavishly enjoying the sunlight of their summer. Today in Oakland, they'll have 14 hours, 28 minutes and 37 seconds of sunlight. But they're starting to lose it. They have lost it on an average of one minute and 9 seconds a day since their summer solstice, our winter solstice. And I just want to remind them that please send a little sunlight our way and we'll return the favor come a little later this year. And, of course, I must give a shout out to my dear friends and colleagues at the Accidental Belgian Beer Garden on Vulcan Lane in Oakland. And I hope to see you one of these days. Again, thank you to the podcast family and welcome to another session.


Chris Dall: [00:05:20] Mike, we'll start today's international update once again in China, which appears to be a house on fire. According to The New York Times, officials in Shanghai said last week that up to 70% of the city's 26 million residents had been infected. And that, of course, is just a fraction of China's population. What's your assessment of what's going on in China?


Michael Osterholm: [00:05:39] Well, if you think about it, Chris, it's only been just over a month since China moved away from a zero COVID policy. And while things clearly were already smoldering before the sudden shift away from control measures, much of which happened on December 7th, essentially open the viral floodgates. So really, it didn't take long whatsoever for them to become the house on fire that they are right now. And remember, this was predictable. It was a year ago. Right now, the Zika manual. And I wrote an op ed piece in The New York Times stating that very fact that they could not bring all Macron under control with zero COVID policy, and that if they were going to relax that policy, which inevitably they had to do that, at the very least they needed to prepare their country for this viral tsunami. They didn't do that. Less than one half of 1% of Chinese residents were vaccinated in the six months before they removed zero COVID. In addition to that, the vaccines that they had used were obviously not up to the same standard and level of protection that ours were. So this is really a very painful situation that at least a large part of it could have been avoided had the Chinese leadership anticipated this very situation. So but right now, what we know about Omicron and its infectivity, coupled with all those susceptible people that China has, is not at all surprising. We're seeing what we are.


Michael Osterholm: [00:07:08] In fact, I'd argue that the predictability of this reality they're facing only makes the situation feel even more tragic. However, that said, the true extent of the damage thus far has been very difficult to assess. At this point, it's safe to say that the official numbers coming out of China mean virtually nothing. Nothing. Testing is now an exception rather than a norm. And over the past month, the Chinese will officially report a total less than 40 COVID deaths combined. Of course, one of the reasons for this low count is the extremely narrow definition they're using to classify COVID deaths. In other words, to be counted, a person has to both test positive and subsequently die from respiratory failure. But obviously that means you're missing anyone who didn't get a test. In addition, it fails to account for deaths that happen outside of the health care setting. And finally, as we know, COVID can wreak havoc across multiple organ systems of the body, which means that focusing on respiratory failure alone will always lead to inaccurate numbers. So that's been a challenge. And I think it speaks to the recurring notion of limited transparency out of China. In fact, similar concerns have been shared by US officials and even the W.H.O., prompting China to push back a bit. But so far there hasn't been any clear effort taken to show what's actually happening. When asked about the death toll, one leading Chinese official said an official investigation would be conducted, but only after the wave was done.


Michael Osterholm: [00:08:35] Likewise, there are reportedly some analyzes that Chinese public health agencies have been conducting on metrics like excess deaths, but nothing has been released since the start of the search. So owing to the lack of comprehensive data, we still mainly are left relying on anecdotal accounts. Nonetheless, they all basically paint the same picture with widespread infections, jam packed hospitals, funeral homes and crematoriums struggling to keep up with the sheer number of bodies. By and large, the journalists in China have done an incredible job providing some sense of what's happening there, whether it's through interviews, stories, pictures or videos. And in fact, the same New York Times article you mentioned, the lead up to your question, Chris, which spoke to the estimated size of Shanghai's outbreak. There are now more than a dozen pictures included in that article. Many show hospital hallways and lobbies lined with patients. Others show families mourning. I've had an opportunity over the past several weeks to talk to a number of journalists who are in China who are actually the primary source of information and sharing what is happening. In addition, we've heard from several private companies that have operations in China. And their observations validate everything I just shared with you about what's happening. Quite honestly and frankly, painfully. There is no way of hiding the situation at funeral homes and crematoriums. In areas hardest hit, many have run out of room to store bodies, even as the incinerators used for cremation operate 24 seven around the clock.


Michael Osterholm: [00:10:09] As an example of just one, funeral home in Beijing is currently cremating about 150 bodies a day, which is almost four times higher than its usual average of about 40 a day at a different facility. Memorial services are no longer being offered for family and friends of the deceased. Instead, loved ones are now given just a couple of minutes to say their final goodbye before the body is moved along for cremation, all in an effort to simply maintain operations. It's a very moving experience to see satellite images of crematoria. Funeral homes in China, where just a month ago there's hardly any vehicles parked near the facilities where today they've had to carve out whole new parking lots, almost, as we would say in our country, block by block wide, just to accommodate those waiting in line to have their loved ones cremated. We have heard of individuals who have had to stand in line for hours and then pay extra money so that they could get their loved one in line for cremation. This is truly a tragic situation. And as awful as all this sounds, there are even further examples of funeral homes that can no longer keep up at all. According to a story published in The Washington Post, one resident of Shanghai whose 60 year old father died of COVID, was told by a funeral home that they couldn't make arrangements to cremate for five days due to the number of people already waiting and tell them they were expected to keep the body at home.


