March 9, 2023

In this episode, Dr. Osterholm and Chris Dall discuss the state of the pandemic in the US and around the world, the role of booster doses and masks in the months ahead, and the debate on the origin of the pandemic.

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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 Dall, reporter for CIDRAP News, and I'm your host for these conversations. Welcome back, everyone, to another episode of the Osterholm Update podcast. In a classified intelligence report recently provided to the White House and select members of Congress, the Department of Energy concluded that the COVID-19 pandemic most likely arose from a laboratory leak in the city of Wuhan. But for other US agencies and a national intelligence panel believe that the origins of the pandemic are likely tied to a market in Wuhan, and none of the agencies have much confidence in their assessments. Needless to say, the latest news has revived the heated debate about how the pandemic began and who is responsible. It's a question a lot of people have but may never be answered. How important is it that we find an answer? That issue is one of the topics we'll be discussing on this March 9th episode of the podcast. We'll also provide an update on the current COVID trends here in the US and around the world. Examine what the plan should be for vaccine booster shots and answer a query about how long we'll need to be wearing masks. 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 opening comments and dedication.


Dr. Osterholm: [00:01:50] Thanks, Chris, and welcome back to all the podcast family, this very special group of people that we are so appreciative to have as part of this podcast to work. To any of you who are new to the podcast, I hope today that we're able to provide you with the kind of information you're looking for that is helpful in understanding where we're at and what we must need to consider with regard to this pandemic. And today I want to address some of the controversies that are occurring right now within the COVID world and the media and the social media world and hopefully provide some context to those controversies as to what do they mean to us every day in our lives. But I do want to comment first about something that happened this past week, and this was for both Chris and myself. We both attended the Bruce Springsteen concert here in Minnesota on Sunday night. And it was a show unlike I've ever seen before. Three hours of nonstop music only as the boss could deliver with an 18 member E Street band. It was simply remarkable. And I was there and I was very, very happy to be there with Fern. And I was there with my N95. On feeling confident that I would be protected if there were anyone there who was shedding the virus in my locale.


Dr. Osterholm: [00:03:09] And it's part of really almost coming out. It's my way of understanding how can I be part of everyday society? How can I get myself back to what it was before the pandemic began and at the same time protecting myself as an aging man? And as many of you know, getting up there, I surely am at risk for potential serious illness, even though I've had all my doses of vaccine, which we will talk about that today, too. So I just wanted to share this with you on this moment of optimism that we can find more and more ways to live our lives with this virus. And we'll talk about why for many people in society, the virus is done. As far as they're concerned, they're done with it and it's done with them. And we'll talk about that today, too. But in the context then of what we're going to be really addressing today, I want to dedicate this podcast to a simple concept, one that shouldn't need to ever be discussed. It should be assumed, and that is truth. Right now, we're beginning to see more and more untruthful misinformation, disinformation messages out there about COVID and what's happening or what did happen and how we reflect on what did happen. And I think that's going to be very important for us as a society, as a world, to move forward and be better prepared for the next pandemic.


Dr. Osterholm: [00:04:35] Only if we really understand what happened here truthfully and then respond accordingly. So at this point, I will just say that I don't own the market on truth. God knows anyone who knows me well knows that, you know, I try to be truthful, but there's a lot of things I don't know. But today we will talk about what is it that we can say about truth and COVID. Now, with that, I want to move on to another very positive aspect of the podcast, and that is the listener response that we get. And I have to say it was overwhelming this past week. How Max touched many of you. I surely find there must be a substantial overlap between the dog loving world and people who listen to this podcast, because we surely have heard from you and thank you so much for all the kind comments and all the stories you shared about your special pups. And so in that regard, I just want to say thank you. It was very rewarding to see so many dog pictures. You can never see enough of them. Also, another very positive aspect of today's podcast is our dedication to the sunlight. As we all know, this is spring. Even though if you're living in Minnesota right now, with snowfalls continuing to occur week after week, you begin to wonder.


Dr. Osterholm: [00:05:55] But I'm very happy to report today in Minneapolis Saint Paul Sunrise will be at 6:36 a.m., sunset at 6:11 p.m. That's 11 hours and 34 minutes and nine seconds of sunlight. We're gaining three minutes and eight seconds of sunlight a day in just a few days, March 13th, we will go to three minutes and nine seconds of increasing sunlight each day that will maintain itself for 13 days, and then the actual increase slows down as we get closer to June 21st. But it's still a positive increase. So this is exciting. And also, of course, I have to acknowledge our dear colleagues in New Zealand at the Occidental Belgium Beer House on Vulcan Lane in Auckland, that you too are still experiencing a lot of sunlight today. You will have 12 hours and 36 minutes of sunlight, but you are losing two minutes and 22 seconds of sunlight a day. We will be happy to share ours with you as the months progress towards these long summer days. So from that perspective, I just want to say welcome on board to all of us as we march into spring, particularly in the Northern hemisphere, and we address some of the challenging issues we have before us today with COVID.


