June 29, 2023

In "Good News," Dr. Osterholm and Chris Dall discuss the state of the pandemic in the US and internationally, a recent report on the origins of the pandemic, and the VRBPAC decision on monovalent boosters. Dr. Osterholm also shares an update on influenza in the Southern Hemisphere and shares a moment of joy from one of our listeners.

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Chris Dall: [00:00:07] Hello and welcome to the Osterholm Update, a podcast on COVID-19 and other infectious diseases 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 draws on nearly 50 years of experience investigating infectious disease outbreaks to provide straight talk on the latest infectious disease and public health threats. 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. Late last week, US intelligence agencies issued a declassified report on what they know about the potential origins of the SARS-CoV-2 virus and the beginnings of the COVID-19 pandemic. In short, while the report provided some new insights, it did not settle the debate over whether the pandemic originated from a natural spillover from animals to humans or from a leak at a Chinese laboratory where scientists were studying coronaviruses. That's one of the topics we're going to discuss on this June 29th episode of the podcast, after we take a look at the international and national COVID trends. We'll also discuss the FDA's recommendation for the next round of COVID-19 vaccines and some parting words from the outgoing CDC director. Answer a COVID query about the public health value of the COVID vaccines. Review the latest flu data from the Southern Hemisphere and talk about CIDRAP's chronic wasting disease research. And we'll share a moment of joy submission 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: [00:01:48] Thank you, Chris, and welcome back to all the podcast family. It means a great deal to be able to be with you again here today. And anyone who might be listening to the podcast for the first time, I hope that we're able to provide you with the kind of information that you're looking for that is helpful to you in responding to COVID and the other issues of infectious diseases that we deal with. And also maybe give you a sense of the spirit that we have with these podcasts that the podcast Family knows very, very well. It's hard to believe, but this is actually our 140th episode that we've recorded today. We've had six special episodes, including three live episodes, one special episode on mass and two holiday mini episodes making Episode 134 as our 140th podcast episode. It's hard to believe we've done that many over the years. And for all of you who have been hanging with us through most of these podcast episodes, thank you so very, very much. And as I say all the time, please continue to provide us with your feedback. It is incredibly helpful. We learn a lot from you in terms of what we're covering today. It's a little bit unusual. I'm going to be making some very personal comments. I don't typically do that. I think most of you know that I surely am not afraid to express myself.


Dr. Osterholm: [00:03:04] But today I want to comment on a couple of people who I've had the opportunity to work with throughout the course of this pandemic and frankly, who have been gifts in my life. And there are people today that you're hearing about a lot in the media because of the kind of comments, the attacks, etc., that they're receiving for their work. And so I'm going to comment a bit about that. But before I begin getting into the meat of today's podcast, I just want to reflect on a dedication that has come to mean more and more to me over the course of recent weeks. This week's dedication is one that we've done once before on this podcast. During episode 103, Words Matter was recorded on May 12th, 2022, but it clearly is worth repeating a second time because of its importance. This week's episode is dedicated to all of those and some who are listening today who are struggling with their mental health. A population has only grown since the beginning of the pandemic, and for me, this is very personal because I have friends, colleagues, people I'm close to who are right now really suffering from some really significant mental health issues. In April 2023, study published in scientific reports found that depression, anxiety and overall mental health among adolescents and young adults worsened during the pandemic.


Dr. Osterholm: [00:04:25] For those with and without preexisting depression and anxiety. According to the study, 73% of adolescent girls felt that their overall mental health was worse than it was before the pandemic, as did 53% of adolescent boys, 77% of young adult women and 66% of young adult men. Among those in the study who did not have elevated levels of depression prior to the pandemic, 35.7% had elevated levels of depression in 2020, and 60.8% had elevated levels of depression in 2021. Similarly, among all those who did not have elevated anxiety levels prior to the pandemic, 28.1% had elevated anxiety levels in 2020 and 43.8% in 2021. And this isn't just the case for adolescents and young adults. According to a survey conducted by the Pew Research Center, 41% of surveyed adults reported high levels of psychological distress and at least one of four surveys between March 2020 and September 2022. High levels of psychological distress were highest among adults with a disability adults aged 18 to 29, lower income adults and adults living alone. Now, this is no surprise. We all are aware of this. And in fact, if you have a family member, a friend, a colleague or yourself who is suffering from mental health challenges and you're trying to access care today, you recognize how difficult that is. And in just one recent situation, again, someone very close to me literally sat in a holding room in an emergency room for five days before they were able to access kind of mental health care in that institution.


Dr. Osterholm: [00:06:14] It's really challenging. And of course, many of us who have lost recent loved ones due to COVID during the pandemic, this is even more of a challenge. Some of us have struggled with long COVID, which can certainly impact mental health. And as our Surgeon General Vivek Murthy highlighted in his recent report, our Epidemic of Loneliness and Isolation, many of us are lonely than ever before, but we've also come a long way in recent years in at least raising awareness and lessening the stigma surrounding mental health, which I hope offers some hope to anyone who is struggling. There is no better time to reach out to a family member, a friend, a colleague who may be struggling with their mental health, or if you yourself are struggling to reach out and ask for help. I know this message will resonate with many of our listeners, so we dedicate this podcast to you. And I also just want to close on that note of reaching out to people so often with mental health, that's a challenge to either acknowledge your condition or to reach out to someone who might have that, fearing how they will take your inquiry or your follow up. And we have to break that barrier.


Dr. Osterholm: [00:07:25] If this were a condition caused by cancer, an infectious disease, there would be no potential stigma associated with it. Talk about it. Find out what you need to do. Here is a challenge, and I would just leave you with one last thought, something that I do think about a lot, and that is when you do reach out, it isn't necessarily the actual words you say or what you do, but it's how the people feel about what you've done. And there's a quote that's attributed to Maya Angelou, which actually, it turns out, was actually recorded largely by someone, Carol Buchner 20 years before she said this. But she is often cited as having said, I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel. So today, this podcast is dedicated to all of us who either are experiencing mental health issues or have close colleagues, family, whoever with these do what you can to make people feel what it is that you want them to feel. Now moving on to something more bright and cheery, which of course, it is from our Minnesota perspective. Today in Minneapolis, I am happy to report Sunrise is at 5:29 a.m., sunset at 9:03. That's 15 hours, 34 minutes and 24 seconds of daylight. Now we are losing daylight now since June 21st at about half a minute each day.


