February 23, 2023

In "Masks, Memories, & Middle Ground," Dr. Osterholm and Chris Dall discuss the state of the pandemic in the US and around the world, the newly released CIDRAP Coronavirus Vaccine R&D Roadmap, and the rise of vaccine misinformation and disinformation.

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Chris Dall: [00:00:00] Hi, everyone. Before we get started with this week's episode of the Osterholm Update, I want to let our listeners know that season two of CIDRAP’s podcast on Antimicrobial Resistance Superbugs & You launches on Tuesday, February 28th. You can hear a sneak preview if you go to the CIDRAP website and click on the podcast link. Season two of Superbugs New is available on the CIDRAP website as well as Apple, Spotify and Google Podcasts. 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. As of the end of 2022, SARS-CoV-2 infections had caused more than 650 million confirmed COVID-19 cases and 6.6 million deaths globally. The toll is staggering. But what if I told you it could have been even worse? Though more contagious, the case fatality ratio of SARS-CoV-2 is much lower than two other coronaviruses that have emerged this century SARS-CoV-2 and Middle East Respiratory Syndrome, or MERS.


Chris Dall: [00:01:36] What will the next coronavirus look like? In CIDRAP, its newly released Coronavirus Vaccines R&D Roadmap. Dr. Osterholm and his coauthors addressed this very topic. They write beyond the global scourge of the current COVID-19 pandemic. Even more concerning is the threat of a new coronavirus in the future that could be both highly transmissible and highly lethal. Thousands of different coronaviruses are circulating in animals worldwide, particularly in bats, but also in other mammals and birds. The trends of the past 20 years are intensifying, with increasing risk of coronaviruses spilling over from animal reservoirs to people fueled by the rapid expansion of human populations into animal habitats and an increasingly interconnected world. That threat and the type of vaccines that will be needed to address it is one of the topics we'll be discussing on this February 23rd episode of the podcast. We'll also provide an update on the current COVID-19 trends here in the US and around the world, take a look at the variant picture, discuss the continued efforts to cast doubt on the COVID-19 vaccines, and answer a COVID query about a large study on masking. We'll also 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.


Dr. Osterholm: [00:02:52] Thank you, Chris. And welcome back to all the podcast family. It's great to be with you again. And for those who are joining us for the first time today, I hope that we're able to offer you something that you find helpful that you can apply in your everyday lives, whether it be dealing directly with COVID or the result of something that happened because of COVID. And today, we're going to try to talk about some practical issues as it relates to what's happening with our response to COVID right now. I think we're in a very confused world. And if you think so too, then I think you're right where many people are. But before I begin, I want to talk about today's dedication. This is probably one that for some of you who only want the hard science coming to this podcast, you may want to take a momentary break. But, you know, I've been thinking a lot about what we must do to move past this pandemic. And it's not just about the science. It's about everything that we do in our lives. And I was reminded this past week of the power of memory. I happen to put on my new long length black coat that Fern kindly got me. And I remembered that last fall, when I had it, I got rid of my old one, which I'd had for many years. Full of holes, sleeves were fraying, etc.. But I did something when I got rid of the old coat and kept the new one. I reached into a pocket and I pulled out three plastic bags, dog poop bags.


Dr. Osterholm: [00:04:17] They belong to Max, my very special Australian shepherd that died in my arms a few years ago. I'd had him for over 14 years, and he and I had become inseparable, literally going to work with me over the course of those years. I also was very involved with restoring a trout stream property down in northeastern Iowa. And Max and I would spend many, many days, lots of hours together roaming that beautiful, beautiful tallgrass prairie savanna area. Max was, without a doubt the smartest dog I've ever known. I often jokingly said that I was very proud of my ability over the years to be bilingual, to speak both English and I won. And I even got to the point where I could speak three languages. English, Iowan, and Max. Let me give you an example how smart Max was. He would know if I were going on a business trip because I'd have a sport coat or a suit on and my suitcase, and he'd go in the corner, sticking his nose as far as he could get to that corner. No matter how I called him, he wouldn't look at me. He wouldn't come. On the other hand, if I had on blue jeans or shorts and I had a suitcase, he knew I was going to Iowa to my trout stream property and he went crazy. You would think someone was torturing him. I literally had to put him in the car sometimes an hour early in the garage, just so he could lay there knowing he was going to go to Iowa.


Dr. Osterholm: [00:05:40] You know, in trout fishing, people often say the worst thing you can do is have a dog because they interrupt your fishing, they get ahead of you, they scare the fish. They get in the water on a single day. When Max was younger, I said to him, you know, you stay behind me. And as I went up the stream, he would move up as I moved up. But he stayed 10 to 20 feet behind me for the entire time that I had that dog. He did that. He knew one time. He knew I could go on and tell all kinds of stories about Max and me and all the different things we have and all the things we shared. He was everything to me. And I will miss him forever. But I have a chance to see him every day. He's on my computer screen. I have many wonderful pictures of him. We've put two of them on the website so you can see him in his glory. One of them, he's actually standing on the bank of a little stream called Brook Creek, the one that I restored back from what was ditched in the 1940s. And looking at me with those eyes piercing eyes, beautiful eyes. And the second one was a testament to the point I just made about him being taught not to get ahead of me fishing. You can see me out in the trout stream fishing, and here's Max behind me.