Chris Dall: [00:07:11] Mike. The most recent global epidemiology update from the World Health Organization indicates new COVID-19 cases and deaths continue to decline across most regions. But the European Center for Disease Prevention and Control recently reported increasing trends in severe disease and deaths, along with increasing case rates among people 65 and older. Is this the type of ebb and flow we're going to see with COVID from here on out?


Dr. Osterholm: [00:07:40] Well, Chris, this is surely an area that we have addressed in the past about the reliability of numbers. How can you even interpret what's being reported if, in fact, you know that there are big, big gaps in what's actually happening and what's getting recorded. For example, just think about the issue of W.H.O. reporting about a thousand deaths a day right now worldwide. Well, the United States is reporting between 400 and 500 deaths a day. So that means half of all the deaths in the world are occurring here in the US. I don't think so. So I don't know quite how to interpret the data other than to say that surely we still have challenges with this virus around the world. How much of what is happening is underreporting? How much of it is actually the dropping number of cases? So to me, Chris, this is one of the premier billion dollar questions. And I said that because its central premise is more or less that about our future and what could the world look like with COVID? In short, the reality is no. One really knows exactly what this virus will do moving forward. And clearly it's a very difficult, frustrating reality. But we also have to understand at the end of the day, we really don't have a lot of experience with pandemic coronaviruses or at least well documented examples. So we're kind of learning as we go, and that's a challenge for trying to understand what's ahead of us, whether it's short term or long term. Will we end up seeing this oscillating pattern of rises and falls? Who knows? We certainly could.


Dr. Osterholm: [00:09:10] Just think about it. Just three months ago, Japan was experiencing its biggest surge of cases in the entire pandemic. What does that mean? Could that happen again in other countries, including the United States? We just don't know, really. If you think about it, it's the up and down ebb and flow like picture that's been the norm throughout most of the pandemic. However, while having said that, I've also continued to emphasize the High Plains Plateau event that we're experiencing here in this country, where literally for the last 12 months, the number of deaths has ranged roughly from 350 to 550. Day after day after day. What's driving that? What's changing that? Well, one thing is certain that the virus is changing and we yet don't understand what each of these changes mean. Every time we see a new variant or sub-variant, does it have any impact on how much immune protection we might have or will it evade that immune protection that we've previously accomplished with either vaccination or previous illness? Does in fact the virus change in such a way to be more infectious? What does that mean and how does that all overlay on the issue of waning immunity? What does that mean? So I might be protected today, but I might not be protected six months from now. And when I say protected, what does that mean? Is it I'm going to get sick, but I'll do okay. Does it put me again at risk potentially of having serious illness? So based on this, there is no denying that our circumstances have changed.


Dr. Osterholm: [00:10:41] And surely for the better. We are not seeing the major house on fire events around the world. And we have to acknowledge that most people on the face of this earth, at least at this point, have had exposure to this virus, whether it was through infection, the vaccines or a combination of the two. So theoretically, this kind of protection that exists at the population is helping us. But of course it's not permanent or perfect. Then therefore, we have to ask ourselves, what will it be like six months from now with the same viruses, but maybe not as a population with the same level of immunity? And we have to ask ourselves, what does that immunity mean? Well, as I just said, keep us from becoming seriously ill but not preventing infection or will in fact, we also begin to see serious illnesses two, three years out. We just really don't know. Fortunately, we haven't seen a dramatic rise in activity with Xbb and at least on paper, the situation so far is improving. As I pointed out, the case numbers are surely coming down, but I don't know how to interpret those because I do believe they are so very, very incomplete. So I think there's still a lot left to think about and consider. And a major piece of that is understanding what happens with immune protection, particularly when it comes to severe disease over time. Chris, you mentioned the European CDC report, which recently mentioned the uptick in severe disease and death, especially in those 65 years of age and older.