Dr. Osterholm: [00:08:59] But we're still because we're losing it in the early morning hours. We have maintained that 9:03 evening sunset starting on June 20th. And it will stay that way till July 2nd, and then we'll start losing sunlight also at that level. Great time of the year to be here in terms of our dearest, dearest friends in Auckland. And for all of you who are at the Occidental Belgium Beer Garden on Vulcan Lane in Auckland today, your sun rises at 7:34 a.m., your sun sets at 5:14 p.m., nine hours and 39 minutes, a few hours less than us. But the tide has changed. It's going to come in for you and ours is going to go out. Finally, I just have to say, we have a listener who contacted me from Cape Town, South Africa, and they specifically asked if I would specifically mention their sunlight length today because they, too, are in their darkest hours. And today in Cape Town it the sunrise is at 7:52, sunset at 5:47 in the evening for nine hours and 54 minutes. Just like our dear friends at the Occidental. They have turned the corner and the days are getting longer. So it's a very, very good day here in Minnesota relative to sunlight. And let's celebrate it while we can.


Chris Dall: [00:10:15] So let's start with the international and national trends as we normally do. The most recent updates from the W.H.O. and the CDC indicate that, once again, with the exception of a few hotspots, COVID-19 activity continues to trend downward. But the CDC did report an uptick in US COVID deaths. What's your read on the latest data, Mike?


Dr. Osterholm: [00:10:37] Well, let me start out this report with a general sense of where we're at. And it's good news. What a beautiful four letter word. Good news. According to the Whose latest weekly epi report for COVID, which was published on Thursday, June 22nd, there were a total of 1.2 million cases and 7100 deaths reported over 28 day period from May 20th 2nd to June 18th. Now, just for comparison, if you look at the 28 days between May 15th and June 11th, total cases were at 1.5 million and deaths were at 7300. So in a sense, the deaths have seemed to kind of more or less bottom out here, but at a level so much lower than we have seen throughout the entire pandemic to date. So, yes, Chris, we are really seeing some downward trends continue, although they're slowing down at this point as they get further and further down closer to those very small numbers. Now, by and large, this was true for almost all the W.H.O. regions. For example, in the latest 28 day period, deaths dropped 73% in the Americas, 70% in the eastern Mediterranean, 57% in Southeast Asia, 49% in Europe and 28% in the Western Pacific. Otherwise, the one exception was Africa, which reportedly saw a 5% increase in deaths. But as you've heard me talking about Africa over a number of weeks, I have little to no faith in the reporting that's coming out of that continent. For example, if you actually look at the number of deaths reported for the African region, which stood at a total of 22 for an entire 28 day timeframe, you can see that the 5% increase in deaths means very little since such major underreporting is clearly going on.


Dr. Osterholm: [00:12:28] I don't have reason to think things are worse in Africa or they're that much better. But it just shows you that in a sense, the lack of information we have coming from there. Speaking of underreporting, you've heard me mention plenty of times that the systems used for testing and reporting are being dismantled in many places. And for that reason, I don't really read into the numbers too much at face value. Well, on that note, there was one data point featured in the latest W.H.O. report that I think helps put that into perspective a bit more, and that is according to the W.H.O., nearly half of the world's countries did not report even a single case of COVID during the last 28 day time span. Let me repeat that. Half of the world's country did not report even a single case of COVID during the past 28 days. Now, perhaps not surprisingly, this gap has consistently grown wider and wider throughout the past year. In short, you just cannot count on these international surveillance systems, even in our own country, for a number of cases, they may be better in most areas of the world for deaths. Even in Africa, they're not good for that. Now, if you look at the W.H.O.


Dr. Osterholm: [00:13:38] report in terms of hospitalizations, they are reporting now 68,000 hospitalizations and 2600 ICU admissions for COVID between May 15th and June 11th for the world. This represents a decrease of about 40% for both metrics compared to the previous 28 day period. Again, I think that the numbers are really down, But to put this into perspective, when you read into these numbers a bit further, you see that these data basically represent only 27 total countries worldwide that were consistently reporting hospitalization data. So we're missing data from almost 85% of the countries in the world. How can you interpret those data? Tough. That said, even with more representative reporting, there still might be a pretty good chance that most places are experiencing this very low level of activity or significant declines. Still, as you noted, Chris, there are exceptions to these trends and having a better understanding of where these exceptions might be happening is obviously important for staying on top of why cases might increase anywhere in the world. In other words, are there places seeing increases because of waning immunity or even a new variant? Undoubtedly, these questions are hard enough to answer when the data is available, but they're basically impossible to answer if there's no data. I'm going to comment on this more later. Question But the one piece of information that I think is very telling is that to date we have seen no evidence of seasonality of the virus, meaning that we're seeing big increases in COVID in the southern hemisphere, where it's now their winter and a lack of cases in the northern hemisphere.


Dr. Osterholm: [00:15:23] Again, we'll cover that more, but I don't see any evidence right now of seasonality. One country I do want to highlight is Japan. Right now, it is the exception to the overall global decline picture since. Early April. COVID hospitalizations throughout the country have climbed from 3500 to 7800. That's as of June 21st. Interestingly enough, the country actually downgraded the legal status of COVID in early May to a classification that aligns it with seasonal influenza. However, since then, there have been parts of the country reportedly struggling to keep up with the uptick in patients needing hospital care. For example, the number of patients hospitalized with COVID in the Okinawa prefecture rose five fold in the span of a month, prompting officials there to place restrictions on hospital services. Unfortunately, the rolling back of data collection system in the country limits the ability to interpret what might be driving this increase. From the data that I've seen, there is no clear connection with any emergent variant. But Japan's sequencing data hasn't been updated for several weeks. So we'll have to keep looking at this to try to understand what's happening. Speaking of variants, we're really not seeing major changes happening overall at a global level. Again, in their latest EPI report, W.H.O. noted that they're still tracking two variants of interest XBB1.5 and XBB1.16, both of which are pretty familiar to most places by now.