Dr. Osterholm: [00:06:55] And as I would move up ten, 20 feet, he would move up, but always staying behind me. That's how smart that dog was. 14 years was just way too short to have that dog. But today, I still have those memories. And as weird as you might think it is, having those poop bags in my coat pocket. Reminds me of Max. And those memories are so powerful. They're so wonderful. Now we all have memories of our dogs or our families, our loved ones, or events in our life. And today, I dedicate this podcast to our memories, to those good memories, what we need to be more intentional and go back and think about them, enjoy them, appreciate them, and in some cases even reach out to others to remind them of those good memories. I can't reach out to Max, but I was once told, depending on whatever your beliefs are of heaven or not, what that heaven might look like. I love the thought that heaven is where you go when you die and you land in a beautiful field of wildflowers and you're sitting there in all the dogs you ever loved in your life come running to you. Man, would that be something? So today I dedicate this to memories of whoever and whatever they might be and why it's important as we work through this pandemic, to keep those memories, to think about them, to appreciate them, and know that not every day is going to be a crisis, not that every day will be more bad than good, but that over a lifetime we've all had those wonderfully good memories.


Dr. Osterholm: [00:08:28] Now, in the scientific side, sort of, I'm happy to report that light here in the Twin Cities, despite the fact we're just coming off of what has been a very large snowstorm. The sun today rose here at 7:01, although we couldn't see it. And we'll set tonight at 5:50, which we might. That's 10 hours and 47 minutes and 42 seconds of sunlight. Wow. We're getting 3 minutes and 2 seconds of sunlight a day. And today was civil twilight. We actually could do outdoor activities without any additional lighting starting at 634 this morning. And we're going to 7:04 tonight. So we're very pleased to see this increasing sun and we're getting closer and closer to that March 21st date with the first day of spring, where the sunlight will, instead of increasing 3 minutes and 2 seconds a day, will go all the way up to 3 minutes and 9 seconds a day. I also want to acknowledge our dear friends and colleagues in Auckland at the Occidental Belgian Beer House on Vulcan Lane today. You had sunrise at 6:59 and sunset tonight at 8:08. That's 13 hours and 9 minutes. You're still ahead of us by a bit, but we're starting to catch you. So again, thank you so much for being with us. It's an honor every time you're here. We so appreciate your feedback, your thoughts, your ideas, your critique. And we hope that again today, we can provide you with information that will be helpful.


Chris Dall: [00:09:57] Mike, the most recent global epidemiology update from the World Health Organization indicates new COVID-19 cases and deaths have declined or remain stable across all regions. While the W.H.O. acknowledges that the case numbers are surely underestimates. This is clearly good news. What are you seeing in the global picture?


Dr. Osterholm: [00:10:17] Well, to be honest, Chris, I think that overview of the latest EPI report you shared in the lead up to this question sums up the overall global picture quite well. Clearly, from a surface level perspective, in other words, based solely on what's being reported in terms of numbers, there really aren't too many examples of places that could be considered as hotspots, something we have not seen since the beginning of the pandemic. So that's good. Or at the very least, it's a preferable to the alternative scenario where countries or entire regions report major activity. On that note, as far as the international numbers go, as of this past Tuesday, average daily cases stood at about 169,000 reported a day with average daily deaths somewhere right around 1200. Now, as you've heard me say time and time again, I have no faith in those numbers of cases being reported and only some in terms of the number of deaths. But they really are very different than we've seen in the previous months. Now, if we're still in a position where testing and reporting was being prioritized and the appropriate systems were in place, I'd probably look at the latest case totals and feel really pretty good about them. And the reason I say that is because this is the lowest reported activity since June of 2020. We cannot ignore that. But as you've heard me say before, the circumstances surrounding testing and reporting have changed and in some cases are quite different than what they used to be.


Dr. Osterholm: [00:11:41] For a glaring example, just look at China. You remember that just a few months ago, in early December, China was running about 150 million tests each day. Of course, this was just before they moved on from zero COVID. So mass testing was still being done. And as we know, that's no longer the case. But what's interesting is that by late January, so just a month and a half after they moved away from zero COVID, the daily numbers of PCR tests conducted in China dropped to 280,000, again from 150 million a day. Now, obviously, China is a unique example, but across most parts of the world, the general trend has been the same, a lot less PCR testing. So without a doubt, we're seeing an undercount. Still, as you mentioned, Chris. It's reassuring to see declines or relatively limited activity across all the different regions and within countries. On top of that, there aren't many places I'm aware of that are currently seeing significant rises in terms of hospitalizations or deaths. In the U.K., it looks like hospitalizations are up about 10% this past week, but the current level remains well below what they've seen during previous surges. In cases are flattening out after a slight increase earlier this month. Otherwise, Austria has been reporting some increases for both cases and hospitalizations, but again, at relatively low levels. Otherwise, deaths there have yet to go up. So overall, I think the most reassuring news, at least in my mind, is that we have yet to see anything like the new variant XBB 1.5 resulting in obvious surges.