Michael Osterholm: [00:11:34] In the end, he managed to avoid the five day wait, but that's only because he stood in line outside a funeral home from 9 p.m. that night to 8 a.m. the next day. Eventually, his father was cremated or given, though at a different site with no family members in attendance. And similar circumstances have almost become the norm throughout all of China. In fact, the lines outside of some funeral homes have grown so long. The scalpers are reportedly selling spots in line for hundreds of American dollars. So even with the lack of official data coming out of China, it's abundantly obvious that they're dealing with a massive wave of COVID and there is no shortage of serious illness or death that's occurring as a result. And with that, we've seen various estimates of the morbidity and occasionally mortality. One example which you mentioned in the lead to your question, Chris, is that 70% of Shanghai's population, meaning more than 18 million people have been infected. According to a different estimate, 80% of Beijing was infected by the end of December. And finally, another suggests that 90% of Henan province was infected this past month, which would be equivalent to almost 90 million cases on its own. Now, I'm not sure how exactly they're getting these numbers, and I really can't speak to how accurate it is.


Michael Osterholm: [00:12:51] But it's clear this virus is finding plenty and plenty of hosts in China. And any time you're dealing with numbers in the tens, even hundreds of millions. A simple 1% or just a fraction of 1% is also a significant number. So with that in mind, I think the death toll in China is very substantial. In fact, as of Monday, a health informatics company based out of the UK projected almost 19,000 people were dying each day from COVID in China. While one could argue that it's not exactly a fair comparison, the highest daily average of deaths reported worldwide was 14,700 in January of 2021. Around that same time, the US was reporting a record high death toll, which reached 3310. So let me just emphasize again, if in fact the estimate of 19,000 people plus dying each day from COVID in China, it literally dwarfs the numbers that we've seen before, where the highest number of deaths recorded for the entire world back in 2021 is 14,700 or for our own country of 3310. So as you can see, China is only now just seeing its darkest days of the pandemic. And although there's speculation that things have possibly peaked in certain hotspots like Beijing, I have no doubt this virus will continue to spread widely in the weeks and months ahead, including in the rural parts of the country. Remember, China's lunar New Year is set to kick off in the next two weeks, and many, many individuals will be traveling back to their hometowns from the large cities to visit with family and friends.


Michael Osterholm: [00:14:28] Pre-COVID this holiday was actually considered the world's largest annual migration of humans with billions of trips taken. And in fact, this year it's anticipated that around 2 billion trips will be made again. So there is plenty of opportunity for this virus to extend its reach in China, and that could signal a disaster for so many rural parts of the country that lack any kind of effective health care system. So as bad as things are for China right now, it could even get worse. If there is anything that might bear some semblance of the silver lining in this situation is that the ongoing absence of any new, highly divergent variants have cropped up in China. Of course, it's true that the lack of testing, let alone sequencing, can inherently limit what we know about the virus and how it's evolving. Most recent sequences out of China are BFR seven. In other words, this is a subvariant of crime that was outcompeted by others like BQ or XBB in multiple countries, including right here in the United States. So it's not one that will drive a global wave from its current form. But regardless, it will be important to keep monitoring the variant picture as this virus continues circulating in China. Harshly at these pandemic high rates that we've never seen before.


Chris Dall: [00:15:43] Mike, are there any other countries seeing a significant uptick in activity?


Michael Osterholm: [00:15:48] Well, that's a really important question, Chris, but at the same time, it's a challenging one. I feel like, again, I'm back to my crystal ball with five inches of cake mud. And the reason I say this is because it feels like more and more countries are changing or even completely dismantling some of the systems they had in place, which provided at least some sense of what's happening in terms of COVID in those countries. Clearly, we've seen testing taper off, particularly when it comes to PCR testing. And that, coupled with increasing reliance on at home tests, has left us flying somewhat, if not almost completely blind in many areas when it comes to COVID activity. In addition, some places have also gone on to adjust their approach to reporting, such as changing the type of data collected or simply just reporting data less frequently. So in some ways it feels like we're not only flying blind, but we're also doing it in a plane with defective equipment, including gauges, meters and sensors that might otherwise give us at least some sense of our position. And unfortunately, that trend, or in other words, stagnancy, doesn't seem to be slowing down. In fact, one of the major concerns that we're facing right now is the continued decline in sequencing data worldwide. For example, since the start of 2022, the number of sequences uploaded to the international repository for this information has dropped by 90%. So not exactly what you want to see if you are having any hopes of effectively monitoring how a virus like SARS-CoV-2 is evolving.


