May 4, 2023

In "A Better Place," Dr. Osterholm and Chris Dall discuss the state of the pandemic in the U.S. and around the world, the latest booster shot update from the FDA, and why the darkest days of the pandemic may be behind us. Dr. Osterholm also answers a COVID query on cardiac events following mRNA booster doses and shares a beautiful place from one of our listeners.

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Chris Dall: [00:00:06] Hello and welcome to the Osterholm Update: COVID-19, a podcast on the COVID-19 pandemic with Dr. Michael Osterholm. Dr. Osterholm is an internationally recognized medical detective and director of the Center for Infectious Disease Research and Policy, or CIDRAP at the University of Minnesota. In this podcast, Dr. Osterholm will draw on more than 45 years of experience investigating infectious disease outbreaks to provide straight talk on the COVID-19 pandemic. I'm Chris Dahl, reporter for CIDRAP News, and I'm your host for these conversations. Welcome back, everyone, to another episode of the Osterholm Update podcast. At a media briefing last week, World Health Organization Director General Tedros Adhanom Ghebreyesus said COVID-19 cases have declined by 23% over the past month, while reported deaths from COVID 19 have declined 95% since the beginning of the year. Still, Tedros noted that some parts of the world are seeing an increase in cases. The emergence of the XBB.1.16 variant shows the virus is still changing and an estimated 1 in 10 infections results in long COVID, suggesting that perhaps hundreds of millions will need long term care. We remain hopeful that sometime this year we will be able to declare an end to COVID-19 as a public health emergency of international concern, Tedros said.


Chris Dall: [00:01:27] But this virus is here to stay in all countries will need to learn to manage it alongside other infectious diseases. The W.H.O. will, in fact, meet later today to assess if the current situation still warrants the global public health emergency. And as we discussed in our last episode, the public health emergency in the United States will end on May 11th. What this all means for how we think about and manage COVID 19 will be the focus of this May 4th episode of the Osterholm Update podcast. As we discuss current COVID trends here in the US and around the world. Dr. Osterholm will also talk about the CDC's reported decision to change how it tracks COVID-19 and discuss the latest booster shot update from the FDA. We'll also answer a COVID query about the risk of cardiac events following a booster dose and share a beautiful place from one of our listeners. But before we get started, as always, we'll begin with Dr. Osterholm's opening comments and dedication.


Dr. Osterholm: [00:02:22] Thanks, Chris, and welcome back to the podcast family to another edition of the Update and also a welcome to anyone who might be listening for the first time. I hope that we're able to provide you with the information that you're looking for and in the context that may make that information more meaningful in your lives. We've been doing this podcast for a long time, more than three years, and today I'm going to ask you some questions about feedback about what we've learned in those first three years and what that means about going forward. What should this podcast look like? Should it exist? Should it be reshaped? I'm going to ask you to give us the feedback, but before I get any further, I have to just say, and I hope that I can get through this without appearing a bit emotional is an incredible. Thank you. An incredible thank you to so many of you. And I can't even begin to tell you it is in many, many, many of you have sent cards, emails, etcetera. Following up on my COVID infection acquired in early March. So we're going to talk more about what that type of contact, that type of interaction, that type of relationship means today. In a world of COVID, it's a two way street. Relationships are never about one. They are about two or more.


Dr. Osterholm: [00:03:36] And I can't begin to thank you enough. I am doing better. I actually have had some long COVID like symptoms. The fatigue has been substantial. I'm used to running at about 110% all the time, and that's been a little tough for me to do over the last couple of weeks. But I'm still running maybe 105% and hopefully it's not too noticeable. So but again, I just want to thank you and I'll come back to this issue in a moment. But this week's dedication is one that is very, very important to me because in part I'm a grandfather of five wonderful, brilliant and loving grandchildren. And so I see primary education in a way that is different than being a college professor in higher education. So this week's dedication is one we've done twice before. First on July 22nd, 2020, in Episode 17—boy, wasn't that a long time ago—Reopening Schools Part 2 and again on August 19th, 2021, in Episode 65: An Ongoing Tug of War. But in light of Teacher Appreciation Day this past Tuesday and Teacher Appreciation Week coming up next week, it's worth repeating this dedication a third time. Throughout the pandemic, there was a tremendous amount of concern about how children would recover socially and academically from the missed in-person learning earlier in the pandemic.


Dr. Osterholm: [00:05:01] With high school graduation rates declining and many children navigating the loss of a family member and even multiple family members during the pandemic, teachers and school support staff were faced with an incredible challenge. But despite this challenge, I'm happy to report that not all the data are so dark. For example, right here in Minnesota, it was just reported this past week that high school graduation rates in the state of Minnesota have returned to a near pre-pandemic level. Not only that, but gaps in graduation rates by race have narrowed in recent years, even in the face of the pandemic. So getting these children through the pandemic was a team effort from teachers, school support staff, parents and other caregivers and God knows countless others, not to mention the children themselves who have shown incredible resilience throughout the past three years. But this couldn't have happened without our teachers and school support staff. And so this week we are dedicating this episode to the over 4 million K through 12 teachers and 3 million school support staff workers in the US. Thank you for everything you did, including putting your own health on the line on many of those days that you were in those school buildings. We dedicate this to you and for helping us have the next generation of children educated in the manner we would all agree is necessary.