Dr. Osterholm: [00:13:15] And I just want to say one more time that the average daily deaths are at the lowest levels reported since the start of the pandemic. Again, this is very, very good news. Surely beats the alternative. But even 1200 deaths a day is still tragic in my mind, and we should keep doing what we can to reduce that even more. Again, our friendly reminder these 1200 people are real people. They're fathers and mothers and brothers and sisters and aunts and uncles and even some of our children. So we can't just accept a number like that. So for the sake of context, consider the following. Right now, the country with the highest weekly COVID death rate per capita is, ironically, Taiwan, a country that had been touted throughout the pandemic as having the best response. As of this Tuesday, they've reported 2.43 deaths per 100,000 population 2.43. Again, that's the highest death rate reported worldwide over the past week. However, if you look at the rates being reported exactly one year ago, you can get a sense for how things have changed. For example, on February 21st, 2022, the country with the highest death rate was Bulgaria, which was reporting 12.5 deaths per 100,000, clearly far above the 2.4 per 100,000 currently being reported in Taiwan. In fact, at this time last year, there were actually a total of 50 countries with death rates above what's being reported in Taiwan right now, the highest death rate in the world.


Dr. Osterholm: [00:14:46] Even two years ago, on February 21st, 2021, Taiwan's current level would have ranked 45th on the list as opposed to number one. So this surely demonstrates the improvement. Otherwise, I think there's still work to be done. And while I think that surely applies to the areas of reported COVID deaths, I also think we need to do a much better job understanding the excess mortality we've seen, obviously in some places, including China, India, North Korea and Russia. I'm certain that. Data in excess mortality would provide a much better sense of covid's impact than the official numbers. As we've talked about fairly recently, China's official death toll of 84,000 is being compared to its estimates, actually of 1 to 1 and one half million deaths and in some cases even more. Similarly, Russia's official death toll from COVID sits at 396,000. But multiple independent analyzes have found that the excess mortality there makes it far more likely that their death toll is more than 1000000 to 1.5 million. So there are places that maybe don't have the capacity or possibly even the desire to report COVID deaths. But for other locations, I think it's important to keep tabs on who's dying and what's contributing to the excess mortality. For example, are these individuals who have procedures or treatments delayed? Again, it's something I think we need to prioritize on an international level.


Chris Dall: [00:16:14] Mike, the COVID-19 trends here in the US appear to be similar with cases, deaths and hospitalizations all declining. What's your assessment of the US situation?


Dr. Osterholm: [00:16:24] Chris, I feel a bit like a broken record answering this question. Not much has changed with the national situation compared to our last episode. I still say that we're in a high plains plateau stage, but we are in a gradual descent on our way down. When we look at the picture from state to state, there are not any significant regional trends or hotspots, even as we see XBB1.5 now dominant in every region. We're seeing COVID-19 trends moving in the right direction by declining across the board, but we are still seeing almost 30,000 people hospitalized with COVID-19 in a given day, and we're losing anywhere from 360 to 420 Americans to COVID every single day. Again, we talked about living with this virus in the last episode, and I don't think it losing on average 400 lives every day is a level that anyone would argue as reasonable to accept as living with the virus, even if these tend to be older individuals. In our last episode, we discussed that XBB1.5 was not going to be a game changer, and I think it is now safe to say that XBB1.5 has officially made its way across the country without making significant waves or surges It did what other variants haven't, which is to become dominant without causing a major uptick in hospitalizations and deaths, which is arguably the best case scenario for a variant. But following up on our last podcast, we're still struggling. How do we live with COVID in these kinds of conditions? For those of us who are over age 65, for those individuals who are immune compromised in some significant way, up to 7 million people in such a category, moving on with this pandemic is not necessarily simple.


Dr. Osterholm: [00:18:07] For many, many people, particularly those under age 50 and maybe up to 65 who are otherwise healthy without any comorbidities, that would put you at increased risk for serious disease. You are moving on. You are over this pandemic. And you know what? I can't say that you're wrong. This should not, however, boil down to a us versus them. I do see far too often the kinds of debates that appear to be occurring among those who, like myself, are older or have underlying health conditions. Feeling like the public doesn't care about us anymore because they're not wearing their respirators, they're not taking care to not transmit the virus. And in their world, this is another acceptable risk that they've come to live with. And I know you can say, but wait a minute, you put me at risk. And so I think we're struggling with this right now. So I don't want to dismiss how individuals who are at increased risk for serious illness, hospitalizations or death feel this is real. At the same time, as a parent, as a grandparent, as a colleague who watches many of my younger colleagues and their families go about their lives every day, we are going to have to work together to figure out how to best deal with this. And so, you know what, to me. 400 Americans dying every day is not acceptable. It is not I don't care that most of them are over age 65. But at the same time, I can't, for that reason, say to the whole rest of the United States or for the world, you got to live like you were living for the last three years because in fact, you need to help protect all of us.


Dr. Osterholm: [00:19:46] And so I don't have a magic bullet answer. I'm sure some of you will find my comments not helpful. You may even be angered by them. Some of you hopefully will say, well, he's trying to find that practical middle ground. You can argue that there isn't a lot of middle ground if you're talking about life and death at the same time. Life is all about middle ground. And so I hope that as we move forward and we continue to follow what's happening and hopefully the case numbers decrease, my message is if you're living your life and you're not at increased risk for serious illness, hospitalization and death, I hope you enjoy this. What you would consider your post pandemic period For the rest of us who are at increased risk, I will continue to wear my N95 in public places. I am up to date on my bivalent vaccine doses, although I'm now six months out from my bivalent vaccine booster. I wish I could get another one. It doesn't look like I'm going to be able to anytime soon. So I think there still is a challenge for us. But what we can't do is get angry at those who are living their lives. And for those who are living their lives, please consider us. We're at increased risk. And this is how we might feel in these kinds of settings.