Dr. Osterholm: [00:12:08] What's causing that in Europe? Obviously, it's something to keep an eye on. Ideally, it'd be great if we had a better sense of who these individuals are and what their exposure histories look like. Well, we see the entire world become part of this high Plains plateau. At the end of the day, we want to protect the most people possible. And if we want to provide the best recommendations, we need to know who's at risk and why that's the case. And frankly, another challenge we're facing is a growing lack of data, whether that's cases, hospitalizations, deaths or populations being impacted the most. What role is reinfection playing? Does it matter which variant you're infected with? How many doses of vaccine have you had? What kind of vaccine? Yet we find ourselves in a position where some of the systems and programs that might help compile this information are being rolled back or completely dismantled. So to summarize, Chris, I'm really not sure what the path ahead with COVID will look like. Will it be a slow, steady burn? Will it be ebb and flows? And if it is an ebb and flow situation, will it come as a result of new variants or waning immunity or both? Nobody knows. But what I can tell you is that this virus is not going to go away. And we have to understand that and be prepared to respond accordingly.


Chris Dall: [00:13:28] Here in the United States, cases and hospitalizations are at their lowest point since October, according to tracking by The New York Times. But as you mentioned, Mike, deaths are still high remaining in that 350 to as high as 550 a day range. So what's your sense of what is going on and who is dying from COVID at this point?


Dr. Osterholm: [00:13:51] Well, Chris says anyone who has been listening to this podcast over recent months, you know that we have been trying to provide some context for how do we live with COVID. And one of the ways to do that is to understand what is our risk. And as I've said time and time again and some have misinterpreted to me and I want everyone to get COVID, I don't. But on the other hand, if COVID was nothing more than a common cold, I think if we all got it twice a year, you know, we wouldn't be at all concerned. Now, we're not saying that the virus is moving towards that direction yet, but surely it's possible that we're going to see milder illnesses associated with these infections over time, particularly for those who have some existing immunity. But we can all agree that deaths are the outcome that none of us want. None of us want to be worried about dying or having a loved one die. If you break the data out so that you can assess the age at which people are dying from COVID, you see that 85.8% of all the deaths are occurring among those 65 years of age and older. If you add in the 50 to 64 year old age group, now it's up to 96.2% of all COVID deaths in this country are occurring in that group, 50 years of age and older. So if you're in that younger age group, in many cases, you don't see this as a major risk, for example.


Dr. Osterholm: [00:15:16] In 2020, 1093 children, 14 years of age or younger died in a car accident. That's 1093 for the time period from July to December of 2022. For those 0 to 17 years of age, 220 individuals died. So on an annualized rate, that would be about 440, less than half of the number that children that died in automobile accidents in 2020. For 14 and younger. So I don't think there are very many parents that would be reluctant to put their child into a car and go somewhere with them with the fear that they are going to die in an automobile accident. And here we have a risk for COVID, which is even lower. Now, if I'm a parent, I'm probably internalizing all of this. I want nothing bad to happen to my children. But is this an acceptable risk that we now, every day in our lives, have to encounter? If you look at all the deaths and those under age 49, they literally account, as I said, for this, 3.8% of all the COVID deaths. And so I can understand how that population is feeling about this. They are feeling that as if this is not a big risk factor. Influenza is every bit as much a risk factor for severe illness also. So I think one of the challenges we have right now is helping those individuals 50 and older to be protected against serious illness. And we come back to the fact that, as I've said time and time again, it is, first of all, being fully vaccinated.


Dr. Osterholm: [00:16:49] And we'll talk more about that later. But in fact, we are surely under vaccinated right now with booster doses for those who are 65 to 74. Only 50% of the population has actually received a booster dose for COVID. For those who are actually over age 75, it's only 48% have received a booster dose. So right there is something we could do to greatly improve upon the likelihood of having a severe outcome. Now, that's interesting, too, because in contrast, 71.2% of the US population over age 65 received a flu shot this past year. So more people are getting the flu vaccine than they're getting the COVID vaccine. Why is that? As I mentioned earlier in the podcast introduction, I was the wonderful, wonderful recipient of an evening with Bruce Springsteen this past week where I felt perfectly safe even though I was in an arena with 18,000 other people because I had my N95 on well fitted. And so I think at this point, to help understand this risk, we just have to keep coming back and concentrating our efforts on those who are older. I don't want to see anyone younger than 52 develop a severe case of COVID and die. But we all know that if we're trying to eliminate the really severe outcomes of COVID, we will basically continue to concentrate our efforts in that older population.


Chris Dall: [00:18:19] Mike. The US strategy for vaccine boosters seems to be in limbo at the moment. There is discussion about going to a yearly booster schedule at the last meeting of the Vaccines and Related Biological Products Advisory Committee in January, but no decisions were made. Meanwhile, there are millions, perhaps tens of millions of Americans who are 5 to 6 months out from their last booster and likely wondering when they can get their next shot. So do you have any sense of what the plan is for booster shots going forward and what it should be?