Dr. Osterholm: [00:06:24] I want to do something a little different this week. Also add a second type of dedication in a sense, and this is really more an alert as much as it is a dedication. I have had the wonderful opportunity to work with Vivek Murthy, the US Surgeon General, someone who I've come to have great and deep respect for, someone who I think is a national treasure in this country. As you know, Vivek actually served as a surgeon general under President Obama and returned to that role under President Biden. Having worked with him in the early days of COVID, I saw not only a very caring but a highly skilled professional in Vivek. But what was not as apparent was the fact that he, like so many in this country, have had long and difficult bouts with loneliness and mental health issues. He came forward this week with a new report, Our Epidemic. Loneliness and isolation. The US Surgeon General's advisory on healing, effects of social connection and community and publicly shared his own struggles and what that meant. We have provided the link to this report on the podcast website and I urge you to go take a look at it. It is remarkable, you know, that, in fact, this has been a tough time. In fact, we now know that up to 50% of our population has experienced significant loneliness over the course of the pandemic.


Dr. Osterholm: [00:07:54] And you know what I'm talking about. It's been tough. This report not only validates that situation, but the fact what we can do about it and how we can respond to loneliness. And so while this has very little to do with an infectious disease agent, it has very little to do with the idea of a virus being transmitted. It has everything to do about our health, and it's about our mental health. And so, Vivek, I just want to thank you on behalf of a grateful professional and a person who also understands the emotions of the day for what you've done for your bravery and bringing this issue forward in such a personal way. And for the in-depth report, which is just simply remarkable. So I hope all of you take time to go look at this report. Whether you yourself have experienced loneliness, whether it be someone in your family, a friend, a colleague, this is definitely worth reading. So in a sense, a second dedication goes to our surgeon general, a dear friend, a colleague, someone who I have tremendous respect for, and someone who has given us an opportunity to really respond to an issue that is so often left in the closet. And we can't do that any longer.


Dr. Osterholm: [00:09:11] That's part of coming out of this pandemic. So thank you. Now moving on to other news, which of course, you all are so well aware must happen in this podcast. And that is light today, May 4th here in the Minneapolis Saint Paul area, we have 14 hours, 23 minutes and 46 seconds from sunrise to sunset. Today's sunrise is at 5:58AM. and tonight's sunset will be at 8:22PM. We're still gaining about two minutes and 39 seconds of sunlight per day. That's a long ways from what happened on December 21st when we were only at eight hours and 46 minutes of sunlight. And of course, I must add in the context of what our dear, dear friends and colleagues are experiencing at the Occidental Belgium Beer Garden in Auckland, New Zealand today, Their sunrise is at 7:02AM., sunset at 5:32PM. They have ten hours and 30 minutes of sunlight today. Now, it was just a few months ago the tables were turned. And thank you for our colleagues in New Zealand for sharing your sunlight with us in spirit. Today we do the same with you. And the next few months will be gorgeous here in the upper Midwest with this increasing sunlight. Finally, the ice off the lakes and the experience of a brilliant, beautiful summer.


Chris Dall: [00:10:36] Mike. As Tedros noted at last week's media briefing, despite an overall decline in global cases, some parts of the world are seeing an increase in COVID-19 cases. So where are those increases and do we know what role, if any, the XBB.1.16 variant is playing?


Dr. Osterholm: [00:10:54] Chris, if I could add any one word to my answer to this very important question, it's context, context. And let me share with you where I think we're at in the pandemic. I think we may be we may be approaching the backside of the pandemic again, as I've said before, I'll probably know that for certain, a year after the end of the pandemic occurred. If there is even such a time as the end of the pandemic. Make no mistake, this virus is now with us from now until eternity. It's not going to go away. The question is, what does it do to us in our population? And like I mentioned in the last episode, it's becoming increasingly difficult to interpret the little data that we have with so little surveillance and reporting. But I'm going to do my best to make sense of what's out there and what's available to us. So, yes, Chris, there are several countries seeing increasing COVID-19 cases, many of which are in East Asia across the globe. Over the past seven days, there have been nearly 440,000 confirmed reported cases of COVID and 2162 deaths, which are surely major, major undercount. Many of the countries that are seeing their cases increase compared to weeks prior are seeing, though, very small increases. So, for example, in Thailand, where they've experienced 150% increase in cases over the last seven days, and we're now comparing 1088 cases to 435 confirmed cases the week prior. That surely seems like a big increase. But when you understand we're talking about literally a thousand cases over a 70 million population base, that really is a very, very low risk situation. Now, yes, there are surely more cases occurring in Thailand.


Dr. Osterholm: [00:12:46] There's no question about that. But what we're not seeing now are these huge surges of many, many tens of thousands of cases, many hundreds to thousands of deaths in any of these countries. So I think that it's really important to understand that when people talk about 150 or 200% increase, that's really deceptive because of the low starting points. And of course, acknowledging that it's also not capturing necessarily, in some cases, the majority of cases. For example, let me just again address another area we covered last episode when we talked about India, which is now seeing an increase in cases of about 9000 new cases per day. Again, this is a country of 1.3 billion people, but the increasing trend was concerning. Fortunately, though, their numbers have fallen again and are back down to about 3000 cases a day. We discussed that XBB.1.16 was not playing a significant role in the increasing cases that we're seeing in India. Now that these numbers have started to decline, I am more confident that this is in fact the case. XBB.1.16 is not going to cause a large surge of cases throughout the world, and we're still not seeing any of the variants or sub variants that are raising major concerns globally. Before I move on, though, I just want to add that the W.H.O. is meeting today to decide whether to maintain the public health emergency. This is a move that is expected to happen at some point this year, but the timeline for this has been unclear. So stay tuned for the decision. Regardless, this would not change the May 11th ending of the US Public Health Service emergency declaration that's already happening.