Chris Dall: [00:20:58] We haven't really talked too much about the variants and the sub variants lately, although you just mentioned XBB1.5. What does the variants picture look like at the moment?


Dr. Osterholm: [00:21:10] Well, Chris, I don't think we've talked too much about the variant picture because it's obviously very important and can change quickly. But to be quite frank, there fortunately really isn't too much to update you on today. As I mentioned earlier, XBB1.5 has now become dominant in every region of the country and in many parts of the world. But it has done so relatively quietly, which is great news. Besides XBB1.5, at the moment, there aren't any new sub variants that are gaining traction in the US. Likewise, there are not any new variants that we have identified globally either. This is not to say that there won't be new variants or sub variants that pop up and are able to outcompete current variants and are more infectious or result in more serious illness. But for now, there just aren't any that we're keeping a watchful eye on. I also just want to come back to the China situation because there had been, as you know, great concern that with the rapid transmission of COVID through millions and millions of Chinese residents, or we'd see a new variant emerge in China, that could be a challenge. Well, I'm happy to report as of today, we're not aware of anything coming out of China that would suggest that's the case. So again, we're monitoring variants and sub variants, but at this point I can say happily that there's nothing on the radar screen that is a major concern.


Chris Dall: [00:22:32] As I mentioned in the introduction, the efforts to discredit the COVID-19 vaccines and to suggest that they have actually been harmful continue. Some of this is coming from well known anti-vaxxers and some from politicians. Particularly noteworthy is a recent letter sent to the CDC by the Florida Surgeon General warning of a dramatic increase in adverse events he says are linked to the mRNA COVID-19 vaccines. Mike, what's your response?


Dr. Osterholm: [00:23:00] Well, Chris, it's certainly very disappointing to see misinformation, even disinformation, about these vaccines continue to circulate. But I have to be honest, I don't think the worst days are yet here when it comes to this issue. We are seeing new approaches. We're seeing new avenues of activity for those who just want to discredit this vaccine for whatever their reason might be. We know these vaccines are not perfect. We're going to talk about that more in a moment. We talk about the vaccine roadmap, but they are absolutely critical in saving millions of lives through this pandemic. And we can never forget that. And while we're working on getting better coronavirus vaccines, we are so fortunate that we have what we do have in these vaccines. So anyone implying that these vaccines are unsafe is simply spreading misinformation at the best and disinformation at the worst. Now, this does not mean that these vaccines cannot be associated with reactions or some health condition. But when we look at these, we have to compare them to what if you don't have the vaccine? And I'll share that with you in just a minute. The letter from the Florida surgeon general, which I think has been one of the worst moments in public health over the course of the pandemic is a perfect example of what absolutely misleading vaccine information looks like. The alert emphasized the increase in VAERS or the Vaccine Adverse Events Reporting System reports in Florida in 2021 compared to previous years.


Dr. Osterholm: [00:24:32] In 2021, Florida saw a 7000 hundred percent increase in VAERS reports, but only a 400% increase in overall vaccine administration. Well, the Florida surgeon general is using this information to say that there is likely more risk with COVID in Rene vaccines compared to other vaccines. This is simply not an appropriate interpretation of these data. And in order to understand why it's important to provide a bit of context as to what does VAERS data actually do. Remember, this is the Vaccine Adverse Events Reporting System. VAERS data comes from reports that health care workers are required by law to submit when an adverse health events occurs following a vaccine. Patients and caregivers are able to but are not required to submit these reports as well. Providers are required to report this information regardless of whether they suspect the vaccine to be a cause of the health event or not. This means that many various reports, including things, were absolutely not likely to be caused by the vaccine or in some cases absolutely were not caused by the vaccine. Still need to get reported. Remember, strokes and heart attacks occur every day regardless of whether or not someone has recently received a vaccine. So just because these events are included in the various data does not mean we should assume that they are caused by the vaccine.


Dr. Osterholm: [00:25:53] And if you start suddenly vaccinating a large number of people and the sensitivity to the safety of these vaccines being prominent, you can see where people would put reports in. You know, I get a migraine headache. I've always had migraine headaches, but I got a migraine headache a day after I got a dose of vaccine which could just by chance alone be when you're going to get another migraine headache. But now that has to be reported. So you can see that there is not even any reason to believe in many of these reports that there was kind of cause and effect. So this is why we use peer reviewed studies to look at the safety of vaccines. These studies can account for the fact that adverse events can occur regardless of vaccination, but various data cannot. It was always meant to be an early detection system that would be providing enough information to trigger these subsequent investigations. Not at all cause and effect. This means that the 1700 percent increase in reports in Florida is truly meaningless in the absence of other data to support the claim that mRNA vaccines are dangerous. And we're currently lacking data that suggests this to be the case. So let me give you an example. One that has recently received lots of attention is the fact the impact of particularly mRNA vaccines on major adverse cardiovascular events or what we call mace.


Dr. Osterholm: [00:27:14] These are in patients with both COVID-19 infection and who are vaccinated. The results of the study were just published in the Journal of the American College of Cardiology this past week actually finds that, in fact, the COVID vaccines, particularly COVID, mRNA vaccines, actually were associated with a decreased risk of myocardial infarction and ischemic stroke after having COVID-19. So what it's really telling us is that if you had COVID-19, you're going to have an increased risk likely of having a heart attack through thrombosis, etc.. But by getting vaccinated, you lower that risk. And so I think it's really important to understand that when we look at these numbers, again, you have to go back to cause and effect. You have to go back to what is likely linked or not. You know, I may be in an automobile accident 24 hours after having a vaccination. And some people would interpret that as I need to report that as a health event. No one would actually say that was cause and effect. So I hope that as we hear more and more of this information being shared out there, that we also actually consider the source of it. And finally, I just have to comment that this past week we saw what I thought was the worst of the worst as it relates to public policy and COVID vaccine administration in the state of Idaho.