Michael Osterholm: [00:17:22] Regardless, the main point I'm trying to get across here is that I really don't know what's actually happening in a lot of places. And so it's difficult to conclude which ones are seeing a notable rise in activity or which are seeing decreases. Now, with that disclaimer out of the way, I'll share some examples of different places that we've been keeping our eye on. But first, let me start with the international picture as a whole, since I think in some ways it helps illustrate what I just got done talking about. Remember, these numbers really don't reflect what's happening in China in terms of cases. Globally, we're reporting an average of around 475,000 cases a day, which is down 13% in the last two weeks. Now, you and I both know that I put very little stock in actual case reports. Meanwhile, data that is more meaningful daily deaths are now approaching 2700 a day, which is up 42% compared to the levels reported just two weeks ago. Now, obviously, deaths are a lagging indicator, but if you compare these latest trends with cases, you can see this apparent disconnect between the two, meaning the rise in deaths wasn't necessarily preceded by a similar rise in cases. And again, I think this really illustrates the difficulty of interpreting what's going on. That said, if you look at the places contributing most to the upticks in deaths, there are some familiar names that appear at the top of the list is the US, which is reported in an average of 580 deaths a day, around 22% of the global total.


Michael Osterholm: [00:18:55] Otherwise, Japan is second with an average of 352 deaths and the UK is third with an average of almost 300 deaths a day. Now, for the most part, it looks like the Western Pacific region is still home to the highest number of hotspots, which has basically been the case for the past couple of months. Obviously, we've just touched on what's happening in China, but in addition, there are places like Taiwan, Hong Kong and of course Japan that are reporting high levels of activity. For example, in Taiwan, once seen as the model for a country's response, cases have gone from 14000 to 26000 just in the past month, and deaths have now climbed from 25 a day to more than 40. In Hong Kong, cases of recently climbed from 5000 to more than 23,000 a day, and deaths have spiked from single digits to nearly 70 a day. Fortunately, there may be some signs of a possible peak in Hong Kong this past week. And finally, Japan remains in a rough spot with cases back at 170,000 a day, despite previous signs of a temporary decline. In addition, deaths are at a record high 352 a day and only continue to grow. For context, their previous all-time high was 293 deaths during the first bar five wave this past September.


Michael Osterholm: [00:20:18] So here they are to 93 versus now at 352. So in terms of hotspots, I think the Western Pacific region remains a focal point. Otherwise, let me point out some places that have seen an increase in deaths that haven't necessarily been mirrored in preceding rises in cases. One example is the U.K., where deaths climbed from 60 a day in early December to 150 a day this past week. Now, this did follow an uptick in cases, but nothing significant. Relative to previous points in the pandemic. But perhaps most striking are the trends out of some of the Scandinavian countries, like Finland and Sweden. Remember the countries that also, again were heralded as having responded the right way to COVID? In these places, deaths have climbed at rates that are far higher than what you might expect given the general steadiness of cases. For example, Finland's cases were basically a flat line from October to December, and if anything, they actually slope downward. Otherwise, the deaths there approached an all-time high. Why the disconnect? Well, there could be a variety of factors contributing, but suffice it to say, we can't imagine or pretend our way out of this. COVID is still a major public health challenge whether we elect to test for it or not. If anything, this complacency only adds additional challenges. And ultimately we shouldn't be assisting a virus that's already so far ahead of us, no matter where it's at in the world.


Chris Dall: [00:21:48] Here in the US, the seven day average of COVID-19 cases has been hovering between 65,070 thousand for the past few weeks for whatever that's worth. While hospitalizations continue to climb and we're still seeing between 304 hundred deaths a day and the XBB.1.5 subvariant is picking up steam, particularly in the Northeast, where the CDC estimates it's accounting for more than 70% of new cases. Mike, could we expect to see a significant uptick in all COVID markers as XBB.1.5 spreads across the country?


Michael Osterholm: [00:22:19] Chris, again, I need to add some context to what I'm about to say with regard to the cases here in the US. Again, I woke up this morning to that crystal ball with five inches of caked mud, and this was every time. Now is the time to have a sense of humility about what might or might not happen. Let me just remind you before I say anything about what's going on in the United States with the XBB.1.5 is what happened back to us in the December 2020 January through March period of 2021. You may recall we saw the alpha variant emerge in Europe late in 2020, and it was wreaking havoc much more highly infectious. People were surely dying at a much higher rate than had been previously documented in the pandemic. And so the people like myself and others said, “Hey, we've got to get ready for Alpha.” It's going to potentially be a major challenge in our country. And why not? We're seeing it happen in other places in the world. Well, as you may recall, we did see it wreak havoc in the United States, but in only two states, Michigan and Minnesota. Why? What was different about Wisconsin or Iowa or North or South Dakota or Ohio or Illinois? What was different? We don't know. And as much as it seemed predictable that Alpha would wipe through the United States, it didn't. So I'm always left with lessons learned in everything I do with COVID. And I'm sitting here with my humility saying, well, you know, right now we're going in a concerning direction with cases, hospitalizations and deaths. They're all increasing, as you just noted, compared to two weeks ago. Hospitalizations are up 17%.