Dr. Osterholm: [00:18:51] Chris, This is one of those situations with COVID where we're learning as we go. The more experience we have with the vaccines and even previous infection and what that means for subsequent immunity remains one of those unknowns. We're not sure what it means to be vaccinated and be out 6 to 12 months. We're seeing more data come forward right now suggesting that with even a bivalent vaccine dose, you have short term protection against any severe illness. But as time goes on, that wanes even potentially by six months. Now, you've heard me say time and time again, we can't boost our way out of this pandemic. And I say that because, as we've already seen, many people will not get additional doses of the vaccine. So from that perspective, what we have to ask ourselves is what might be the course forward? Now, I've already shared on multiple occasions with our audience here the reason why I don't think that this virus right now is acting as a seasonal respiratory pathogen. Surely there may be some impact with regard to crowding and indoor activities, etcetera. That could be associated with season. But as I've pointed out time and time again, we have seen activity in the southern hemisphere and in the northern hemisphere mirror each other at the same time. That's not a seasonal virus picture. So when the FDA had made a decision to tie flu vaccine administration and COVID vaccine administration together, I was very challenged by that because we know with influenza vaccine, we need to give it in the late fall.


Dr. Osterholm: [00:20:38] Why? Because we know that in the northern hemisphere we can count on the flu season to occur somewhere between November and February. And we also know with flu vaccines, we may lose up to 15% of the protection per month after administration. So if somebody gets a dose of vaccine 6 to 10 months before the actual activity, how much have they lost in terms of their protection? So we want to tie that vaccine specifically in time to the flu season. Well, if that's not the case with COVID, when we don't know when that activity will pick up, you know, tying it to a seasonal situation is, I think, unfortunate. Now, as we've learned in the past week and FDA has clarified there won't be a COVID flu shot combination available by the time that we get into this 2023 flu season. So, again, we're going to have to separate them out. I think it's really important to acknowledge the data. We have supports that probably at six months out, you've lost a substantial amount of your protection. So for those who are wanting and willing to get vaccinated, I would hope that there would be a permissive recommendation that says you can at six months. Now, it was interesting, just last week the UK actually made an announcement that they are going to offer what they call a spring dose of vaccine to those who are 75 years of age and older.


Dr. Osterholm: [00:22:07] Those who are immunocompromised or residents in care homes for older adults. So they've already started to take this issue on. And it's not as if the federal government hasn't at least given some signal of that in a very thoughtful October 21st, 2022 story by Helen Branswell. Instead, she interviewed Dr. Peter Marks, who leads the FDA's vaccines operation. He stated in that interview that he was concerned that it would be necessary to give a booster dose every six months to really heighten protection for those who were at highest risk of serious illness. So whether we adopt that approach, I don't know. I am now in a high risk group my age. I am also more than six months out from my bivalent booster dose. I want one. And now I know I'm not like everyone else. There are many who say I'm done. I don't want any more doses, but I hope that for our audience here, people who are really trying to protect themselves the best they can, that that will be allowed and that we will be able to be permissive. Now, I'm surely aware of the fact that many people will still not likely take the vaccine. The fact that, as I said before, if you look at influenza vaccines, 71.2% of those over age 65 this past flu season got a dose of vaccine 71%. And yet with COVID, only 50.3% of those, 65 to 74 and only 48% of those 75 and older got a COVID booster dose despite the same energy in terms of our recommendation to get one.


Dr. Osterholm: [00:23:45] So we have a lot of work to do yet. And I hope the fact, though, that we can be creative with how we do it as we learn more about these vaccines and that's what we need to do right now is I think, let people who are at increased risk get their additional doses and then I think we just have to really concentrate on getting better vaccines. Do not interpret that comment to mean that the vaccines have not played a key role in literally saving millions of lives. They have. But these are good vaccines, but they're not great. We need great vaccines. And this was, of course, what we talked about in the last podcast with our roadmap rollout from CIDRAP. You know, we put together a very comprehensive coronavirus vaccine roadmap showing what we need to do, how we need to do it, when we need to do it, to actually achieve these better improved vaccines that hopefully will get us durable immunity over time. So in the meantime, sit tight. Hopefully the FDA is listening. Many of us are talking about it and we can get additional vaccine booster doses available to those who are at least six months out and who are at high risk for serious illness.


Chris Dall: [00:24:54] Now to the origins of the COVID-19 pandemic. Mike, as you know, the Department of Energy report only added more fuel to this fire. What do you make of the department's conclusions and how important is it to find out how the pandemic started? I don't mean to suggest that it doesn't matter how it started or that people shouldn't look for an answer to that question. But will knowing how it started, help us prevent future pandemics?