Dr. Osterholm: [00:28:41] Two state legislators have introduced legislation to make it a misdemeanor for any health care provider to administer an mRNA vaccine. Can you believe that? So in other words, you would be criminally involved with this activity if you did good medical practice? That's crazy. So we're up against this. And I have to tell you, from hearing from so many people in the public and even some of our listeners who have real questions about the safety issues, we should have questions that our job front and center to make sure that everyone has a full and complete composite picture of the risk and benefits of this. But let me just say right now that if people really believe that these mRNA vaccines are so unsafe and maybe shouldn't even be available, then I'm going to start a list of a million things that should not be in the market. And I'll start out there with aspirin. The health consequences of aspirin use far exceed any negative health consequences we've seen with mRNA vaccines. But no one would say take an aspirin off the market. So I think it's really important that we have a good sense of context here. And just to say that just no, this is mis- or what I would consider disinformation.


Chris Dall: [00:29:57] Now to CIDRAP’s Coronavirus Vaccines R&D Roadmap. Mike, can you give our listeners an overview of the roadmap and talk about why this effort is needed?


Dr. Osterholm: [00:30:08] Well, Chris, this likely is one of the most significant activities I've ever been involved with in all of my 48 years in public health. And I'm very excited to talk about this effort because it is so important. And our center, fortunately was able to play such a key role in this. A little more than a year and a half ago, I understood that the vaccines that we had were surely saving millions of lives. But they weren't everything that we needed or wanted in an effective COVID vaccine, either for this pandemic or potentially future ones. And we've talked already in this podcast, there could be a big one that we have before us. And so at that point, I thought about, well, how can we help drive the kind of research and development that will get us these better vaccines? And our center had already been involved with the vaccine work with W.H.O. on Ebola, Lassa, Nipah and Zika vaccines. And also we did a road map for influenza vaccine supported by the Wellcome Trust and now actually follow very closely what investments are being made into influenza vaccine work. So what we decided to do is see if we could find the source of support for doing a R&D roadmap for the coronavirus vaccines. And we were very fortunate that both the Bill and Melinda Gates Foundation and the Rockefeller Foundations did come forward with support.


Dr. Osterholm: [00:31:36] And then our team at CIDRAP, led by Dr. Kris Moore, who I think is a national treasure, with all due respect, in terms of her ability to help lead this, put together a roadmap that identifies barriers, gaps and strategic goals as well as milestones that must be met in order to develop better and more broadly protective coronavirus vaccines. This process involved many organizations from around the world and more than 50 subject matter experts, and they all came together to help us address five major topic areas with coronavirus vaccines. One the virology and how it is applicable to vaccine development. Two is immunology and how the immune response of the host dictate what the vaccines could or couldn't do. We looked at vaccinology itself, just the technology that might be available. We look closely at animal and human models for coronavirus vaccine research and how they could be used to fast forward this research. And then finally, the fifth area was policy and financing. Without policy and financing support, we would go nowhere. Vaccine development is clearly a team effort, and we cannot expect to develop and distribute a broadly protective coronavirus vaccine in the days ahead without meeting the milestones identified in all five of the topic areas of the roadmap. Listeners of this podcast are already very familiar with the many reasons why we need to develop a broadly protective coronavirus vaccines.


Dr. Osterholm: [00:33:10] Again, I emphasize the vaccines that we have now, while safe and are very useful tools, they're not perfect. And we know that by boosting our way out of the pandemic is not a realistic or sustainable option. And of course, broadly, protective coronavirus vaccines may play a critical role, as I just said, in responding to the next pandemic. Now, in the roadmap that we laid out, we actually used a six year horizon to say over the next six years, what could we reasonably accomplish? What would be something that would aspirational but not beam me up, Scotty kind of goals? We came up with 20 goals, 86 research development milestones, and 26 of those milestones were rated as very high. We looked at all the key barriers, gaps, strategic goals, milestones and R&D priorities in this roadmap. Now our job is to work to keep it alive as a living document. So when we look at all of these particular milestones by date, by time, we can actually track what's being done and what's not being done. I'm hopeful that in the days ahead, we're going to hear more about funding and public policy opportunities to use the roadmap to move forward. I just want to say at this point, thank you so much to the CIDRAP team. Many people in CIDRAP contributed substantially to this effort. This was an effort that I have to say was in some ways a Manhattan project for us.


Dr. Osterholm: [00:34:40] I want to thank all of the subject matter experts that did so much to work on this, spending many, many, many hours on Zoom meetings, reviewing documents. And of course, I want to thank the two foundations for their support. Let me just conclude by saying that the roadmap is actually on the podcast website. Please feel free to take a look at it. There's a press release there that goes into some detail about it. And then we actually had the good fortune to have Vaccine, one of the most respected journals in the area of vaccinology published a summary of the roadmap with Dr. Moore as the first author and as well published a commentary by Dr. Margaret Hamburg, former Assistant Secretary of Health and former FDA director, and Dr. Greg Poland from the Mayo Clinic actually published a commentary about the significance of this roadmap. So I'd urge all of you to take time to go take a look at that, and I think you'll get a sense for what we're talking about of the comprehensive nature of this and why it is so important. Again, we cannot rest on just these vaccines we have today. We need to do better. But in the meantime, please use what we do have because it is what could save your life.