Dr. Osterholm: [00:16:55] As it stands, XBB.1.5 remains the most frequently reported variant worldwide and XBB1.16 ranked second. That said, the prevalence of XBB1.5 has dropped, going from 37% prevalence in early May to 23% prevalence in early June. And meanwhile, in that same time frame, the prevalence of XBB1.16 increased from 14 to 22%. Still, nothing dramatic is happening as a result of these changes. Maybe the most interesting trend that we do see to date with this was the growth of XBB1.16 was less notable in places where XBB1.5 was already prevalent. If we move to the US, the variant picture here mirrors a lot of what we're seeing globally with XBB1.5 accounting for the larger share of cases but declining, while XBB1.16 grows slowly behind. Right now, if you look at XBB1.5 and 1.16 in the United States, they collectively account for about 55% of all the variants we're seeing. If you look at the XBB1.92 and 1.912 new ones that are emerging slightly, they account for about 20%. But the bottom line is that there just really isn't anything right now that appears to be driving increased cases based on the variants. We are still obviously looking carefully at what does waning immunity mean in terms of infections, serious infections, hospitalizations, and we just don't have the data at this point to really address that. So I would leave you with the fact that at least for now, if we look at where we're at with cases with deaths.


Dr. Osterholm: [00:18:40] If we look at regional data, we just don't see anything suggesting that case numbers are going to go back up anytime soon. That could all change. Again, this is where the humility comes in. You have to acknowledge, I don't know what this virus is going to do next, but nothing right now gives me any sense that we're going to be revisiting those days that were so painful, so difficult. At the same time, I do want to acknowledge and it's important to for those who have underlying health conditions where they may be at increased risk for serious illness, hospitalizations or deaths, this virus is still there. It's not gone. And while your risk of acquiring it may have dropped precipitously, being in public places or with lots of people, please still do what you can to protect yourself. Being up to date on your vaccine boosters. If you do become sick, getting tested quickly and getting paxlovid. And as I shared with you in the previous podcast, Metformin, a common diabetic drug may also lower the likelihood of developing any kind of long COVID symptoms. So continue to protect yourself. Respiratory protection today is almost a twofold issue for many parts of the country. Use it because of the smoke. It'll also give you the benefit if you're in public settings or with large numbers of people from actually acquiring COVID itself.


Chris Dall: [00:20:04] As I mentioned in the introduction, US intelligence agencies last week released a declassified report on what they know about the origins of the COVID-19 pandemic. Mike, what did you make of this report and do you think we're ever going to find a definitive answer?


Dr. Osterholm: [00:20:19] Well, you know, the more things change, Chris, the more they stay the same. Let me just make it very, very clear. I am as convinced now as I ever was. We will never know what the source of this virus was for this pandemic. It was interesting because we have watched almost like a boxing match going on over the last year of those who are convinced that the virus leaked from the lab or somehow at least was in the lab and then got into the public domain versus those who are convinced it was a virus that jumped from an animal to a human. And that's what started the pandemic. And one group will come up with some new information that's interesting but hardly defining. And then the next group will come up with something that counteracts the first one. And they go back and forth and back and forth. So last week is a good example. We have the US government report coming out, basically giving a sense that we won't know. In the meantime, however, there was an online newsletter called Public that said that three scientists developed COVID-19 in November 2019. That was prior to the outbreak becoming public when a cluster of cases at the end of December 2019 surfaced in people linked to a Wuhan marketplace.


Dr. Osterholm: [00:21:39] Public report was quickly embraced by the camp that argues that COVID-19 came from the virus stored and possibly manipulated at the Wuhan Institute rather than from an infected animal host. This was picked up by the Wall Street Journal. Well, it turns out that since that time, John Cohen, who was a reporter for The Insider, one of the best science reporters in the business, actually debunked much of what was in those reports, actually with interviews with those individuals who supposedly were infected. Now, can you trust what they told you that, you know, they weren't really infected with COVID prior to the outbreak and in fact, they were antibody negative early into the outbreak, which if they had been infected in November, should have still had antibody. Will anybody believe them? And the whole point of this is I think we're going to continue to see this volley back and forth between who has what new information. And as I said before, I am convinced we will never know. Now, what I like to know, sure, all of us would. But does it make a difference in how we prepare for the future? And the answer is absolutely no. We have to consider lab leaks as a very important possible way that any virus could get into the human population and be devastating.


Dr. Osterholm: [00:23:01] But then we have to consider the animal spillover in the same light. And so for me, it doesn't change anything about what we do or don't do, what we prioritize or don't prioritize. There is nothing in this discussion that's going to help us be better prepared for the future. We know what the challenges are with lab leaks and the whole issue of security of our laboratories and biosafety. We know that we have constant spillovers of animal viruses into humans in many parts of the world that we're going to have to deal with. So I hope at the end of the day, at some point we'll just agree to say we don't know. And and I know that there are people who literally put their career reputations on the line supporting one point or the other. I would just come back to the fact that the bottom line is we are unlikely to ever find a definitive answer to the question. But the important takeaway is we have to be prepared for an animal spillover or a lab accident as possible events that could occur and bring us the next pandemic.


Chris Dall: [00:24:09] Tomorrow will be Rochelle Walensky's last day as director of the CDC. And earlier this week, she penned an opinion piece for The New York Times titled What I Need to Tell America Before I Leave the CDC. Here's an excerpt from that piece. As leader of the CDC, I had the privilege of a unique perspective seeing public health in the United States for both its challenges and its gifts. And yet the agency has been sidelined. Chastened by early missteps with COVID and battered by persistent scrutiny, we tackled the aforementioned threats and barreled forward to address the hard lessons learned along the way. Even amid the challenges, Americans must recognize the need for a strong public health system and for a robust CDC. Mike, your thoughts on what Walensky had to say?