Dr. Osterholm: [00:14:33] So I think the point we want to just raise here is that we have to look at the actual numbers. We have to look at what we call incidence data. We have to consider are we getting full case reporting? And the bottom line message I have for you is that we are looking as well as we've ever looked in terms of the global picture of COVID as any time since the 2020, early days of the pandemic. And that's a good, good thing. Will it stay like that? I think it sure could. It could, because we now have, in a sense, what I call kind of a new element of herd immunity. John Barry, who we, many of you know, was the chronicler of the 1918 swine flu pandemic. And I have had numerous conversations about this issue in recent days, and I think we both appreciate that there is enough immunity in the population right now that that by itself means that while you don't stop transmission, you don't stop people from getting infected, but you can have a major impact on the actual incidence of severe illness, hospitalizations and deaths, which in a sense is kind of like a herd immunity against serious illness. It's not the same as we see with measles virus where there you may have lifetime immunity. But here I think we are seeing now a world that after three years. Between actual infection and having been vaccinated. We are beginning to see a protection against the severe illness. And as I've said time and time again, that is by itself a major accomplishment.


Chris Dall: [00:16:09] And Mike, to add to that, here in the United States, all COVID-19 markers continue to fall, most notably hospitalizations, which are declining among all age groups, but most dramatically among those aged 70 and over, according to the latest New York Times tracking. So, Mike, given what you just said about this newly defined herd immunity, is it fair to say at this point that a SARS-CoV-2 infection is not as much of a threat as it previously was?


Dr. Osterholm: [00:16:35] Well, Chris, I wish it were that simple, but let me just try to parse that and share with you what I believe is, in fact, a combination of the best of times and the worst of times issue. As I just noted, for the international picture, we are seeing the same thing here in the US. It's more and more likely that we are truly entering a new phase in this pandemic. COVID-19 activities decreasing across the board in the US and has now hit all time new lows in hospitalizations and deaths, numbers that we've seen slowly decline for months. We are actually in a better place than we even were in early 2020. As you mentioned in your question, the 70 year old plus age group has seen the most significant decline in hospital admissions, but they are still seeing the highest rate of any age group. Before I answer your question, I just want to add that while this is all great news, I do want to just remind everyone that we're still losing lives to COVID every single day. I don't ever want to gloss over that topic and make it seem like losing a thousand Americans each week is anything to celebrate or to accept. As you know, as I've said time and time again, these are people's loved ones who are dying. These are people who had consequence. So we can't just accept the fact that COVID is okay now because it's only a thousand people a week dying. But let me also add some context to this, because this is what we can do about that.


Dr. Osterholm: [00:18:04] You know, when you look at the vaccines, we've had all kinds of discussions about are they the perfect vaccine? The answer, of course, is no. Do they in fact, stop someone from getting infected? Well, at least in the first days after vaccination, that's true. But over time that wanes. Do we see, though, however, that those who are vaccinated have lower rates of serious illness, hospitalizations and deaths? Absolutely. And just to put this in context, let me just say that right now, when you look at the unvaccinated general population, never having received a dose of vaccine versus those who are vaccinated, having had at least two doses, you have a 5.1 times higher risk of dying being in that unvaccinated category. It's even more dramatic when you look at those who have received at least one booster dose there. It's 5.6 times difference of those who have not been vaccinated at all, dying that much more frequently than those who have been vaccinated, including one booster dose. Then when you take it to that 65 to 79 year old age group only, which is where we continue to see the most impact with serious illness, hospitalizations and death there, If you're vaccinated versus unvaccinated, meaning vaccinated, just your two doses, you have a nine times higher risk of dying being unvaccinated and really almost dramatically, you have a 13 times higher risk of dying being unvaccinated versus somebody in that age group who is vaccinated and including one booster dose.


Dr. Osterholm: [00:19:40] Isn't that remarkable? So there is still much we can do to reduce serious illness, hospitalizations and deaths in this country. We've got to continue to push vaccines. Now, I know right now many Americans are done with getting vaccinated. I understand the frustration, the fact that they feel like, wait a minute, I thought it was just a couple of doses and we're out. But this information is life saving information for so many. So please, please understand that. And I encourage everyone to get fully vaccinated, meaning up to as many booster doses as they can get with the Bivalent vaccine. I am convinced. I'm an N of one. And that does not make for data. But having had five doses of vaccine on board and having had my paxlovid that that's what kept me out of the hospital and potentially being one of those statistics. I don't want anybody, anybody on this podcast family to ever be one of those statistics. So again, I can't say it more strongly than please, please get vaccinated. So I think the message is that we are in a good place relative to where we've been. But good is not good enough. When we're losing a thousand people a week, we're still seeing cases of long COVID. We're still seeing 4000 hospitalizations a day in this country. We can do better. We must do better. And I think that's what's going to help get us even further along in trying to get to the backside of this pandemic.