Chris Dall: [00:35:54] So, Mike, this is a scientific and not a political report. But as we've just discussed, vaccines have become a political issue in this country and around the world. Do you worry that growing anti vaccine sentiment is going to hamper efforts to develop and deploy the type of vaccines that are going to be needed?


Dr. Osterholm: [00:36:12] Chris You know, in my 48 year career, I have witnessed some amazing advances in public health practice and medical practice. I've seen all the good that we can bring to a society with those measures. But there is nothing, simply nothing that pains me more. Then to see how we've regressed in so many ways around the public health messages and the public acceptance of vaccination. It is so unfortunate. So I'm very worried about this. I think that the COVID pandemic really took what was already a festering problem of misinformation and literally exploded that. And now it's much easier not to just to be critical of COVID vaccines, but to actually be critical of any vaccine. So I am very concerned. And I think one of the things that we in public health and medical practice need to understand is how do we counter this? Is there a way, you know, let's just acknowledge there are some real political overtones in all of this. And when you can start having discussions about alternative facts, you know that you've already lost the scientific high ground. So that, in fact, we have to think about how do we address intentional misinformation or disinformation. A good example today we see it every time someone dies from an acute myocardial infarction.


Dr. Osterholm: [00:37:42] The first thing that set it up probably had to do with the COVID vaccine. We've seen that time and time again, and yet that's not true. And the pain and suffering it brings to families are significant. They're already in a very, very bad way with the loss of a family member or a friend. And now to have to add this piece onto it. So we do need a lot more work done in this area of myths and disinformation. We need to understand from the behaviorists, from the psychologists, we need to understand from the sociologists, from the media, consultants, from people who are into social media, what can we do? How can we do this better? And we've got to start at the early stages so that at this point, I think we're going to continue to see a degradation of our vaccine rates for all childhood immunizations, as well as for some of our adult vaccines in the days to come. And what a waste that would be not only for the individual who becomes infected because they weren't vaccinated, but the risk that they pose now to the public of increasing transmission because they, too, are infected. So this is a huge issue.


Chris Dall: [00:38:52] Now it's time for our COVID query. We received a lot of questions this week about a new Cochrane review on the effectiveness of masks in interrupting or reducing the spread of respiratory viruses, including SARS-CoV-2. Here's what Kendra wrote: “What does Dr. Osterholm think about the Cochrane Review that supposedly says that masks made no difference? I had two people, one physician, one nurse practitioner mention the study today and say that the Cochrane Review is the gold standard, supposedly, well, well-done randomized studies. I suspect that you'll have quite a few questions on this from the podcast family.” And yes, Kendra, you are right. So Mike, what are your thoughts on this Cochrane Review? And maybe you could start by providing our listeners with a brief primer on Cochrane reviews and their significance.


Dr. Osterholm: [00:39:37] Well, Chris, this is a very painful situation in a way, because it is the ultimate irony in medicine. The Cochrane reviews are supposed to be authoritative reviews of a topic area in medicine or public health in which they bring the standards of medical and public health evaluation to a discipline such as Do mask protect. What is a mask? But I have to tell you that there is a misconception that, like so many other organizations that are supposed to be adjudicating the actual validity of some of these data, the Cochrane reviews itself have come under criticism. They're done by people. They're done by people that some of us believe are biased, that do not follow the actual approaches that do provide for an unbiased, fair review. I can say with certainty the Cochrane Review staff that generated this one with regarding to mass are some of the same people that I had terrible concerns about and what they did with influenza vaccine reviews some ten years ago. And so I do not consider the Cochrane Review as a gold standard. And I'll share with you in a moment exactly why they came in with a point of view. And the people who are part of that have been well known for their point of view. So that from my perspective, while some would say it's a gold standard, I'll tell you, it is not. If there's anything we need a study of, it's a study of the Cochrane Review process. And just how good is it or isn't it, depending on who is involved with it. So ideally, Kendra, the Cochrane reviews could be helpful tools, but they're not.


Dr. Osterholm: [00:41:11] And before I address this, let me just note that we have a commentary posted on our CIDRAP website today on this very topic led by Lisa Brousseau and also Raina MacIntyre from Australia, as well as Angela Ulrich and myself. And we've tried to really go through not only the Cochrane Review, but also a recent study that was published in the Annals of Internal Medicine providing such confusion. First of all, if you look at the Cochrane Review, they assume based on the very definitions they use, that SARS-CoV-2 is only spread by large droplets from people coughing or sneezing. They recognize that some people can be asymptomatic with influenza and COVID-19, but failed to consider them as playing any important role in transmission by small particles, both near and far from a source. Those biases right up front already speak to what they're going to find. They also fail to recognize that exposure could occur at times when mask and respirators are not being worn at work. Non-COVID patients coworkers. They lumped community and health care studies together, although exposure and mask wearing will be very different in these two settings and they do not consider that randomized controlled trials that were well done showing that surgical masks do not prevent surgical wound infections, which means if they can't prevent that, how are they going to prevent actually the individual wearing them from getting infected with aerosols? And they assume that surgical masks are the standard of care and failed to recognize the importance of a true control group. No mask at all.