Dr. Osterholm: [00:24:55] First of all, I want to just start out this discussion with a very sincere, deeply grateful thank you to Dr. Walensky for what she did as the director of the CDC during this time. Unfortunately, being the head of the CDC during this pandemic was virtually an impossible task in terms of pleasing the world, pleasing even your colleagues. And in that regard, I wouldn't wish that job on anyone during a pandemic. At the same time, it is a job you have to do. And while I surely did not agree with everything the CDC did, I still don't agree. And particularly there are issues around respiratory protection. But there are a few people in our business that have more class, that have more sincerity, honesty, humility than Rochelle Walensky. She is truly someone who everyone would want to have as a colleague and a friend. This is an individual who, you know, in many of my discussions with her, would have every reason to be angry or hurt or, you know, wanting to debate something. And she always sought to find the place of consensus or how could we move people. And, you know, I just want to thank her for her service. As I said, again, just so this doesn't appear to be an advertisement, but I didn't agree with everything that CDC did or how they did it. But I have to tell you, I have such respect and admiration for Rochelle as a person, as a professional. And I wish as a country we could just let that happen rather than demonize people because of what was an incredible challenge, where people made mistakes, where organizations failed us. There are still really good people there, and we must never, never forget that. So here it is to you, Rochelle. Thank you. Thank you. Thank you. You helped us get through this pandemic, and I'm glad that you were there at the helm. And thank you.


Chris Dall: [00:27:01] And we'll post a link to that piece for you to read. But also a follow up question here, Mike. The job of being CDC director has never been an easy job, but it's probably infinitely more difficult now because of the way the job has been politicized. Is that a concern for you in being able to find good people for this job and in how the CDC director goes about doing their job going forward?


Dr. Osterholm: [00:27:25] Well, I think being CDC director is among those jobs in public service that are almost impossible to do, such that everyone thinks you're doing a great job. You just have to expect that you will be criticized at the same time trying to run an organization that many thousands of people things happen for which under a great leadership management style, you still wouldn't have had an impact on. You can't, you know, go down into the administrative depths of your organization and be accountable for what 1 or 2 individuals did or didn't do. You have to provide the overall leadership. I think that what is really important here is that we have the general sense of where we're going. The major leadership issues in that regard, Rochelle has put a reorganization of CDC and front and center. And I've seen people say, well, why are you leaving before that's done? And her response was, it's never going to be done in just one administration. We are going to constantly be updating, changing, learning what to do and how to do it. And so every director has to be that way. Now, in that regard, I have to offer one comment also about the new CDC director coming in, Mandy Cohen. I know Mandy, I think very highly of her. She is a wonderful organizational expert. She comes in with the right tools in terms of experience, having been the the commissioner of health in North Carolina.


Dr. Osterholm: [00:28:56] She had senior roles at the CMS relative to the work that they did on their Obamacare websites and so forth. She is very well known in Washington. I can tell you that since she's been named to the job. Before she took over, she has had a very frank conversations with many people in our business, listening to them about what they think should and could be done. And so I feel very good about this new person coming in. And she surely has 110% of my support for what needs to be done. And again, this is not just an advertisement for CDC. You know, we need them. We need them badly. We need some things to change. But on a whole, they are our public health infrastructure at the federal level. And we must never forget that as they go, So do we. And so therefore, I want us all to be in the same boat, successfully traversing the rough waters, getting through, and also understanding with a moment of humanness that the people who lead this are basically people just like us. They get up every morning, they put their clothes on, they do all the same things we all do together. And I can only hope that we can all find the people that we can work with closely to deal with these complicated issues.


Chris Dall: [00:30:18] Our last episode was released right before the FDA's vaccines and related Biological Products Advisory Committee met to discuss the makeup of the next round of COVID-19 shots. As was expected, VRBPACrecommended switching to a monovalent strain containing the Omicron Sub-variant XBB. And the FDA subsequently agreed. So, Mike, what does this mean for people who are waiting for the next round of booster shots?


Dr. Osterholm: [00:30:44] Well, Chris, the FDA's VRBPAC did meet on June 15th to discuss the strain composition for the 20 2324 formula of COVID-19 vaccines in the US. And as we anticipated, even on our last podcast, the committee voted to recommend an update of the current vaccine composition to a Monovalent XBB lineage for the 2023 2024 formulation. There were a number of considerations discussed before the vote, including virus surveillance and genomic analysis. Antigenic characterization of the viruses, human serology studies from current vaccines, preclinical immunogenicity studies, evaluating immune responses generated by the candidate, vaccines, etcetera. Let me just provide some detail on the key takeaway messages from this meeting. First, as I noted earlier in the podcast, the Omicron XBB lineage viruses are currently the dominant circulating strains of SARS-CoV-2 virus globally, despite gaps in genomic surveillance globally. The available sequencing data indicates that the index viruses and other early variants, meaning the Alpha, Beta, Gamma and Delta variants, are no longer detected in humans. The index virus antigen elicits undetectable or very low levels of neutralizing antibodies against currently circulating SARS-CoV-2 variants, including Xpb descendant lineages. By several measures, the current COVID-19 vaccine appears less effective against XBB lineage viruses than against previous strains of the virus. We see that individuals who have received two, 3 or 4 doses of the index virus based vaccines or the original Wuhan strain or a booster dose of a bivalent mRNA vaccine, including BA one or BA 4 or 5, have much lower neutralizing antibody titers against this XBB lineage compared to titers specific for the antigens included in the vaccine. Also, people with high bred immunity from any SARS-CoV-2 infection show higher neutralizing antibody titers against XBB0.1 descendant lineages compared to responses from vaccinated individuals who had no evidence of infection.