Dr. Osterholm: [00:25:21] Chris This is the segment of the podcast that I wanted to really hammer home the concept of truth. And truth is, in some cases not clarity, but it's what we know. What do we not know? And being honest and truthful about that and what I've watched happen over the recent days has been a heightened effort to basically put forward conspiracy theories and accusations about motive and so forth that really had nothing to do with the issue at hand. It had everything to do with just one's political persuasion. And anyone who has listened to this podcast and who has ever worked with me knows that I'm I'm agnostic when it comes to the politics of such of government. I'm here to help however I can, as I have in all of the last six presidential administrations that I've been involved with. And so today I'm approaching this from the very same position. I also have an added experience here that may reflect on what I think about what's happening here, and that is that I served on the National Science Advisory Board for Biosecurity from its formation in 2005 until 2014. And it was all about the idea of what kinds of research could be dangerous if done in a laboratory and that particular infectious agent were ever to get out. And how might that information, if even if it doesn't get out but be made public, would allow a third party to duplicate potentially a dangerous experiment or creating a dangerous virus for humans and animals? And so I've been in the cutting edge of that discussion as a member of the National Science Advisory Board for Biosecurity.


Dr. Osterholm: [00:27:09] And in fact, in 2012, I was one of several individuals on that committee that actually raised serious questions about the safety of some of the influenza research that was being done, looking at what we call gain of function research, where there was an attempt made to make the virus become what we call mammalian transmissible or transmissible between mammals, in this case using ferrets to better understand what might be the predictors for when it could potentially become a pandemic virus in humans. And so, of course, I'm talking about the H5N1 virus. And I raised many questions at that time about lab safety. So from that perspective, you might think that my orientation is, you know, lab safety first is the issue and then everything else after that. But having worked with SARS and MERS, I've also seen what a spillover looks like with the coronavirus. So from the very earliest days of the pandemic, I've approached this issue with an open mind. And what I like to think is agnostic. What do the data tell us? What do they tell us? And I can say at this point right now that we will likely never know what happened, not because I don't want to know, but we have to be truthful and say in this case we will not know because the data just don't exist to allow us to understand that it's like these cold criminal cases that go on for decades and decades and are never solved, not because somebody didn't try or they wanted to, but the evidence just did not give one a confidence that this was the actual perpetrator, in this case, the cause of the pandemic.


Dr. Osterholm: [00:28:50] Now, I will say at this point that what I think we're seeing right now is more political theater than we're seeing anything that has to do with science. For example, let me just share with the audience, which I think is probably going to be somewhat of a surprise to you, to know that when the Department of Energy put forward its new assessment of the possibility that this was a lab leak, they did this under the auspices of the office of the Director of National Intelligence. This is a body that brings basically all of the US intelligence agencies together and comes up with common definitions and common approaches to assessing intelligence information. And if you look at what the director of the national intelligence definition is for a low confidence level conclusion, which is what they did, this is their definition. A low confidence level generally indicates that the information used in the analysis is scant, questionable, fragmented, or that solid analytical conclusions cannot be inferred from the information, or that the IC has significant concerns or problems with the information sources.


Dr. Osterholm: [00:29:57] Does that give you a confidence that that lab leak now has a new level of evidence supporting its occurrence? No. And even with the FBI, I appreciate what they do and how they do it. And they came up with basically a moderate level of confidence. But remember, this is the same organization that for two years after 911 were certain that they had the guy that perpetrated the anthrax attacks only to find out two years later they were completely wrong and they had a high level of confidence that they had the guy. So I'm not suggesting that they don't do a good work, but they hardly are infallible. So I come back to the point of saying I don't think we'll know. And let me just give an analogy here that I think may also be helpful to understand what the Chinese are up to. You know, I'm not here to defend them. We know that they have been untruthful in many instances in public settings about many different issues. So I'm not an apologist for them at all. But imagine if a new virus emerged in the Caribbean, highly lethal, highly transmissible. Where would we likely pick it up first? Probably in Atlanta because of the air hub that it is for the Caribbean and because they have laboratory capacity there to actually identify such viruses. It would show up there.


Dr. Osterholm: [00:31:16] Can you imagine what the world would say if this new virus suddenly showed up in Atlanta? It was a leak from the CDC. And no one would be dissuaded in many countries around the world that that wasn't what happened. And I could see the Russians and the Chinese, just like the United States, asking to see the China lab information, wanting to come into our labs here in this country, and we would say no. So I'm only trying to lay that out to say I don't have an expectation that the Chinese are going to be more forthcoming. I wish they were, but they won't be. And even if they were more forthcoming and it turns out that there was no evidence in the lab that there was anyone who was infected in that earlier time period of October and November who might have gone into the community with the virus. There was no evidence of an accident in the lab itself. Would many people believe them, even if they said, you know, showed us all the information, they'd say, oh, don't believe them. So I remain in this agnostic position, but I will say that the data that has been published and there were two recent articles this past year from a group of scientists which I think do lay more support for the idea that this was a spillover event and actually happened that way. But take a step back.