Chris Dall: [00:21:16] It was reported earlier this week by CNN that the CDC is planning to scrap its color coded COVID-19 community levels reporting system. And going forward, we'll use hospitalizations as the main metric for tracking the spread of COVID-19. The agency will also reportedly continue wastewater surveillance and testing of air travelers. Mike, is this the right move?


Dr. Osterholm: [00:21:39] This is absolutely the right move. I've been saying all along that hospitalizations, deaths and wastewater data are by far the best metrics we have for tracking the spread of COVID-19in our communities. Wastewater data is a leading indicator. Hospitals are a lagging indicator, and in that matter, deaths are too. But they still remain the most reliable information that we have. The one caveat I would add to the wastewater data is we're still all working on trying to understand what the actual levels of virus activity in wastewater that we're picking up mean. Does each and every variant have the same level of excretion of virus into our wastewater? What does it mean to see activity in wastewater over time? So we still have questions we need to answer. But I think at this point it's fair to say that it surely is giving us the best sense of just what is really happening in a world where we no longer can rely on everyday surveillance data. Let me note that the CDC community levels reporting system I think was flawed to begin with. We actually covered this last May in Episode 104: Tougher Than Rocket Science.


Dr. Osterholm: [00:22:54] The CDC's goal was to provide a way to measure how many infections were occurring in a community. But unfortunately, the metrics are based primarily on the number of new cases per 100,000 population over a week time span and coupled with new COVID-19 hospital and admission rates and average percent of hospital beds occupied by COVID-19 patients. Now, we all know that case counts cannot be trusted. And to base any metric or reporting system off of case numbers means that the metric reporting system also cannot be trusted. In addition to the case numbers not being reliable, there are also fewer states, communities and hospitals reporting their COVID-19 data, making it increasingly difficult to track such metrics. So what does this leave us with, Chris? Honestly, it leaves us exactly where we were all along, which is looking at wastewater and hospitalization as well as death data to track the overall activity of this virus in our communities. I don't really know that the community level map was used by many people, and I frankly don't think it should have been. So this is really a welcome move by the CDC.


Chris Dall: [00:24:02] And since our last episode, we've also had another booster update from the FDA, which announced last week that it has authorized additional doses of the Pfizer-Biontech Bivalent booster for young immunocompromised children. So Mike, what are your thoughts on this decision and can you summarize who at this point can get an additional booster shot?


Dr. Osterholm: [00:24:22] Chris, This authorization is for an additional dose for kids six months to four years. And these are children with conditions such as being a solid organ transplant recipient or a condition that is considered at a similar level of being immunocompromised and at least one month after their mostrillionecent dose. As far as my thoughts on the decision, I am in full support of any additional boosters that the FDA will authorize. While we can't boost our way out of this pandemic, and you've heard me say that many, many times, these vaccines are safe and they are the best tool we have to reduce the risk of hospitalization and death, especially for those who are at increased risk of severe disease. Now, to answer the second part of your question, the individuals currently eligible for an additional booster are those over age of 65 and those six months of age and older who are immune compromised. This leaves those under age 65 who are not immune, compromised and eligible to receive an additional dose, even if they have a condition that puts them at an increased risk for severe disease and death. There are many conditions that increase COVID risk for serious illness that are not considered immunocompromised. And so it is disappointing that these individuals do not have the option to protect themselves with an additional dose. Going forward, I hope the FDA will approve regular booster doses for this group and anyone else under 65 who wishes to get them. I also hope the FDA will continue to approve these boosters every six months until more effective vaccines that provide long term durable protection are available. This isn't going to boost us out of this pandemic. But for individuals at high risk of severe disease and death from COVID, it may be the difference between a mild infection and a COVID hospitalization or death. Please leave that choice up to the individuals, and at the same time, I will do everything I can to encourage any of those individuals to get their dose of vaccine.


Chris Dall: [00:26:18] Mike, I want to circle back to what I discussed in the intro and what you discussed in your opening comments, the possible end of the public health emergency of international concern. We don't know when it will happen, but Tedros indicated that the W.H.O. hopes it will end at some point this year. Now, I know you've been thinking a lot about where we are in this pandemic and looking at past pandemics for some clues. So what are some of the questions that you're grappling with?


Dr. Osterholm: [00:26:46] Well, first of all, we have to understand that this pandemic has had multiple arms that have embraced us in an unfortunately, in many cases, strangled us. One of those arms is just the actual number of infections that resulted in serious illness, hospitalizations and deaths. I've said this time and time again that, you know, if we had lots of COVID in the community, but it was very mild illnesses, there was no long COVID people had immune compromised conditions were not at risk of serious illness. We'd say, okay, we can live with that. Now, that's not where we're at. Please understand. I'm not suggesting that. But what we haven't had is a good discussion as to how to unring the bell. When is this over? How long do we have to monitor variant development? And what does that mean in terms of then declaring that the pandemic is over? This will be, I think, a very difficult situation because while we have, as I pointed out, a much more highly immune population, we still have to live with the uncertainty of these new variants that could arise. So, you know, just theoretically and this is totally almost science fiction, but imagine if we saw one of the SARS-CoV-2 variants that we'd seen in white tailed deer jump back into humans and suddenly we have a challenge to the immunity that we had acquired from previous infections or from vaccine, and we saw large new surges.