Dr. Osterholm: [00:32:57] Preclinical data from three different vaccine manufacturers show that vaccination with the Monovalent XBB0.1 descendant lineage containing candidate vaccines has a higher neutralizing antibody response to the current circulating SARS-CoV-2 variant compared to the responses elicited by the currently available vaccines. Available data also strongly suggest that the inclusion of an antigen from early strains of SARS-CoV-2. In other words, Wuhan in an updated vaccine formulation, is unlikely to enhance the response to current vaccines. The 21 member panel voted unanimously to recommend that the Monovalent updates with a preference for the XB 1.5 composition. Fda has advised manufacturers seeking to update their COVID-19 vaccines that they should develop vaccines with this Monovalent XBB1.5 composition. And as I mentioned two weeks ago, this is aligned with the recommendations from the W.H.O. Technical Advisory Group on COVID-19 vaccine composition and the decisions by both the European CDC and the European Medicines Agency earlier this month. There is not a definitive timeline for when the Monovalent booster will be available in the US, but they should be ready for use beginning even as early as late August or early September. As much as this is good news and having these vaccines available, I remain concerned that people are not going to receive a booster this fall when they're available. Less than 20% of the US population received a bivalent booster, though importantly, over 40% of people 65 years and older got a bivalent booster. I can't stress enough that when the monovalent booster becomes available and you're eligible, please get your booster.


Chris Dall: [00:34:48] That brings us to a query from a listener named Frank who wrote, I'm now starting to get bombarded with questions about vaccine efficacy. I get it that they still seem to be pretty effective when it comes to preventing severe illness and death. But what about infection in the first place? Transmission long COVID. While clearly helpful at the individual level, is there a public health reason to get vaccinated and or boosted? Mike, what can you tell Frank?


Dr. Osterholm: [00:35:14] Well, first of all, thank you for this very good question, Frank. You're right on the mark. And I want to start out by emphasizing that what you already said in your question, which is that these vaccines remain effective in preventing severe illness and death. They are not 100% effective. They are not. And we do see waning immunity occur, but they are important tools for preventing hospitalization and deaths due to COVID. And so I continue to encourage all the listeners to receive all the doses that they're eligible for. That said, when you look at the ability of these vaccines to prevent infection and transmission, the data is far less promising. Now, again, let me please distinguish between stopping transmission, keeping you from getting infected versus do they still protect your life? Do they keep you from getting into a hospital and into an ICU bed? And I will take even the latter benefit from a vaccine. If that's all I can get, I'll get that vaccine. And I think that's an important point. A review published in April 2023 that assessed vaccine effectiveness against different variants in the UK found that two doses of COVID-19 vaccine were 15% effective against BS1 and 28% effective against BA2 infections 25 weeks after the second dose and that three doses were 37% and 44% effective against BA1 and BA2 infection respectively, 15 weeks after the third dose. While this is better than nothing, it certainly won't result in any kind of high level population based immunity. Even if the vaccine and booster uptakes are very high, recent data also suggests that individuals that are infected and vaccinated shed similar amounts of virus as those who were infected and unvaccinated, meaning they are just as likely to transmit the virus.


Dr. Osterholm: [00:37:08] A study published in Nature Communications in November 2022 found that during periods of Omicron dominance in affected individuals received two primary series doses of vaccine, did not have significantly different cycle thresholds on lab testing than infected individuals who were unvaccinated. This means that they were likely about the same in their level of infectiousness. Those who received a booster dose had a significant higher threshold, which actually means a lower viral load. So less infectious than unvaccinated individuals, but only for the first 70 days following their booster dose. The bottom line is that since these vaccines offer only minimal protection against infection and do not significantly lower viral load, they are far more of a personal health tool than a public health tool at this point. I've said time and time again we can't boost our way out of this pandemic. And it's because despite their ability to reduce severe disease and death, these vaccines are not going to be enough to stop transmission of the virus. Again, very good vaccines. They're just not great. I hope that in the coming years we will have more effective and broadly protective coronavirus vaccines and that I can have a different answer to this question. This is at the very heart of our work with the coronavirus vaccine roadmap, trying to get us those better vaccines. But for now, with the vaccines we have, we should be fully aware that there are excellent personal tools, particularly with booster doses and not public health tools that are capable of stopping transmission.


Chris Dall: [00:38:42] Mike is a follow up. You're probably aware of some of the controversy surrounding Robert F Kennedy Jr and some unsubstantiated claims he made about the COVID vaccines and many other vaccines on the Joe Rogan podcast. This controversy is also involved. Scientists and vaccine developer Peter Hotez, who is since then come under a lot of criticism from anti-vaccine people. Is there anything you want to say on this issue?


Dr. Osterholm: [00:39:09] I don't think it helps to say anything relative to Mr. Kennedy's comments. You know, this is not about a debate. This is about taking unsubstantiated, erroneous information, linking it together and making what I consider to be dangerous statements. My point in even talking about this today, again, is part of that dedication that I talked about earlier. This is about a person I've had the opportunity through this pandemic to work very, very closely with. Peter Hotez. We talk weekly, if not more often. I've worked with Peter for many, many years, but during the pandemic in particular got very close to him. There are very few people that I've come in contact with in my career where better scientists, more concerned individuals about the health of all. Then. Peter Hotez, He is a man of great scientific honor. He's a man that is honest to a T, and he cares and he is willing to take the arrows from so many who will label him in the most horrible ways, who will threaten him, and all because of his desire to help those who want help to avoid infectious diseases that could be prevented by vaccines.


Dr. Osterholm: [00:40:34] So, you know, my words are surely not going to make Peter's life any better, but I hope many of my colleagues will collectively come together and support him in the way that, you know, just thank you for what you're doing. And I will tell you, he has a book coming out later this summer on disinformation, misinformation, and there is no one better qualified to take this issue on than Peter Hotez. So my sincere, sincere appreciation and thanks to you, Peter, for what you do and I know how tough it is personally. You and I have had many conversations about the challenges. I just am so, so fortunate to have you as a colleague and a friend, and I hope everybody in the podcast community, if you have nothing else to do today per helping the world, send a card to Peter Hotez at his office at at Houston and just tell him thank you for what he's doing to stand up to this horrible, horrible information campaign that is truly putting people's lives at risk.