Dr. Osterholm: [00:32:33] Why does it matter? I don't think it does in terms of we have to be prepared for the future for both events, another spillover event and for the lab leak. And what I worry about is we are now so focused on the politics of this issue, we're missing the fact that we're wasting time. We are wasting precious time to get better prepared for either one of these. How are we going to tighten up laboratory security around the world? You know, it's one thing to say the US will tighten it up. Surely it's important. But that doesn't mean that all the other countries of the world are going to agree or organizations are going to do what we're recommending. So what do we do to anticipate another laboratory challenge? We're going to see more spillover events. Look what we're seeing right now just in Africa with the Ebola and Marburg. These are spillover events from animals. Well, we're going to have more respiratory pathogen spillovers that are going to occur around the world. We need to be concentrating on that and not going back and trying to basically find an answer to a question for which that answer will never be found. I'm convinced of that. If we can. Great. But I think the other thing that has been challenging with this issue is this has been a tough week for me personally, and I'm not asking for sympathy. You know, I'm in this job.


Dr. Osterholm: [00:33:55] I took it. But I wish you could see my emails this week. They were some of the most distressing, threatening and frankly, just really sad experiences with people who are convinced now that I was supporting the Chinese or I was on the Chinese side, you know, that, you know, I was somehow not supporting the United States and these efforts to show that China lied and that they did it and in some cases threatening about what should happen to me for basically being a traitor. And, you know, that again, is not helping us get to an answer. And it's our new reality out there that there will be those who will always believe this. So to sum it up, I wish we could move on from this political theater. I wish we could actually get more information that might give us some sense of what happened, but I don't believe that that is ever going to be forthcoming. And for thatrillioneason, I'm prepared to move on and just concentrate on both laboratory leaks and on the issue of spillovers, as both events that are necessary for us to be prepared for the future. And if we don't take steps now, I fear that we will actually see all the lessons that could have been learned from this pandemic lost. And we will start all over again and maybe even in worse shape in the future in terms of a response to the next big challenge.


Chris Dall: [00:35:25] Now it's time for our coveted query, which this week is a variation on a question we receive from a lot of listeners. Joe wrote, I'm 64, healthy, vaccinated and twice boosted. I've been wearing a respirator everywhere since they became available. Serious question. Will I have to continue masking for the remainder of my life if I want to avoid COVID? Mike what can you tell Joe?


Dr. Osterholm: [00:35:53] Joe, I really wish I had a clear answer for you and everyone else who was feeling the exact same way. As you know, I tried to address this issue somewhat earlier in the podcast, but as you might have suspected, this is a very, very tough one to answer, especially because my very mud crusted crystal ball just still hasn't cleared up at all. As much as I wish I could give you a clearer yes or no answer, I just can't. There are so many factors that go into this, and personal comfort level is one of those factors. I think and hope that there will come a time when the daily threat of COVID is much lower and that we have a better idea of how this virus will change and act from season to season. But there is still a lot to be learned before we get to that point. For now, I encourage everyone to continue wearing a respirator. When you're in public and staying up to date on your vaccines when they become available. In particular, this is for those who are at increased risk of serious illness. I realize for the vast majority of the population, COVID is over. They're done with it. I see it all the time. I took particular note at the Bruce Springsteen concert where it was interesting because there were a lot of people there that were 50 and older who were long time fans of his.


Dr. Osterholm: [00:37:09] I saw only three people were in an N95 respirator out of 18,000 people at that concert. Vern and I were two of them. And so from that perspective, I realized that people moved on. They have. And unfortunately, yet we still continue to see the 450 to 500 deaths a day right now with COVID, which, as I've pointed out before, for comparison purposes, remember that the number one cause of death in this country every day for cancer is actually lung cancer. And that's about 350 deaths a day. So we still have what I consider to be this very unacceptable level of deaths. But it again, is in that older age population or those who have underlying conditions. So we now have to take care of ourselves because others are not going to. And we have to acknowledge and understand that. I know that I touched on the Cochrane Review in The New York Times masking op ed in our last episode, but in the spirit of my dedication to truth, I just want to reiterate and summarize the flaws that these two pieces had. First, the Cochrane Review was written by a biased group of people. Simple. No. The way to say it that is the case. It was inherently flawed when the authors failed to recognize that aerosols are most likely the primary form of transmission, not large droplets that fall out shortly after they've been exhausted.