Michael Osterholm: [00:24:06] The percentage of patients in the ICU are up 15%. Deaths are up 10%. And test positivity, for whatever it's worth, is up 14%. None of this is good news. And with an average of more than 47,000 people hospitalized with COVID in a given day, hospitalizations are the highest they've been since February of 2022 at the tail end of the Macron surge. And we're just repeat that today. We're seeing 47,000 people hospitalized with COVID in a given day. These are the highest numbers since February of last year. Now, why do I add this context about Alpha? Because it appears that the subvariant picture that's really having an impact in this country is XBB.1.5, which now makes up 27% of all new US cases, while BQ 1.1 makes up only 34% and BC 2.1 accounting for 21.4%. Bottom line is what we're seeing is XBB is surging in a dramatic way, particularly in the Northeast, which is also the area of the country leading in terms of these horrible numbers of hospitalizations, ICU bed use and deaths. So the question is, what will happen with the rest of the country? Will we see it spread throughout the rest of the country? Could we be in for another? What I guess I would call moderate surge of cases. Remember, I've talked over and over again about shifting baselines. When we think about where we were with Omicron and we had up to 3300 deaths a day. We are surely a much better place today with 580 deaths. That concept of a shifting baseline where in fact at one point things were so bad that at 580 deaths a day, it doesn't seem so bad.


Michael Osterholm: [00:25:52] But let me remind you that when you want to make a comparison about the impact of COVID and death today, I keep coming back to cancer, the number one cause of death for cancer in the United States on any one given day is lung cancer. And that average is about 350 deaths a day. So it gives you some relative sense of where we're at with COVID and will actually be results in a surge, not just in the Northeast throughout the rest of the country. I don't know. But I think one of the things that is very clear is this virus is not done with us yet. You've heard me say that time and time again. How many times do we have to say it before it becomes actually a believable fact? Just look back on the last three years. So I don't know where we're going to be in six weeks. We could see major challenges in parts of our country with ZB 1.5 or not. I don't know. What I do know is this virus isn't done with us and so we have to maintain our protection against it. And this comes back to getting your vaccines, getting your booster doses, making sure that you have access to COVID or another drug if you get sick. And, of course, wearing your N95 respirator, not just a mask, an N95 respirator. If you're in public locations where you might get exposed to the virus there at this point. Hold on. We're not done with this virus in this country yet. I wish I could tell you with more clarity what that means. I can't, but I surely can tell you we're far from done with it.


Chris Dall: [00:27:32] So what do we know about XBB.1.5 at this point? Beyond being more transmissible. Do we know if it causes more severe disease?


Michael Osterholm: [00:27:40] Gross At this point, we just don't know what XBB.1.5 is going to do. It is part of the sub lineage of XBB, which was a recombinant variant of the BA.2 lineage. This is what caused a big surge of cases in Singapore. Now, those cases did drop, but then again, the number of cases in Singapore have actually dropped substantially since that initial surge. We also do know that XBB.1.5 likely originated in the northeastern part of the United States, possibly in the New York City area. And it quickly became very dominant there. It has a high level of immune escape as well as a high level of infectivity, meaning it can better attach to human cells. As I hinted in the previous answer of the ten regions in the US, XBB.1.5 is dominant in two. Both the Northeast, it makes up double digit percentages in three additional regions, primarily on the East Coast. While it grew in prevalence quickly in the Northeast. It has not spread across the rest of the country as rapidly. As I noted, our situation here in Minnesota. It accounts for a single digit percentage of cases in half of the US regions, which are mostly the Midwest and the West Coast. But now to answer your question, Chris, as far as severity, there's currently no evidence that XBB.1.5 causes more severe disease than other subvariants. Obviously, this is a new subvariant and there's still a lot to learn. But for now, I think this is good news. However, this is nothing to celebrate. Just because it does not cause more severe disease does not mean that it doesn't take away from the fact that by being more transmissible it can lead to a surge in cases reinfections and ultimately result in hospitals being overwhelmed yet again.


Chris Dall: [00:29:23] Mike, you mentioned vaccines a little earlier, and there are three pieces out this week in the New England Journal of Medicine, two research letters and a commentary that suggests the bivalent COVID-19 vaccines may not elicit a much better antibody response to the new variants compared with the original Monovalent vaccine. What do you make of this?


Michael Osterholm: [00:29:41] Well, let me begin by saying, I think that the publication in the New England Journal of Medicine of these two letters is very important. It's information we need to hear and to talk about. But I do think that the commentary published in the New England Journal with these two letters by Paul Offit was not responsible. And I fear that it will serve as a reason for people to promote misinformation about the vaccine. Let me be really clear that we all had questions early on that if we went to this new bivalent vaccine, the BA.5 vaccine, that we didn't have data to say that it would be better than the previous Wuhan ancestral strain vaccine. But in fact, there are a number of studies beyond the two that were published in the New England Journal of Medicine that assess, for example, the neutralizing antibody to the bivalent booster vaccine compared with the original Wuhan strain. And these were not included in any of office commentary with regard to the New England Journal of Medicine. And if you look, there are now eight reports, five actually used live virus, which is a far more reliable assessment than the pseudovirus that were used in the two studies that were actually reported on in the New England Journal of Medicine. I know this may seem over your head about pseudovirus or regular. Just trust me that in fact it has some relevance here about how well you can measure how the vaccine will cause a response in a human.