Chris Dall: [00:41:43] Now for some other infectious disease news. Earlier this month, the W.H.O. said in its global influenza update that while overall flu activity is declining, there's been an uptick in countries like Australia and New Zealand and South Africa, as well as some South American countries. Mike, what can you tell us about this? And does this have any implications for the flu season in the Northern Hemisphere?


Dr. Osterholm: [00:42:05] Well, Chris, as you mentioned in your question, flu activity in the southern hemisphere has been high for the past few months. This is not unexpected as flu season in the southern hemisphere typically begins in the month of May and peaks in July or August. Australia is experiencing higher hospitalization numbers than usual so far this season, particularly in children. Sadly, many of these hospitalizations were likely preventable as the increase in hospitalizations is likely a reflection of lower vaccination rates than usual, especially in children, and not a result of a more novel strain causing more severe illness. At this point in the 2020 influenza season, 40% of children in Australia between the ages of six months and five years were vaccinated against influenza, and that compares to only 20% this year. Now, just like the COVID vaccines, as we've talked about with influenza vaccines, they're hardly perfect. You know, we may get 40 to 50% protection per year in a good year, but that still is real protection against infection, against illness, against hospitalizations and against death. So I use the very same approach with COVID vaccines and influenza vaccines in terms of the boosters and how important they are on an annual basis. Now, according to the W.H.O. report that you mentioned in your question, overall case numbers in South America are starting to decline. This is mostly due to a decline in cases in Chile, as Argentina, Paraguay and Uruguay all saw increases in influenza like illness over the past week.


Dr. Osterholm: [00:43:42] Case numbers in the Caribbean and Central America are still increasing as our case numbers in Australia and New Zealand. It's just too soon to say whether we can expect cases to start declining in these regions soon or if we're on track for a particularly bad flu year. I've had conversations this past week with researchers in Australia who indicated that they might be seeing a very high peak of cases right now and that hopefully the case numbers will drop. That said, I want to remind everyone that this time last year, countries in the southern hemisphere were seeing record numbers of influenza cases for this time of the year, but also saw cases decline earlier than usual. And then, as you know, the same thing happened months later in the northern hemisphere. As many said, we were entering a triple demic when reality we just had an early flu season similar to any other year, just early. It's too soon to say that if this will happen again this year or if cases in the southern hemisphere will continue to climb and reach record levels. The one thing that I can say with some certainty is that the situation in Australia highlights the importance of vaccination, just like our current COVID vaccines, as I just said, are Influenza vaccines are far from perfect, but they still reduce the risk of hospitalization and death.


Dr. Osterholm: [00:44:58] So for all the listeners in the southern hemisphere that have access to a flu vaccine, don't wait to get a dose. And for listeners in the Northern hemisphere, please get vaccinated this flu season. It may not prevent you from getting infected or being ill, but it surely can reduce your chances of severe illness and death, just like our COVID vaccines. The last comment I want to make relative to influenza in the Southern hemisphere. You may recall all the debate we had in this country during the three years of the COVID pandemic and people saying, oh, it's going to become a seasonal virus. Now it's becoming a seasonal virus. Now it's going to happen in the winter here, etcetera. Well, it's interesting to note here that there's very little COVID activity going on in any of these countries in the southern hemisphere. There simply is no data yet to support that. This is likely to be a seasonal virus infection this next year. Could be eventually. Surely it could happen. But just as we've been pushing back on those who have wanted to make this a seasonal virus infection picture, we just don't have any evidence yet that that's the case.


Chris Dall: [00:46:08] Also, earlier this month, the Minnesota legislature approved $1.62 million in funding for CIDRAP for research into chronic wasting disease or CWD. I don't think we've discussed CWD On the podcast. So can you explain to our listeners what it is, why you're concerned about it and how this money will be used?


Dr. Osterholm: [00:46:30] Well, Chris, this is a pretty complicated topic, so I will try to do my best in short order to give you an overview. But I would urge you all to take a look at our website that actually is dedicated to chronic wasting disease, and we'll put a link on that on the podcast site so that you can go there. Chronic wasting disease is a condition in cervids or white tailed deer, mule deer, elk, etcetera, which has some similarities with what we saw with bovine spongiform encephalopathy and mad cow disease back in England in the 1980s and 1990s. And what this disease is caused by a prion which is nothing more than a misfolded type of protein that can, when it's in the brain, cause all the other proteins such to misfold causing these kind of changes that result in dementia. Chronic wasting disease was first picked up in cervids in Colorado more than 50 some years ago, and at that time it was isolated to that area. But what's happened is that it has continued to spread. This is the disease in cervids that actually the animal may be infected for potentially months to several years before they actually show symptoms. But the prion gets into the central nervous system of the deer. And we now know even more so that it can get into the nerves, even in the muscle area, which if you consume this prion, which is very, very difficult to inactivate, you could potentially become infected.


Dr. Osterholm: [00:48:11] Well, over the course of the past 50 years, we've recognized, number one, that it has spread widely. It is now in 31 US states and four Canadian provinces, and the number of cases continue to grow in some of these states areas, for example, in Wisconsin right now, up to 80% of the deer in some counties have chronic wasting disease prion infection. Now the challenge is, is what does that mean for humans exposure to the CWD? Prions is increasing when you can eat meat from an animal that is infected and it clearly increasing in the sense that more and more animals are infected each year. Also. In addition, the strains are changing such that they can have unique host range and they're continuing to emerge, meaning that what might not have been able to infect a human 30 years ago. Now today those strains surely could. Documented transmission of CWD to humans or production animals such as cattle would literally result in an overnight crisis with a significant implication for public health, agriculture, trade, wildlife, health and beyond. Unfortunately, no state, federal or international agency is really adequately preparing for this potential crisis should we see the transmission to humans? And I think one of the things that we have done at CIDRAP is try to provide the summary information of why we believe that this is surely likely to happen.