Dr. Osterholm: [00:42:42] And of course, we all know that that would not be ethical to do, but surgical masks would never be a standard of care for an airborne or aerosol transmissible respiratory infectious disease. Any good arrow, biologist or industrial hygienist would tell you that. So right there, the Cochrane Review is flawed. And if you go through their analysis and our commentary really draws this out, you'll see what I'm talking about. There was an additional study that came out recently in the Annals of Internal Medicine by Loeb and colleagues in Canada. And here this is also received a fair amount of attention, suggesting, again, that there really was no difference between wearing a surgical mask and a respirator in patient care. They compared surgical masks and respirators and health care for COVID patient care only. There was no control group. The group that wasn't wearing masks, which I already said would be difficult to do because of the ethics of that. This would have allowed comparison, though, surgical masks to wearing nothing, and it would have shown that surgical masks are not effective at all and respirators to no mask might have shown some efficacy, except they weren't worn for all encounters with infectious people. So you can't protect yourself only X percent of the time and assume that you'll get 100% protection. The Loeb study assumes that surgical masks are the standard of care, which is just isn't true for aerosol inhalation or airborne transmission. Respirators and negative pressure rooms required for TB patients and measles patients are an example of that. They did not recognize that aerosol transmission is the primary mode of transmission, despite increasing amount of scientific data supporting this as the predominant mode of person-to-person transmission.


Dr. Osterholm: [00:44:25] They do not recognize that health care workers could have been exposed to COVID-19 from non-worker, non-COVID patients, asymptomatic people at work, and last they did not recognize that asymptomatic transmission can be responsible for person to person transmission. These are simple fatal flaws in these studies. And again, go back to our commentary. You'll see what I'm talking about. But it's terribly, terribly unfortunate the studies like this get published. And let me tell you, it all came to a head yesterday when The New York Times published a very well known op ed writers column. The mask mandates did nothing. Will any lessons be learned? And in this op ed piece, which is getting a great deal of play, Bret Stephens said basically that the most rigorous and comprehensive analysis, scientific studies conducted on the efficacy of masks, reducing the spread of risk for illnesses, including COVID-19, was published late last month. And its conclusions, said Tom Jefferson, the Oxford epidemiologist who was the lead author, were unambiguous. There's just no evidence that they mass make any difference. Well, this is just simply not true. Again, the Cochrane Report is seriously flawed, as was the study published in the Annals of Internal Medicine. And so this whole assumption that if you looked at masks, you included all respirators and surgical masks, and that this study would give you an opportunity to understand that simply not true. And so I feel sorry for all of you who are going to hear from friends, colleagues, family members, whatever.


Dr. Osterholm: [00:45:59] See, you are wrong about the mask issue because you're not. Remember, in N95, respirators can do a great deal to reduce your risk of either transmitting the virus if you're infected and you have one on and or becoming infected if you are wearing one. So I hope that this commentary that we have on the website, you can send that wide and far. I hope people read it and see it and provide a counter to this. And I wish op ed writers like Bret Stephens would stop writing on topics they have no knowledge or no expertise. And this has been a problem throughout the media through this pandemic. And it's time we call this out because I think that we are doing a great disservice to the public. Do we have work to do in our own house as public health professionals? Absolutely. We still have many medical care professionals who believe that this virus is only transmitted in that 6 to 8 feet by droplet, which is obviously a challenge to the scientific data supports. That's not the case. But so, Chris, I wish I could tell everyone this is not going to get more confusing, but I'm afraid it will as more and more myths and disinformation in this area comes out. But just for everyone's personal sense, if you were wearing your in N95 and you have it fitted to your face, I can tell you absolutely you will have a much, much higher level of protection than anything else you could do in terms of respiratory protection.


Chris Dall: [00:47:33] Mike. This week we received an email from listener that is both a beautiful place, a mission, but also a celebration of life. What can you tell us about it?


Dr. Osterholm: [00:47:43] Well, this is a very, very special, beautiful place of mission, a beautiful picture. So I want you to take a look at that on the website. But also Gayle. Has shared with us the pain and the suffering of the pandemic. And yet the celebration. And Gayle, I can't begin to tell you how much your beautiful place of mission has meant to all of us. It has moved us, and I hope all of the listeners take time not only to listen to this, but to go and look at the picture. So this is from Gayle. “My beautiful place is the Susquehanna River in south central Pennsylvania. As the world started shutting down, my father was in a nursing home close to death from dementia. Although his nursing home was closed to visitors, they did allow us to say goodbye. Fully gowned, he died alone. We couldn't have a funeral, so we had a small graveside service with immediate family only. Although it was hard, we knew it was a blessing that Dad died when he did, because he wouldn't have understood why his family stopped visiting and would have thought we abandoned him as an essential worker living alone.


Dr. Osterhholm: [00:48:55] I wasn't part of anybody's bubble except for work. I was always alone. I spent most of my free time exploring the Susquehanna River, hiking the hills surrounding it, bicycling along its banks and kayaking every weekend during the summer. My dad loved fishing, birds and trains, all of which can be found at the river. And I felt close to him there. Knowing how much he would enjoy being there with me. Nature was our bond. As I explored the river, I found many beautiful places, including the one in the photo taken near Lock 15 in York County. The river and its many beautiful places was my refuge during a very difficult time. Gayle.” Thank you, Gayle. That is so powerful. I'm so sorry you had to go through what you did with your father and how he died alone. But at the same time, I celebrate the fact that you have been able to share this beautiful environment with him in spirit and your ability to see that. What a beautiful place, both in your heart and in the pictures you shared with us. Thank you, Gayle, from all of us.