Michael Osterholm: [00:31:10] And of these five studies, they all converged on the Bivalent superior neutralizing antibody response to BA.5 as hoped and anticipated, and even evidence that it has more effectiveness against XBB, which is obviously fortuitous given that XBB.1.5 is potentially on this path to US dominance. We just don't know. These live virus studies offer consistent evidence of broad immunity from the BA.5 vaccine that has improved over the original booster shots. In contrast, the two letters, the Ho and Baruch Lab studies using pseudoviruses showed minimal difference for the original and bivalent booster versus BA.5. Again, both of those labs did great work. They reported out it was Paul Offit’s responsibility to share the information that I'm sharing with you, and I would urge you to go to the website for the podcast. And there we have provided the link to a paper by Dr. Eric Topol that was actually published yesterday on Substack. And you can link to that and it lays out all of the data that supports that. In fact, there is evidence that the BA.5 bivalent booster is superior at this point. For example, if you look at recent reports from the CDC showing there that the bivalent booster was performing very well, particularly in those over age 65 and even potentially superior to the BA to the ancestral vaccine.


Michael Osterholm: [00:32:43] I urge you to read the Substack piece, and I know that you'll come away with a broad understanding of why the BA.5 Bivalent vaccine is in fact superior right now to our previous Wuhan ancestral strain vaccine. I am disappointed that the New England Journal commentary limited it in such a way as to make it the assumption that that's not the case. And none of the data that you'll see in your octopus paper that I'm referring to right now was included in the New England Journal commentary. I think that, again, was just not responsible. Let me just share with you the bottom line for whatever you might hear in the media. Bivalent boosters work to prevent severe COVID as manifested by hospitalizations and deaths. Their efficacy against infections is limited and of short duration, which has been the case for the shot since the Omicron variant came along in late 2021. But we do know that the clinical data is unequivocal. It is far better to have the bivalent BA.5 booster to help bridge this challenge we have between the new viruses and their ability to evade immune protection. So clearly this bivalent vaccine is broad in our immune response and I believe has exceeded our expectations, not actually fallen short.


Chris Dall: [00:34:07] So we'll talk a little bit more about vaccines in a minute. But as we well know, there are other respiratory viruses floating around the country and elsewhere. What are you seeing in the latest flu and RSV data? Mike?


Michael Osterholm: [00:34:20] Well, Chris, the latest flu and RSV data reflect the message I've been trying to get across over the past four or five episodes. We are not in a tripledemic this term, which I find very unfortunate. As you know, this term was thrown around left and right just a few months ago as flu in RSV, hospitalization rates rose to unusually high levels for that time in the calendar year. Let me just remind you again, when we look at the cases of RSV and influenza, we report them out by surveillance week, meaning in a 52 week year. Week one is the first week of January. Week 52 is the last week in December. What we saw in the northern hemisphere are happening with influenza. This year was actually almost identical to what we saw in the southern hemisphere with their winter months, our summer months occurrence there. Whether you look at what happened in Australia, Argentina, Chile or South Africa was a very early season, meaning 5 to 8 weeks earlier than you expect to see flu virus show up. But again, it was a situation where the case numbers were going up quickly, early on, peaked and came back down. And in fact, it turned out to be no more than an average flu year in each of those countries, including a below average number of deaths.


Michael Osterholm: [00:35:44] Well, that's what's happening here right now. And so for all that hype that went on about this, the cases have dropped precipitously. Instead of seeing cases rise in week 42 or 43 of surveillance, which is very early, and then continue into regular flu season into January, which would be, wow, a lot of cases it didn't. Right now, the case numbers are down below what we would see for any normal flu season at this time. So I think that it's really important to emphasize that that we are not seeing this epidemic. I want to come back to a point I've made multiple times in this podcast. Do not confuse the fact that this was not worse than a typical flu year, slightly worse for RSV, but in general, not the epidemic situation and our ability to care for these cases. It was in fact, a nightmare in many hospitals around the country. So how do I reconcile this? It wasn't a bad flu year, but it was a challenge to care for these patients. And this comes back to a point that has been missed over and over and over again in this discussion. We have so reduced our capacity to respond in our hospitals around this country, particularly for pediatric beds, which are from a finance standpoint, reimbursement standpoint.


Michael Osterholm: [00:37:08] The beds you don't want to have because you can't keep them occupied routinely in a way that it's reimbursement wise, it makes money for you. And so the challenge has been not the fact that, yes, we had a problem caring for these patients, but the challenge is why? Why do we have a problem? And we are not addressing that issue. We're dealing with a 1968 Medicare funded health care system in a way that is never going to work in a modern world from a reimbursement standpoint. So bottom line message is flu and RSV are pretty much on their way out. We could have a resurgence. I don't want to say we couldn't. I doubt it. We didn't see it in the southern hemisphere countries. And they're in their winter. And I don't want to minimize the challenge that we had in our health care system. But the answer is not about how do we deal with a huge surge of cases, it's how do we deal with even a slight bump in cases that is challenging our health care system. And that's what needs to be addressed. And frankly, we just have not done that.