Dr. Osterholm: [00:49:43] And this is not a popular position, particularly among many who are afraid that it will actually negatively impact deer hunting. And I agree it will. But it doesn't mean that you can put your head in the sand and not deal with the potential preparedness issues. What happens if it happens? What will we do today? For example, wildlife conservation in this country is largely supported by deer hunter licenses. And should there be a decrease in deer hunting, you would see more animals on the land, resulting in more auto accidents, resulting in more transmission of CWD and less resources by a long shot for doing the wildlife conservation work that is so important. Will chronic wasting disease become a human threat? For all we know, it already has. We have studies today showing that these prions from cervids, when put into what are called humanized mice, mice whose immune systems have been set up more to look like that of humans that they now readily can be infected by this CWD prion. We also now today that the exposure to contaminated venison is only increasing, with an estimated more than 15,000 infected cervids each year actually being consumed by many different humans from that one deer.


Dr. Osterholm: [00:51:06] We know that we can also find the prions in the skeletal muscle of the infected cervids, which is unlike bovine spongiform encephalopathy, where back in the 1980s their cattle in the UK were getting infected by refed bone meal, taking the waste of animals, putting it in, cooking it, and then sending it back, including the spinal column. And with that alone, they then got infected with the prions because they are so difficult to destroy. Well, today, if you're not only just eating the central nervous system, but you're also eating the nerve contaminated prions in the muscle that again, just continues to increase the risk. So our program is really all about anticipating the situation. I tell our staff often that, you know, we don't get paid to be popular. We get paid to be right. And I take that very seriously. And I say that with great humility. But it would be easy to say, Oh, this is going to be a problem when in fact, we think it very well could be. And so what we're doing is we've established an internationally renowned group of experts who are serving on our CIDRAP CWD advisory group. And we really have, I think, the opportunity to continue to help promote the kind of information that the public should have about what the risk is and if it should ever happen, where someone does become infected with one of these prions and potentially develop this very severe dementia like illness, what does that mean? What will happen? And so what our mission here is now is to take our group of international experts and to address five different areas of chronic wasting disease, human medicine and public health, human services and production, animal testing and surveillance, agriculture and trade disposal issues.


Dr. Osterholm: [00:53:07] And then finally, wildlife, health and conservation. And what we're doing is making the assumption that there has been transmission. And if there has been, then what's the next step? What's the next step? What's the next step? And if there are suspect transmission, what do you tell people? You know, where you're kind of in that gray land. So we're hopeful that we can be better prepared for what I think is going to be an inevitable public health crisis in the future. Again, I hope I'm dead wrong. I hope I am dead wrong on this issue, but I think not. I think that CWD is going to be come to the United States. Everything that we saw with bovine spongiform encephalopathy and mad cow disease in Europe in the 1980s and 90s should that occur? The implications are huge. They're far reaching. And at this point, we just aren't prepared.


Chris Dall: [00:54:01] Now for our latest moment of Joy submission. Mike, who did we hear from this week?


Dr. Osterholm: [00:54:07] Well, Chris, this is actually a special one because it's actually a follow on to one that was from several years ago. This is actually from Evin. And she wrote in her Moment of Joy to the CIDRAP podcast team. “As someone that gives me joy, I am reminded of my pandemic partner that was profiled in episode 77, my grandson Arthur, and he was at the time he was eight months old. Now he's two and a half and we still have a beautiful relationship. In fact, we moved across the country with his family and my husband and I in order to still be in one another's lives. We moved from the desert to the Pacific Northwest to a forest near the ocean. Arthur has now been joined by a little sister, and I get to play with him every day. At that time, Arthur was not speaking, but he would play the piano and the drums. Now he is speaking and learning to color and cut with scissors. Just yesterday put both his hands around my neck and his cheek against my cheek and told me that he loves me. I attribute my peace during the pandemic to the information I would get from these podcasts, and I was able to calm myself during the pandemic and be a grandmother who is present for her grandchildren. Thank you for being a part of that journey for me, Evin.” Evin, Thank you. You have no idea how much this warms our hearts at CIDRAP to hear this. Thank you so, so much.


Chris Dall: [00:55:33] And just a reminder to our listeners that we would love to hear about your moment of joy even as we move past the pandemic. We know that we live in challenging times and finding the thing that brightens the day, even if just for a moment is so important for our mental health. So what is the thing that you look to for a little bit of joy in your life? It can be a place, a person, a pet, a piece of art, a memory or whatever you want it to be. You can share it with us at OsterholmUpdate@umn.edu. And now for a little bit of business. As we get closer to the end of our fiscal year, we hope that you've come to appreciate all the timely information, support and positivity that we've been able to provide you through the Osterholm Update. With that, we'd like to take a moment to remind all of you how critical it is to have access to the type of high quality, authoritative and unbiased scientific information that you get from this podcast and from CIDRAP. Please help us continue to provide the coverage and voice you have come to expect from us regarding the latest infectious disease threats. By supporting the team you trust, respect and depend on any amount of financial support is extremely appreciated and will ensure we can continue to offer this podcast going forward. Your support means more to us than you'll ever know. To contribute to this podcast and everything we do here at CIDRAP, please visit cidrap.umn.edu/support to make it easier for you. We'll put a link on the podcast page. We so appreciate your support, trust and continued partnership. So Mike, what are your take home messages for today?