Dr. Osterholm: [00:28:23] Do I think that will happen? I don't think so, but I don't know. And so I think this level of uncertainty right now is one that we have to just continue to monitor. We have to try to do the best we can to understand what it means in terms of are we seeing changes in the virus itself that would signal that we might see something that overrides the immunity we've acquired? I already discussed the fact that I think in a sense there may be a need for a new definition of herd immunity in addition to the one that we had previously had in that previous one, which still holds. That is where enough people are immune to the infectious agent through either vaccination or previous infection that it's like rods in a reaction. It stops the reaction from occurring because so many people are no longer susceptible to that infectious agent. Well, now we can't say that we're going to gain a level of protection that would stop transmission. But what if we begin to really have an impact on the level of serious illness and we reduce that? When does this pandemic then be called on? Well, it's over with.


Dr. Osterholm: [00:29:35] I might add that I mentioned earlier in my discussions with John Berry, who is truly a mentor to me, that in the 1918 pandemic, there were waves in 1918 and 1919, 19 and 20, and even in 1921. And there was actually even a wave in 1922 that most people just didn't call a wave because they were done with the pandemic, even though there was still significant illness. And death. So I think we're at a point right now as to deciding at what level of activity has to occur in the world and where in the world before we say that this pandemic is over and we're now back to living with this virus? Now, I said that there are two arms to this. That's that's the science arm. The other arm is what's in our hearts, what's in our heads, what's in our emotions. And if you were to say to somebody today, the pandemic is over, the visceral emotion for some people would be one of. It's absolute anger because it would be minimizing what they feel and where they're at. There's others who would say, look it, this thing was over with months ago, and to say anything to the contrary would arouse emotions in them. And what we're trying to thread right now is the psychology of the population.


Dr. Osterholm: [00:31:00] And I've had people say to me, the pandemic will be over when the public decides it's over. Meaning that they're accepting whatever is occurring at that point is just background or ongoing future infection. So, Chris, we're really trying to deal with the epidemiology of this infection and what it means. And we're also trying to deal with the psychology of this pandemic. And I don't have easy answers yet, as I've already shared, I am feeling much better about where we're at, but I do not accept a thousand deaths a day in this country as acceptable. So we really have to work through this. And I think this is going to be a process. If you're coming to me for a simple black and white answer, forget it. You know, I have about 30,000 shades of gray right now that I'm working with. And all I can do is just tell you where I think it's at, what I see. And I can only hope that I can report to you that as we continue to march down this pandemic journey, that we are on the back side of it. But even that, I can't tell you exactly what that means to be on the back side of it.


Chris Dall: [00:32:07] Now it's time for our COVID query. This week, we heard from several listeners who wanted to know about the risk of cardiac events following a COVID-19 booster shot. One listener, in fact, said their physician told them they've seen many patients experience heart attacks following a Pfizer booster dose. Mike, I think it's time to set the record straight here, as there has been a lot of misinformation on this point. What do we know about the risk of cardiac events following a booster shot?


Dr. Osterholm: [00:32:36] Well, Chris, one of the things that I promised our podcast audience way back in 2020 is that if I didn't know something, I would tell you I didn't know, but I would tell you what I did know and what I was doing to find out what I didn't know. That was number one. Number two, I promised you I'd always be a straight shooter. I'd just tell it like it is. And that that would be an important context to say that, yes, you're going to hear a lot of the things out there, but this is the best data we have to support this point. So with this question, Chris, I just want to start out by saying the idea that many individuals are going into cardiac arrest following their booster shots is completely untrue, simply disinformation. And it is coming from some physicians who I think in some instances aren't fully aware of what cause and effect and association means. And I'll comment on that in a moment. But also they're just poorly informed. And what I mean by that is I deal all the time with challenges among friends, colleagues, acquaintances who should be receiving paxlovid with their diagnosis because of their underlying health conditions or age, etcetera. And their physicians will say, Oh no, you don't need to get that unless you get severely ill. The total wrong answer. Now, do I think that these are individuals trying to do harm to their patients? No. Do I think that they are poorly informed? Yes.


Dr. Osterholm: [00:34:09] And so part of what we're dealing with right now, there will be individuals, men and women in white coats that will say with some certainty, oh, yes, you know, people are dying from this shot. They get heart attacks after they get vaccinated. So let me just share with you what this misinformation or disinformation means. It just didn't appear out of thin air. It is a product of fear and misinterpretation of scientific information. So I want to take a step back and look at two pieces of factual information. Explain why, contrary to what many are speculating, this information does not support the claim that mRNA vaccines are causing sudden cardiac deaths. The first piece of factual information I want to address is that people who have had heart attacks in the weeks following a booster dose of mRNA vaccines. Sadly, heart attacks occur every single day. They even occur in relatively young and otherwise healthy adults. Grant You had a much lower rate. But also remember now we're vaccinating millions and millions of people. Some of these heart attacks are bound to occur, coincidentally in the weeks following mRNA vaccination, just like heart attacks occur within the day of watching my favorite TV show, Ted Lasso. They occur. Ted Lasso did not cause that person's heart attack, but by the time they were linked, in fact, it'd be quite notable if no one ever experienced a heart attack in the weeks following vaccination. It would be then a suggestion that the vaccine is protecting you against heart attacks.