Chris Dall: [00:38:15] Now it's time for our COVID query. This week, we received a number of questions about an opinion piece published in the Wall Street Journal on January 1st titled Our Vaccines Fueling New COVID Variants. Our listeners want to know what you made of this piece, Mike.


Michael Osterholm: [00:38:31] Well, Chris, we did hear from a lot of listeners who wanted more information about this. And I want us always to be that place where we ask all the questions. We don't just make assumptions. We don't just say, well, that's the way we believe it to be. So therefore, that's the way it is. As I've said many times on this podcast, the older I get, the more vulnerable I am to learning. And I think that this is a really important point here. Are we in a situation right now where what's happening is these new variants are actually being fueled by viruses interacting with individuals who have had previous immunity from vaccines? Well, let me just say without any question, I am convinced that surely some vaccine immunity could play some minor role. And so therefore, it's not black and white. But let me put it in context. If you look at all the new variants of concern that we've had, starting with Alpha, starting with beta, starting with Gamma, going on to Delta, going on to Omicron. They all emerged in parts of the world where there was virtually no vaccine immunity at the time. It was all based on previous infection immunity that drove those variants. And since that time, we've not seen one new variant arise that could be associated with the ecological or an evolutionary pressure of immunity due to vaccine that drives these new variants.


Michael Osterholm: [00:40:04] So we've got kind of a very important history here that says that, in fact there is no evidence to date that any vaccine immunity has played a role in a new variant. Now, you could argue, well, how about the subvariants? How about some of these ones that we're seeing now, the XB, 1.5, etc.? And again, I come back and just say it's infections that are really causing this immunity issue. And it may very well be, as we've talked time and time again, not just an average infection, but that for those individuals who have some level of immune suppression, they may stay infected for a more extended period of time. And there is how we actually see the variant develop is being in an environment where it's over time that the environment changes and then becomes one that is now transmissible in humans. So it's very important to understand we should not confuse the vaccines by having someone raise a question, Oh, well, what if what if? Oftentimes those questions are not meant to be questions or meant to be provocative statements that then give people the sense, well, there's some problem. But let me just put into context vaccines and how important they are.


Michael Osterholm: [00:41:19] There was a paper published last week in general, the American Medical Association, and we'll provide a link to it. It was actually published by Alyssa Berlinski, Katherine Thompson. And, you know, my dear friend and colleague Zeke Emanuel. The title of it is COVID-19 and Excess All-Cause Mortality in the US in 20 Comparison Countries, June 2021 to March 2022. So this is about what role does the vaccine play? And I'm just going to share with you a very high level result section here to give you some sense of why I think this is such an important observation. As they noted, the US reported about 370,000 COVID deaths during the Delta and Omicron waves. And if you look at that in total, that comes out to 112 deaths per 100,000 population, equally distributed roughly between both of those. But if you look at the deaths in terms of the state in which the individual lived and what their vaccination uptake rates were, if you looked at those that were in the upper level, the ten states that had 73% coverage or more, they had 75 deaths per 100,000 compared with the bottom ten states in terms of vaccine coverage, which was averaged 52%. They had 146 deaths per 100,000. So again, 75 versus 146, almost half in the high vaccine states versus the low vaccine states.


Michael Osterholm: [00:42:47] And in their findings, they concluded that from June 27, 2021 to March 26, 2022, the US would have had averted 122,000 deaths if COVID mortality matched that of the ten most vaccinated states and 266,000 deaths. If the excess all-cause mortality rate matched that of the ten most vaccinated states. In short, vaccine is saving lives and will continue to save lives. I think these data are very compelling in showing that it's not about getting vaccinated, that we should be worried about new variants developing. It's about getting vaccinated to prevent people from dying. And so I hope that this on. Online discussion is one where anyone can ask a provocative question if in fact it's going to lead to some useful answer that we then can incorporate into public policy. In this case, let me be very clear. I am much, much more concerned, much, much more concerned about not getting a vaccine and getting infected and dying than I am about getting a vaccine and being protected, but at the same time allowing for the development of a variant to occur. So I hope this gives some context to this situation and we need to move on and not confuse the fact of what these vaccines are doing versus what is the possibility for new variant development.


Chris Dall: [00:44:18] And as a follow up to that question, Mike, I'd also like to ask you about the conspiracy theory that has been floating around on social media following the incident involving Damar Hamlin, the Buffalo Bills football player who went into cardiac arrest during a game against the Cincinnati Bengals. This theory suggests that the COVID-19 vaccines played a role. There's been similar speculation about the death of soccer journalist Grant Wahl. Now we don't want to give this theory more oxygen than we need to, but the reality is it's out there and it's part of a familiar pattern we've been seeing since vaccines became available. What's your response?


Michael Osterholm: [00:44:54] Someone is going to need to hold me back on this one, because this is one that is near and dear to my heart. First of all, let me be really clear. Truth about science is what we're all about. And I would never for any political or social political reason, not say I've got a problem with this or I think this is an issue. But we're watching here is not about science. I have a disclosure to make that when you talk about Grant in particular, this is a very, very, very, very, very hard issue for me because I happen to be a close colleague of Celine Gounder, who is his wife. I've published with her that paper I talked about, you know, on what we need to do in this country for COVID and so forth. Recently, we coauthored Celine is one of the most marvelous, remarkable, capable scientists I know and someone who is so kind and giving. And what she went through with Grant's death was nothing short of terrorism. I think the kind of feedback, the emails suggesting the fault and it was COVID and she somehow was complicit. She wrote a piece in the New York Times published on January 8th entitled Grant War was a Loving Husband. I will protect his legacy. Absolutely. One of the most stunningly beautiful pieces I've ever read on COVID or any aspect of it.