Chris Dall: [00:50:04] Just a reminder to our listeners that if you want to tell us about the beautiful place that has helped get you through the pandemic or share a celebration of life for a loved one friend, neighbor or coworker who died during the pandemic, please email us at osterholmupdate@umn.edu. Mike, what are your take home messages for today?


Dr. Osterholm: [00:50:23] Press. I think the first one that we keep coming back to the take home message almost every podcast is how do we live with COVID? And today I tried to share a sense of for many people in this country who are over the pandemic, who are not concerned about the serious consequences of COVID infection, we have to acknowledge that that is a reality. And we realize that that is a different scenario or situation than for those of us who may be at increased risk for serious illness, hospitalizations and deaths. So we have to figure out how can we live together, how can we be together? And I think that this is really going to be a point over the next few months that we all have to work on How do we go see our grandkids now? Do they still have to be tested or are they not They're not going to test because there are in every day out there. What does that mean? Number two is I think the vaccine safety issue is huge. I can't say that more clearly. The misinformation, disinformation, not just about COVID vaccines, but how it's creeping into all of our child immunizations is in fact, a serious risk to our public health, not just in this country, but around the world. And finally, the whole issue of respiratory protection, the whole Cochrane Review issue, the Loeb study and the Annals of Internal Medicine, these are all huge challenges for the public to say, Just tell us what to do. Be clear. And we're not doing that. There are so many, you might say, cooks in the kitchen, many of them who've never cooked a food item before in their life. Now, confusing everyone, what's going on? So I hope that the commentary that we've supplied for you is helpful and that you find it to be something that you can give to others and share with them when they actually counter you and say, Oh no, you don't know what you're talking about.


Chris dall: [00:52:15] And Mike, I'm guessing that your closing song or a poem today is going to have something to do with Max. Am I right?


Dr. Osterholm: [00:52:24] You might just be right. When I thought about this issue of memories. Max has brought me so many wonderful, beautiful memories. I got to experience unconditional love. Remarkable. And I've thought about it as I've spent so many hard, hard days in this COVID pandemic. And thinking about, you know, there's got to be other things in life that I can remember, that I can celebrate, that I can find a place of peace and quiet. And so I think for memories, we sometimes take those for granted. Surely bad memories continue to bother us. Forget those, but think about the good memories and share them. And so as we get through this pandemic, I hope that's what you can do. And I hope that you, based on this, intentionally find, identify, think about, feel and share a good memory. So today I want to share a song that's all about that. This was a song written by Billy Strange and Mac Davis, especially for Elvis Presley to perform an Elvis, his comeback TV special that would air on NBC on December 3rd, 1968. Actually, Mac Davis recalled later that he was asked to write the song, and he literally did it overnight. Staying up all night at Billy Strange's house in Los Angeles. The song was released in 1969 and it reached number 35 in the Billboard Hot 100 the week of April 12th, 1969.


Dr. Osterholm: [00:54:01] The song is just about what I just talked about Memories. By Mac Davis and sung by Elvis Presley. “Memories press between the pages of my mind. Memories sweetened through the ages. Just like wine. Quiet thoughts come floating down and settle softly to the ground. Like golden Autumn leaves are on my feet. I touch them and they burst apart with sweet memories. Sweet memories of holding hands and red bouquets and twilight trimmed in purple haze and laughing eyes in simple ways and quiet nights And the gentle days with you. Memories press between the pages of my mind. Memories sweeten through the ages. Just like wine. Memories. Memories. Sweet memories. Of holding hands and read bouquets and twilight trimmed in purple haze and laughing eyes and simple ways and quiet nights and gentle days with you. Memories pressed between the pages of my mind. Memories sweetened through the ages. Just like wine. Memories. Memories. Sweet memories.” Memories. Mac Davis, sung by Elvis Presley. Thank you all so very much for being with us today. I hope that the rather eclectic order of everything we covered and what we talked about is acceptable this week. I'm sure you weren't thinking about getting an entire podcast on a dog, were you? Well, of course, when you talk to me, God knows what you're going to get.


Dr. Osterholm: [00:55:46] And any of you who own dogs before you know what those poop bags are all about, they're very, very important. And I will have mine forever. As long as I'm alive and my coat pocket will exist. Those same poop bags, and they bring me sweet memories. Thank you for spending their time with us. Again, we covered a lot of numbers today. Please never forget who these numbers are all about. They're about our loved ones, our family, our friends, our colleagues. We can't ever forget that days are getting better with COVID. We must acknowledge that. But at the same time, I want to be very clear. I don't think what we have right now is yet acceptable. We can do better. Hopefully, the vaccine roadmap will one day lead to a vaccine that will make it so that we don't have to go through another COVID pandemic like we have done over the last three years. So thank you very much. Have a safe two weeks as we bury her in Minneapolis from all of our snow. I just know the days are getting longer and that's great. So thank you. Thank you so much. Be kind and again this week. Go back and find one of those memories and share it. Thank you.


Chris Dall: [00:57:03] 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/donate. The Osterholm Update is produced by Cory Anderson, Meredith Arpey, Elise Holmes, Sydney Redepenning, and Angela Ulrich.