Dr. Osterholm: [00:35:48] So we shouldn't deny the fact that occasionally people do have heart attacks shortly after receiving a booster dose. But these events are simply a reflection of the everyday incidence of cardiac deaths in this country and should not be interpreted as anecdotal evidence that the vaccine causes or increases the risk of heart attack. But grant you, due to the tragic nature of these heart attacks and the sudden cardiac deaths that occur, people remember them and are reminded of them frequently. We never think about all the loved ones who got their booster dose and didn't have a heart attack the next day. This can make these events seem far more common than they really are, and they are incredibly painful and therefore ingrained in our memories, and then lead us to the false conclusion that because they are so common that these vaccines must have had something to do with them. Even physicians like the one you mentioned in this question are susceptible to this type of bias. This is why we rely on peer review evidence to tell us if a risk really exists. And there is simply no peer reviewed evidence suggesting that mRNA vaccines are causing an increase in sudden cardiac death in young adults. Let me just repeat that. This is really an important point. There is simply no peer reviewed evidence suggesting that mRNA vaccines are causing an increase in sudden cardiac death in young adults.


Dr. Osterholm: [00:37:14] Now, the second piece of factual information that may be contributing to this misconception is that mRNA vaccines are associated with an increased risk of myocarditis in the weeks following vaccination. Remember, myocarditis is an inflammation of the heart. This is true, and there are several studies that reflect this. But in a very important but an increased risk for myocarditis is not the same thing as an increased risk for sudden cardiac death. A lot of the concerns surrounding myocarditis and cardiac deaths can be traced back to an accurate but widely misinterpreted statistic that 20% of sudden cardiac deaths in young adults are linked to myocarditis. This does not mean that 20% of young adults that get myocarditis will experience a sudden cardiac death. A majority of myocarditis cases are mild and can even be asymptomatic and myocarditis often goes away on its own without any kind of medical treatment. Now myocarditis risk is also much greater following COVID-19 infection than COVID-19 vaccination. A meta analysis or a comprehensive review of all the studies published in the Frontiers in Cardiovascular Medicine in August that included data from a total of 55.5 million vaccinated individuals and 2.5 million infected individuals from 22. Studies found that while COVID-19 infection and COVID-19 vaccination were associated with an increased risk of myocarditis, the risk was actually seven times higher in recently infected individuals compared to those who were in vaccinated individuals. So you still buy a high level of protection against myocarditis by being vaccinated, even if there's a slight risk of experiencing as a result of vaccination.


Dr. Osterholm: [00:39:05] And I might add that among all the patients included in this meta analysis that were diagnosed with myocarditis, only 1%. Let me repeat this only 1% were hospitalized and 0.015% died. The bottom line is that COVID-19 mRNA vaccines are associated with an increased risk of myocarditis, particularly in young adult males. And we need to be transparent about that. But these myocarditis cases are almost always mild and the risk of myocarditis is much greater following infection than vaccination. These vaccines may not be perfect, but they are helpful tools and they certainly aren't causing a surge in sudden cardiac deaths. I don't care how many physicians say that. Let me also just add one context here, because when people talk about risk, it's a point of if you know one person that had something happen to them, the rest of the measures about risk don't matter whether it's a 1 in 100 event or 1 in 1000 event or 1 in 1,000,000 event. I mean, why do people buy lottery tickets? You know, I've never bought one, and that's because I kind of understand risk from the one in, you know, 290 million chance of me winning the lottery. But if you look at studies, for example, of something like aspirin and you look at what happens when you take aspirin to help lower the risk of certain cardiac events. Yet one study estimated that for 50 year old men, 325mg of aspirin daily ran a fatality rate of 10.4 per 100,000 person years.


Dr. Osterholm: [00:40:41] Think of that ten per 100,000 person years. Now, would anybody say we should take aspirin off the market? Sold over the counter. And again, nothing in this world is safe to the extent of saying it will never happen or it is absolutely protective. So I only want to point this out to you that in our world of public health, we're measuring risk all the time and making comparative risks. The likelihood of dying because you do have a seatbelt on in the car is substantially lower, even if you get trapped in the car because the seatbelt is jammed and it catches fire. The people say, See, we shouldn't be wearing seatbelts. But when we look at the number of lives that have been saved over recent years from wearing a seatbelt, no one would say, yeah, that one accident could happen where the jammed seatbelt contributed to that person's bad outcome. Because we have a whole lot of examples where seatbelts saved lives. So think of that kind of example when you hear this information about, oh, my one, people had heart attacks after they got vaccinated. Yep, they did. And that happens every day in this country. But that's not cause and effect At the same time, also for the risk that we do see with myocarditis. The benefits far, far outweigh the risk with this vaccine.


Chris Dall: [00:42:08] Mike, what can you tell us about our latest beautiful place submission?