Michael Osterholm: [00:46:24] Let me be really clear. There are a number of people who have alleged that Grant actually died from COVID or something to do with COVID vaccination, and that in a sense, implying that Celine must have something to do with this, all because she's such a pro COVID vaccine scientist. It's absolutely not true. The rumors, disinformation and almost terroristic comments have no validity whatsoever in this tragedy. Grant died from an aortic aneurysm confirmed by autopsy here in the United States in an uninvolved body, meaning that they made every effort to get every piece of information they could and to watch. What this has done to Selene and the immediate family is simply shocking and angers me to no end. It is the cruelest of the cruelest of things. So this one put to rest has nothing to do with COVID. And again, on behalf of all of us as CIDRAP, we offer our dearest and deepest sympathies to Celine and her family. So let me move now to Mr. Hamlyn. We are all so pleased to hear yesterday that he's released from the hospital. He's back home with family. This is a remarkable, remarkable story, one where when he went into cardiac arrest during the game, it was only because of the incredible medical personnel response that kept him alive and got him to the hospital.


Michael Osterholm: [00:47:53] Now, he suffered a blow to his chest, which has been known in other activities to actually to cause the kind of cardiac arrest, the experience. But right away, there were those disinformation, almost evil people out there, that this had to be COVID related myocarditis associated with the vaccine, myocarditis being an inflammation of the heart muscle. All I can tell you at this point, there are no data, none nothing that would support that COVID vaccination or COVID infection even had anything to do with this particular event. And it does nothing to promote anything about the truth. Just to continue to say that and to cause this kind of fear and panic about the vaccine. So I hope no one, no one will avert getting the vaccine. Who should, as we've talked so many times before, about who those people are, based on this case alone. And while I don't believe whether it be Grant's case or whether it be Mr. Hamilton's case, we're going to see those people change what their messaging is. But we in the public should not stand for that. We can't stand for that. Put it down every time you see it. Don't be afraid to put it down. It's what we should do. And as part of this podcast family, this is how we take care of each other. Put that information down.


Chris Dall: [00:49:18] Mike, on a brighter note, you recently received a letter from a podcast listener with a slight twist on our Beautiful Place segment. What can you tell us about it?


Michael Osterholm: [00:49:27] You know, when you're an almost 70 year old man who has seen all the different shades of color in a lifetime, there's not supposed to be those moments that can literally bring you to your emotional knees. And that's one of the beauties of this podcast. I'm constantly surprised and yet so wonderfully blessed to have this kind of exchange back and forth with the people on this podcast. You've taught me a lot. You've been there for me. Well, we received a letter from Stacey, who lives in Nova Scotia. She shared with us what she thought was her beautiful place. And at the risk of sounding like maybe we think we're more important than we are. I think many of you can relate to this. I know I do. So let me share with you Stacey's beautiful place. And thank you, Stacey. You are a beautiful person for what you did. Here are the time you took to send the letter. It means the world to us. So here are Stacey's words. A beautiful place. I live in a small island off the coast of Nova Scotia in Canada, which is, of course, a very beautiful place. But I'd like to offer a suggestion for a beautiful place that more, if not most of your listeners will relate to. This beautiful place is a community of connection that your podcast has created and nurtured throughout the pandemic.


Michael Osterholm: [00:50:55] I've come to believe that there is more to the concept of light that you discuss in each episode. When you welcome the podcast family at the beginning of each episode. I imagine there is a connective lighting of spirit amongst your listeners. I always feel it knowing that you consistently provide an objective evidence informed and straight shooting perspective on the pandemic. More than that, it is a perspective that reminds all us of the virtues that will sustain us despite the uncertainty. Humility, kindness, compassion, respect, and gratitude. You connect your podcast family, and I think that is a beautiful place indeed. Wow. Wow. Thank you. Thank you. Thank you, Stacey, for that very, very kind message. I hope that's true for the podcast family out there. You know, we don't have anything to sell. You know, we're just trying to tell you what we know and what we don't know. And again, I also want to emphasize that this podcast is clearly a production of a wonderful team of individuals who has even made it possible for me to be with you. So thank you, Stacey. Thank you to the family out there. I hope that this is something that can provide you with the kind of picture that Stacey so eloquently and beautifully painted. Thank you.


Chris Dall: [00:52:23] What are your take home messages for today, Mike?