Dr. Osterholm: [00:57:01] Well, I think the single most important thing I hope people take away from this podcast today is good news, good news. We are surely seeing the backside of this pandemic in every way. And again, while we may have some increase in cases over time, again, it's not seasonal yet. We may see a new variant be the reason for that. I don't see us ever experiencing what we did between 2020 and late 2022. I think we really have crossed the river, you might say, of the pandemic. That's good news. Now, it still doesn't address the issues for those who are at increased risk for serious illness, hospitalizations and deaths, because, in fact, there still is virus out there. We're still seeing infections. But for the vast majority of people today, they have moved on and they have reason to. It is good news. There is no seasonality yet with this virus. So I can't predict for you that this fall and early winter is going to see a big increase in cases. If we look at what's just happening right now in the southern hemisphere, that's exactly the experience. Very little COVID, lots of flu. And finally, when the booster doses are available, particularly for those who are at increased risk of serious illness, please get that booster dose that can go a long ways, at least for some months, in greatly reducing your risk of serious illness, hospitalizations and deaths, and therefore get it, even if you've had COVID before, even if you've had 4 or 5 doses of vaccine before, what we're seeing is it's right now it's the most recent dose you had relative to the variant that you're vaccinating against and to be vaccinated against the variants, you want to have this current new vaccine. So I'll continue to push that. And it's a safe vaccine. It's one that I would urge that even if you're not at increased risk of serious illness, hospitalizations and deaths, that can still happen. So I would urge people just to get the vaccine.


Chris Dall: [00:59:11] And what closing song have you chosen for us today?


Dr. Osterholm: [00:59:15] Well, Chris, I'm tying this back to my opening dedication, and I want to say that this song really in part fits the dedication very well. But it also, from a timing standpoint, was something that I think is at least front and center here in Minneapolis, Saint Paul. This past week, the phenom Taylor Swift, the 33 year old entertainer of entertainers, was here and put on two sold out concerts at the US Bank Stadium, which was a remarkable event. I've never seen the reviews of a concert ever written up like this before. The lead reviewer for our largest paper here said it was the best concert that Minnesota had ever experienced and listed, you know, all of the greats Bruce Springsteen, Barbra Streisand, Paul McCartney, etcetera, and said this was by far this is a young lady who has clearly captured the art of communication through her music and also a presence that so many people have really fallen in love with her. And she's also someone who's not afraid to write about the hard things in life and to describe them in a way I think that is really difficult to hear sometimes. But what we need to. So while choosing a closing song this week, we wanted to choose a song that really emphasized the message in the dedication. In a time where depression and anxiety rates are climbing, supporting friends and allowing our friends to support us couldn't be more important. And I think the lyrics of this song by Taylor Swift describe the pain and fear that can come with mental health issues and the importance of having support from our friends.


Dr. Osterholm: [01:01:05] The song that I'm using today is Taylor Swift's Forever Winter, the 27th track on the rerecorded version of Taylor Swift's third album, Red. The song was written by her and co-writer Mark Foster back in 2012, but didn't make the cut from the original Red album that was released that same year. It was included as a “From the Vault” track for the rerecording, or “Taylor's Version” of Red, which was released in November 21st of 2021, 11 years after the song was written. The album Red (Taylor's Version) was Swift's 10th album to reach number one on the Billboard charts and has remained in the Billboard Top 100 ever since, currently at 25th over a year and a half after its release. Forever Winter peaked in the Billboard Top 100 songs at 79 during the week of its release. Swift has never specifically stated who the song is about, though fans speculate that it was written about a friend of hers who had struggled with his mental health and passed away from a drug overdose at age 21. She has said publicly about the song that the song Forever Winter is about “being in a moment in your life where you love someone or someone is such a good friend of yours, or you feel really close to someone and you realize all at once they've been struggling for a very long time and you feel guilty that you didn't see it sooner. You wish you would have checked in on them more.


Dr. Osterholm: [01:02:34] That person means so much to you, but you didn't necessarily pick up the signs that maybe that they weren't. Okay, so that's Forever Winter.” In a sense, it's a dialog back and forth between Taylor Swift and someone else. So here it is, Forever Winter. He says he doesn't believe anything much he hears these days. He says, Why fall in love just so you can watch it go away? He spends most of his nights wishing it was how it used to be. He spends most of his fights getting pulled down by gravity. I call just checking up on him. He's up 3 a.m. pacing. He says it's not just a phase I'm in. My voice comes out begging. All this time, I didn't know you were breaking down. I'd fall to pieces on the floor if you weren't around. Too young to know it gets better. I'll be summer sun for you forever. Forever winter. If you go. He seems fine most of the time. Forcing smiles and never minds. His laugh is a symphony. When the lights go out, it's hard to breathe. I pull it at every thread. Try and solve the problems in his head. Live my life scared to death. He'll decide to leave instead. I call just checking up on him. He's up 5 a.m.. Wasted. Long gone. Not even listening. My voice comes out screaming. All this time I didn't know you were breaking down. I'd fall to pieces on the floor if you weren't around.


Dr. Osterholm: [01:04:05] Too young to know it gets better. I'll be summer sun for you forever. Forever winter If you go. If I was standing there in your apartment. I'd take that bomb in your head and disarm it. I'd say I love you even at your darkest. And please don't go. I didn't know you were breaking down. I'd fall to pieces on the floor if you weren't around. Too young to know it gets better. I'll be summer sun for you forever. Forever winter. If you go. I'll be your summer sun forever. At 3 a.m.. Payson. All this time I didn't know. At 5 a.m.. Wasted. I'll be in pieces on the floor. Forever winter if you go. He said he doesn't believe anything much he hears these days. I say believe in one thing. I won't go away. Taylor Swift and Mark Foster. Very powerful, from a 33 year old genius. Well, thank you all very much for being on the podcast with us this week. I hope we've given you some information that's helpful and useful. Please take the good news to heart. We'll hopefully continue to be able to report on that. Reach out to someone. They will know that you care. Have a good two weeks. Enjoy the 4th of July. Be safe. Be kind. Be kind. Right now, this world needs kindness. And again, I want to just thank Peter and Rochelle for what they've done and how they've done it. And we look forward to talking to you in two weeks. Thank you so, so much. Thank you.


Chris Dall: [01:05:43] Thanks for listening to the latest episode of the Osterholm Update. If you enjoyed the podcast, please subscribe rate and review wherever you get your podcasts and be sure to keep up with the latest infectious disease news by visiting our website cidrap.umn.edu. This podcast is supported in part by you our listeners. To contribute, please visit cidrap.umn.edu/support. The Osterholm Update is produced by Sydney Redepenning, Elise Holmes, Cory Anderson, Angela Ulrich, and Meredith Arpey.