Dr. Osterholm: [00:42:13] Well, in keeping with the dedication today about teachers and the incredibly important role they play in our children's lives. I found a beautiful place that just means so much to me. And as someone who is a professor who teaches for a living and has been doing that now for 48 years, I can identify with our beautiful place today beyond anything I can put into words. This beautiful place comes from Diane. Diane, Thank you. Thank you for a lot of things, which I'll obviously address more at the end of reading your beautiful place letter you wrote. Dear Dr. Osterholm and team to the entire team. Thank you for your informative and eminently sane podcast. It serves as a beacon of rationality in these irrational times. Dr. Osterholm. I send my regards, my thanks, and my hope that by the time this reaches your desk, you're feeling well and energetic again. I too have not been infected and hope to keep it that way in the last few months. I admit to not being as diligent about wearing my KN95, which I realize is not an N95, but I simply cannot tolerate anything other than ear loops around my head. Your experience is a reminder that if we wish to stay well, we are not without tools, though of course nothing is foolproof.


Dr. Osterholm: [00:43:32] This is my beautiful place, my classroom. I have taught for almost 20 years, first in the English language program for international students and now in the English department for domestic students. I am well past retirement age, but retirement is not on my horizon. Because what could be better than looking at a sea of hopeful, bright and energetic faces each week? The energy I get from my students is my life force. They are all there because they want a life illuminated by knowledge and reason. Their optimism and drive to improve their futures is contagious and inspiring. Although each semester brings different challenges, there is nothing better for me than working with students to help them identify, shape and achieve their goals. I never repeated a lesson plan in all these years. The objectives may stay the same, but each class composed of new to me humans and each group requires a new and different approach. I try to create lessons each semester that will hopefully connect and light a fire in them. I can feel the energy of a good lesson plan and it is awesome. On the flip side, I can also feel the low ebb of energy in a lesson that doesn't connect and that motivates me to analyze and retool.


Dr. Osterholm: [00:44:51] By the way, for all you teachers out there, when you sense the attention flagging, get those students out of their seats to stretch, do yoga and deep breathing, these few minutes will perk up everyone. And my college students love it. For me, there is an undescribable treasure to be found each semester. We start out as strangers, but over time we become so much more. Of course I hope I have a positive and lasting impact on their lives. But there can be no doubt that the impact they all have on me. I'm a very fortunate woman to visit this beautiful place each week. Diane Wow. Talk about the very best in teaching someone who not only understands what they get from doing the teaching, but because of that, are able to impart such important lessons to their students. Diane This touches me very much as someone who is in the classroom, has taught a class this semester and I thank you for sharing this. This is truly a beautiful place. I wish all of our kids could have you as a teacher, particularly teaching English. And today that's an important topic. So I thank you very, very much. And on behalf of all the CIDRAP team, we thank you too, for your very kind words.


Chris Dall: [00:46:09] 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 I also want to let our listeners know that we here at the Osterholm Update are thinking about what the future of the podcast looks like and we would love to have your input. What would you like to hear more of? What would you like to hear less of? How often should we be doing this podcast? You can either email us at or fill out a survey that will be on the podcast page. And Mike, is there anything you'd like to add?


Dr. Osterholm: [00:46:50] Well, first of all, thank you for being with us again today and for allowing us to be a part of your lives over the course of the recent years. I have said this time and time again, and I say it with great humility and truly real emotion. Thank you for all you have done for us at CIDRAP and me in particular. The feedback that we've received from this podcast family has been nothing short of remarkable. I think that you have been a very important reason in helping me get through the pandemic. I owe you a great deal. And I want to continue to have a hopefully helpful, thoughtful and responsive relationship with you in the future. But as the pandemic moves to potentially a new place, we'd love to hear from you. Are these podcasts helpful in the future? Are they necessary? What are the topics that are important? And we don't want to just do a podcast because our ego says we have to do a podcast. Trust me, there are a lot of people at CIDRAP that would welcome the chance not to have this additional workload on top of their already incredibly busy workload. But at the same time, we are committed to you. You are our number one reason for doing these podcasts, and we never forget that.


Dr. Osterholm: [00:48:14] So in terms of this survey, I hope you will take it. We welcome constructive comments and that can be critical, meaning that they're constructive, but they they at the same time surely tell us what we could do better. And so from that standpoint, I hope you fill it out. I promise you at the beginning of this podcast three years ago that we would stick with you through the duration of the pandemic come hell or high water. And, you know, we've been fortunate in being able to do that, and we're willing, if it is helpful to you to continue going forward, sharing with you perspectives on infectious disease, public health and life in general. And so we look forward to hearing from you. We welcome your feedback. And if you tell us to retire this thing, we will surely consider that. If you tell us, you know, you want ten more of them a week, well, that one I think I'd have a hard time getting across to everyone. But just know that these are very important to us and we never, never, never take you the audience for granted. And so, again, your input will be absolutely essential to how we move forward.


Chris Dall: [00:49:23] Mike, what are your take home messages for today?


Dr. Osterholm: [00:49:28] Well, Chris, the three messages of the day. Number one, I'm not sure where we are at, but it does feel better than almost any time since January of 2020. And for that, I am very grateful. Now, I say that because I still want to make it clear we're not done, but we're in a much, much better place than we have to understand that. Number two, it really follows number one is that we still need to protect those who are at the highest risk of serious illness and who are most likely to be hospitalized or even potentially die. Those are those 65 years of age and older or even really, if you look at 50 years of age and older. Those are people who have underlying health conditions. And while I wish we could get vaccine to many more of you who I think should qualify for booster doses but aren't right now included in the FDA approval, we will continue to advocate loud and strong that the vaccine availability be expanded and let it be permissive. Let it be where you're not telling everybody they have to get it because some will say, you know, forget it, but there are those who do want it and who do believe that that will make their life safer and also make them feel more confident in everyday living. So protect yourself. And then finally, as I just shared with you about our review of where we're at and where we're going, please help us understand how we can best serve your needs. What can we do to be most helpful? And that is surely job one for us. And so we look forward to getting your feedback and that will be very important in determining what we look like in terms of a podcast family going forward.