Michael Osterholm: [00:52:26] Well, at the risk of sounding somewhat repetitive, all I can say is welcome to another chapter of COVID reality. My first point is, is that we are still in this major battle between the virus and us. And as much as I want to have a roadmap going forward saying we just have to do this, this and this and this and we're home, I can't. So I don't know what it is. Just the discussion we had today on XBB.1.5, what's happening in other parts of the world? How do we live with this? What does this mean? Do we have to continue to live in a pandemic world forever? I don't think so. But as I've said before, I probably won't know that the pandemic is over with until many months after it's done and realizing the other shoe hasn't dropped again. So maybe it's over with. So we're living in the COVID reality. We have to never forget that. Number two, China is far from over. Their catastrophic experience with COVID is going to have a major impact for potentially weeks to come, if not months, in terms of supply chains of the impact that will have on the rest of the world and of course, the impact that will have on the Chinese population. This is tragic, just tragic. And I think that when you think about sensibilities, there are just some things that once you cross that line, you've crossed the line of sensibility. The Chinese government could surely put people on lockdown so they could do all kinds of things, not get them enough food, not give them access to the health care they need.


Michael Osterholm: [00:54:02] Those are all very, very painful and frankly, potentially politically moving experiences. But I would argue there is none worse, none worse than having a family member die and not having that body be respected and handled in a loving and judicious way. And what we're hearing over and over again is how people are literally at home for days as a dead body in a home, not as a viable loved one, just because of the lack of capacity to handle these bodies. I think that's going to continue to be a haunting moment for China and will be one of the moments of definition of how the Chinese population will look towards their leadership and what they've done. The final piece is just a repetitive story over and over again. Vaccine. Vaccine. Vaccine. I hope I've given you reason today not to be dissuaded from getting your vaccine from either of those horrible rumors out there or because this particular bivalent vaccine may not be doing as well or is no different than what the previous vaccines provided us, simply not true. I urge you to go back and read the papers that we've linked to, particularly Eric Topol paper and Substack, and I think you can see that in fact we are very fortunate to have what we have. So those are really the COVID reality. China. Vaccine vaccine vaccine. And wear your N95, if you're in public potentially exposed to the virus, you can do a lot to protect yourself.


Chris Dall: [00:55:46] And do you have a closing song or a poem for us today?


Michael Osterholm: [00:55:50] Well, I do. And again, it reflects the podcast family members and their feedback to us. This one comes from Vivian. And Vivian is a lover of live music, sent us some beautiful pictures and a lot of information about concerts she's gone to, well, basically testing and being part of what was, in a sense, every effort to minimize the risk of transmission in a concert setting. And one of the concerts she went to and one of the songs that she thought would be of real interest to our audience is actually a song by Jason Isbell. Some of you may know he's actually a country Western singer. And in his Nashville Sound album released in 2017, he wrote a song for his daughter. And it is a very telling song in the recording, actually, both he and his wife, who performs with them, share these lyrics to his daughter. So think of yourself at your daughters, your friends, your loved ones, what these same words might mean. And again, I want to particularly thank Vivian for pointing this out and for her kind comments that she shared with us. So here it is today, a song by Jason Isbell, Something to Love written for his daughter. I hope you find something to love. Something to do when you feel like giving up a song to sing or a tale to tell.


Michael Osterholm: [00:57:24] Something to love. It'll serve you well. I was born in a tiny southern town. I grew up with all my family around. We made music on the porch on Sunday nights. Old men with old guitars smoking. Winston lights, old women harmonizing with the wind, singing softly to the savior like a friend. They taught me how to make the chords and sing the words. I'm still singing like the great speckled bird. I hope you find something to love, something to do when you feel like giving up a song to sing or a tale to tell. Something to love. It'll serve you well. Tonight we're lying on a blanket in the yard. The wind is cold, the sky is dark, and the ground is hard. But your mama loves to count the stars at night. So if I get a little chill and that's all right. I hope you find something to love. Something to do when you feel like giving up a song to sing or a tale to tell. Something to love. It'll serve you well. You were born in a hot, late summer day. We turned you loose and tried to stay out of your way. Don't quite recognize that world that you call home.


Michael Osterholm: [00:58:32] Just find what makes you happy, girl. And do it till you're gone. I hope you find something to love. Something to do when you feel like giving up a song to sing or a tale to tell. Something to love. It'll serve you well. Something to love. It'll serve you well. Thank you again for being with us this week. Covered a lot of information. I hope that it's helpful to you. And I want to thank the podcast team for all your efforts. We're at a period where I don't know what we're going to be talking about two weeks from now. It could be interesting. But in the meantime, please don't forget these 580 deaths. There are somebody's mom or dad, somebody's grandparents, somebody's siblings, somebody's friends, somebody's child. That's what we have to keep remembering and keep taking those virus on day after day. We're trying to live our lives in the least disruptive way possible, but we can't give in to this virus. Thank you. I hope you have a wonderful two weeks. I hope weather is good wherever you're at. I know some parts of the world right now are very challenged by weather. And all I can say is I just keep looking at that sunshine. So thank you. Be kind. Thank you.


Chris Dall: [00:59:54] 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 CIDRAP.umn.edu. This podcast is supported in part by you, our listeners. If you would like to donate, please go to CIDRAP.umn.edu for donate. The Osterholm update is produced by Cory Anderson, Meredith Arpey, Elise Holmes, Sydney Redepenning, and Angela Ulrich.