Dr. Osterholm: [00:38:33] They also failed to acknowledge to what extent asymptomatic people can transmit the virus and contribute to the spread of COVID-19. Next, the authors combined the results of community and health care worker studies. This is an issue because they don't take into account the differences in respiratory protection in these settings or the different types and levels of exposures. Additionally, they don't have a control group, which makes it really difficult to make any valuable conclusions. And lastly, they didn't consider health care workers and how they could be exposed to COVID outside of work. The New York Times piece assumed that all masks and respirators provide the same level of protection, which we know is just not true in any sense of the word. And unfortunately, many of the previous studies that have addressed this issue of respiratory protection in of themselves was seriously flawed. As you may recall, we have a link in the commentary we published that we told you about in the last podcast that actually links to a review that we did on why these studies are flawed. So just because somebody had a thousand people on a study doesn't mean it was any good if in fact there are serious flaws. So as I mentioned in my dedication, I really hope we start to see the truth prevail over the misinformation that has been and continues to be spread in a world of social media.


Dr. Osterholm: [00:39:54] Everyone seems to think they're an expert on everything. We're seeing people with no expertise in the subject of respiratory protection, covering important and timely topics right now. People are listening. I see so many people who don't have a clue what they're talking about and their understanding of respiratory protection of industrial hygiene based principles, aerobiology epidemiology who are making all kinds of concluding comments about what's going on with respiratory protection, and they couldn't be further from the truth. So I just cannot say for certain when I confidently will say we don't need to wear our respirators anymore. I wish I could give you a better answer, Joe, but for now, I just don't know when. And even if I'll stop wearing my respirator in public. And I think it's going to be an issue for you. When are you comfortable or confident that if you do get COVID, you won't be seriously ill? And if you can't, then you have to balance that with what is the feeling you have of security if in fact you're wearing this N95 respirator? I know this is not a satisfactory answer. I'm dealing with it myself. I ask myself constantly, when will I be able to get rid of this thing? And right now, I just can't do that because I don't want to get COVID.


Chris Dall: [00:41:13] Mike, what can you tell us about our latest Beautiful place submission?


Dr. Osterholm: [00:41:19] You know, one of the gifts of being part of this podcast is not just working with you, Chris, and the rest of the podcast team. Oh, that's a real gift. Trust me, it is. It's hearing from all of our listeners. You know, I know we say this and we say this and we say this, but we can never say it enough. You have no idea how much you mean to us and what your words mean to us or how we feel the importance of this family situation. And so I just commented a moment ago that I surely had a rough week in terms of a lot of my emails about the whole issue of the lab leak versus a natural spillover for every one of those that I got. That was painful. I got a number more that were so incredibly wonderful and supportive, and I can't tell you how much we appreciate that, all of us. So thank you. And it's in this light that we see another beautiful place of mission that I find just so wonderful. Today's beautiful place is from Elizabeth. She wrote, “Hello, Dr. Osterholm the entire CIDRAP team. Your latest podcast, when you dedicated it to memories, especially in the honor of your sweet Max. That really hit close to home.


Dr. Osterholm: [00:42:32] I got choked up when I heard you getting emotional and talking about Max, which I did. I loved his photo behind you fly fishing. Our 15 year old chocolate lab Sunshine is getting close to her end of life, and she has been the best, smartest, sweetest dog I've ever had the privilege of loving. I can only hope and pray she will die in my arms like Max did in yours when she decides to leave us. Besides sunshine being part of my beautiful place, I wanted to share our vacation home we have in the Texas hill country in a little town called Leaky. We are right on the Frio River, and even in the winter it's beautiful. It's a spring fed river that's always 72 degrees. We were here when lockdown happened and it was a surreal time for the world. We used this place while we rode out the lockdown. Thank you, Dr. Osterholm. And I hope you may enjoy my beautiful place. I hope you all thaw out soon.” Elizabeth And please go to the website. Look at these pictures are beautiful. I know you'll love them. And most of all, I couldn't help but continuing to look at sunshine. It's. What a wonderful, wonderful picture. And I know a very special dog.


Chris Dall: [00:43:46] 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 We love hearing from you. Mike, what are your take home messages for today?