Chris Dall: [00:51:19] And Mike, what is your closing song for today?


Dr. Osterholm: [00:51:24] Well, Chris, this is a situation where there's a lot of different angles all brought together here. First of all, let me just say it was with a very heavy heart that I learned that on Monday, Canadian balladeer Gordon Lightfoot died. I had always been very, very fond of his music and actually had gone out of my way to go to his concerts. I remember the last one I attended in Ithaca, New York, in the fall of 2019, just before the pandemic arose, I watched a man who literally had a major health crisis several years before and with a resultant stroke and had to teach himself how to sing again and how to play the guitar. And that night and that stage in Ithaca, New York. You can close your eyes. And you wouldn't know you were hearing a live concert. You would think it was a studio recording. It was that good. So I've always been very fond of him. And I took particular fondness because of what in a sense was a shared event. I happen to have started to work at the Minnesota Department of Health in the early summer of 1975, and I was a wonderful teaching experience for me, trust me. And I actually was asked to attend a local community health meeting. On November 10th of 1975 in Duluth, Minnesota. And we got there that afternoon and you could hardly stand getting out of your car because the wind was so remarkable. It was estimated that night that there were wind gusts as high as 70 miles an hour.


Dr. Osterholm: [00:53:08] And in fact, at the hotel, we were instructed that best to stay away from the windows, just given this unprecedented level of wind. Well, some of you know, November 10th, 1975. Was the night that the SS Edmund Fitzgerald sank in Lake Superior. It had just been in the Duluth Superior Harbor just a day and a half before. And we all know from the famous song that Gordon Lightfoot wrote about the Edmund Fitzgerald. He immortalized what happened. But many people don't know is the Edmund Fitzgerald was a remarkable ship. It was the largest of all of the ships on Lake Superior and in all of North America's Great Lakes. And it was captained by one of the senior most well respected captains in all of maritime sailing. And yet they were 15 miles short of Whitefish Bay and were lost forever to the bottom of Lake Superior. It's very interesting that Gordon Lightfoot decided to write the song about the Edmund Fitzgerald because he read a Newsweek article about it in which they misspelled the word Edmund, and only as Gordon Lightfoot would consider that was disrespectful. He believed to those 29 lives that were lost that night and their families. And so he actually wrote the song because of the misspelling of Edmund in the Newsweek article and the loss of those 29 men. So when Gordon Lightfoot wrote that song and I had been in Duluth that night, grant you this was before social media or Internet, so we didn't know about the actual sinking of the Edmund Fitzgerald for almost a day.


Dr. Osterholm: [00:54:53] But it stuck with me, that moment and his song. So I bring that all together in honor of Gordon Lightfoot and his many, many wonderful, wonderful songs and his very special connection with regard to the Edmund Fitzgerald. And I chose a song that is one that fits. I think so well today with what we're trying to understand about this pandemic and ourselves. And this is a song that is one that reached number 13in Canada and peaked at number 58in the US. Billboard Hot 100 in the week of July 29th, 1972. It turned out to be a number one hit on the Canadian adult contemporary chart, and it was another classic Gordon Lightfoot ballad. And I hope that this song can be understood and appreciated really in two ways. One is, as we talked about loneliness and we talked about the challenges of loneliness in our lives. There is nothing that means more than to have someone beautiful in our lives. And today I want to share with you the song Beautiful by Gordon Lightfoot. And however you take this song, whether it be with your partner or whether it be with your friends, and I am taking it in both ways. I am the luckiest man in the world with my partner, and I'm the luckiest man in the world with my friends. So here it is. Beautiful by Gordon Lightfoot. At times. I just don't know how you could be anything but beautiful.


Dr. Osterholm: [00:56:30] I think I was made for you. And you were made for me. And I know that I won't ever change. Because we've been friends through rain and shine for such a long, long time. Laughing eyes and smiling face. It seems so lucky just to have the right of telling you with all my might. You are beautiful tonight. And I know that you will never stray because you've been that way from day to day for such a long, long time. And when you hold me tight, how could life be anything but beautiful? I think I was made for you. And you were made for me. And I know I won't ever change because we've been friends through rain or shine for such a long, long time. And I must say it means so much to me to be the one who's telling you. I'm telling you that you're beautiful. Gordon Lightfoot, thank you for spending another podcast with us. I hope it was helpful in terms of some of these rather complicated issues and where we're at, where we're going, what the vaccines mean or don't mean, and also just in time together. What it means to be beautiful. Thank you. Please be kind. We must continue to reach out and be kind in a world that sometimes makes us very tough. Be thoughtful. And don't forget, cases are more than numbers. They are so much more than that. Thank you. And we look forward to getting your feedback. And I hope you have a good two weeks. Thank you. Bye.


Chris Dall: [00:58:20] 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.