Dr. Osterholm: [00:44:09] Well, my first take home message is one that I hope has been through the entirety of this podcast, and that is a very, very heartfelt thank you. Thank you. As I just said a moment ago, I don't think you necessarily have a sense of just how important your feedback is to us and what it means and how we hear you and we try to respond accordingly. So thank you so much for that, that that is truly a gift in terms of the science policy side to today's podcast. The thing that I have to emphasize is we're still on this High Plains plateau in the United States and it's impacting disproportionately those who are over age 50 and specifically for those who are over age 65. There surely is some risk, as we're seeing right now, for serious outcomes among those who are immune compromised, who have underlying health conditions. That puts you at higher risk. But for the vast majority of the country, you are not at high risk for developing a serious life threatening COVID case. You surely may get COVID, but not as likely to get severe life threatening COVID. Doesn't mean it can't happen. But in terms of the overall risk issue, it doesn't. My third take home is booster dose. Booster dose or booster dose. I don't know what's going to happen. I hope that we are allowed for those of us that want an additional booster dose after six months are able to get one.


Dr. Osterholm: [00:45:38] We are surely pushing the FDA as much as we can to have that happen. But in the meantime, I know my waning immunity is getting to be a bigger challenge for me every day as it is you. And so we'll stay on top of that one. And finally, I just have to conclude by saying the reality is we do live in a politically charged world. There's no doubt about it. But I worry that in the weeks ahead, we will continue to see this politically charged world manifested in what I would consider political theater. And right now I know how important it is for us to concentrate on getting through this pandemic and getting prepared for future ones. And all of this distraction is going to get us nowhere. And as I've said before, there are a number of cold criminal cases that have been on the books for years that no one's ever solved, not because they didn't want to, but because they couldn't. There wasn't sufficient information. And I'm quite certain that is exactly what's going to play out with this one. So let's get on with it. Let's assume it was a lab leak. Let's assume it was a spillover and we need to prepare for both.


Chris Dall: [00:46:49] And Mike, I'm guessing that your closing song today may have been inspired by the Bruce Springsteen concert.


Dr. Osterholm: [00:46:58] Well, first of all, let me just say that, Chris, you are just right on the mark. And the fact that you yourself were at that concert. You can understand that. I just have to tell you, I mean, I know I'm concluding a podcast based on a public health issue today, but if you get a chance, please go see The Boss. He is remarkable at 73 years of age to go three hours straight without a break, literally going from song to song to song in of itself, it is a miracle of nature to watch that happen. It's remarkable. And yes, I am going to use a song from him and a song that I've used for previous times because it means so much to me and hopefully it means something to you. I've chosen the song Letter to You. We used it on September 17th, 2020 in Episode 24: Long Haulers. We used it on a live episode on March 23rd, 2021. We used it on August 12th, 2021, in Episode 64: Straight Talk, and we used it on December 29th, 2021, in Episode 84: Imperfect Situations and Imperfect Solutions. Letter to You is a 2020 single written by Bruce Springsteen and played with his E Street band.


Dr. Osterholm: [00:48:17] The song was released as a lead in to the album of the same name on September 10th, 2020. The song has received critical praise, and in fact it reached number one on the US adult alternative songs on Billboard. So it surely has also been a very popular song. But for me, this is what I would like to share with you what this is about. Our podcasts are my letter to you. Here it is Letter to You, written and performed by Bruce Springsteen with support from the E Street Band. Neath a crowd of mongrel trees. I pulled that bothersome thread. Got down on my knees, grabbed my pen and bowed my head. Tried to summon all that my heart finds true and send it in my letter to you. Whoa. Things I've found out through hard times and good. I wrote them all out in ink and blood. Dug deep in my soul and signed my name. True. And send it in my letter to you. In my letter to you. I took all my fears and doubts and my letter to you. All the hard things I found out in my letter to you all that I found true. And I send it in my letter to you.


Dr. Osterholm: [00:49:35] I took all the sunshine and rain, all my happiness and all my pain. The dark evening stars and the morning sky of blue. And I sent it in my letter to you. And I sent it in my letter to you. In my letter to you, I took all my fears and doubts and my letter to you. All the hard things I found out in my letter to you. All that I found true. And I send it in my letter to you. I send it in. My letter to you. Bruce Springsteen. Thank you, everyone, for spending another podcast with us. I hope that we were able to provide you that information that you find helpful. Also want to just remind all of us that in the weeks ahead, things could get crazy around the COVID issue in this country. And in that light. When all else fails, be kind. It's amazing what that can do. Just be kind. Even when you surprise someone who has no idea that someone might be kind to them, it's it's such a miracle of what can happen. So be safe. Be safe. Be kind. And just know that we appreciate you so very, very much. Thank you.


Chris Dall: [00:51:02] Thanks for listening to this week's episode of the Osterholm update. If you're enjoying the podcast, please subscribe rate and review and be sure to keep up with the latest COVID-19 News by visiting our website This podcast is supported in part by you, our listeners. If you would like to donate, please go to The Osterholm Update is produced by Cory Anderson, Meredith Arpey, Elise Holmes, Sydney Redepenning and Angela Ulrich.