March 21, 2024

In "Good News in a COVID Indifferent World," Dr. Osterholm and Chris Dall discuss the national and international COVID trends, the latest research on long COVID, and antibiotic-resistant Shigella. Dr. Osterholm also shares the latest "This Week in Public Health History" segment and interviews members of the podcast team. 


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Chris Dall: 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. Last week, the National Institutes of Health announced the launch of two phase two clinical trials to test the safety and efficacy of three treatments for long COVID patients who've experienced symptoms such as fast heart rate, dizziness and fatigue. The trials are among several efforts aimed at long COVID understanding what causes it, how to best treat symptoms, and how to test for it. On this March 21st episode of the podcast, we're going to spend some time talking about those efforts and what some of the latest research on long COVID tells us. After we examine the latest data on COVID-19 here in the United States and elsewhere. We'll also discuss a recent survey on how Americans are feeling about COVID-19. Look at the latest flu and RSV data, discuss the latest measles outbreak, and examine the emergence of antibiotic resistant Shigella. We'll also bring you the latest installment of This Week in Public Health history and our first segment marking the four year anniversary of the podcast. But before we get started, we'll begin with Doctor Osterholm's opening comments and dedication.


Dr. Osterholm: Thanks, Chris, and welcome back to all of you to the podcast. For those who might be first time listeners, we welcome you and hope that we're able to provide you with the kind of information you're looking for. For those who have been with us throughout the duration, many of you through the four years. Uh, it's always special to have you back. Before we dive into the many topics we're going to cover today, I want to take this dedication segment as an opportunity to personally and professionally express my heartfelt appreciation to all of you who take time to connect with us. Every week we receive many listeners comments, questions, and emails, and we read every single message. I try to read every one, and I feel so grateful that I get to connect with you through this podcast. When I call us a podcast family, I really mean that. I know that that's been a bit of a point of discomfort for some in the scientific world. They don't not necessarily get into those parts of who we are, but I think it's been very important because we share the scientific information, but often we share what that scientific information does to our lives, which is far beyond just the physical well-being. As I just noted, many of you have been with us since the beginning of the podcast four years ago. We've received photos of you and your loved ones excitedly gathering safely outdoors, hearing stories of how long COVID has affected you.


Dr. Osterholm: And we've shared your grief for how the pandemic has challenged your work, relationships, and well-being. We've even cried with you with regard to loss of loved ones. I note that was actually one year ago right now that I was experiencing my own case of COVID that went on and lasted for more than four months of what really was a long COVID like picture. So in this global podcast family, we have tried to share our highs and lows over the past few years. I know, as does the entire podcast team, what a privilege it is to be part of your lives in this small way, and I can only hope that we can continue to provide that kind of support that you're looking for. So it's with that regard. Also, I want to note that when it comes to the feedback on the podcast itself, we hear you. It always means so much to hear what resonates with you. And it helps us to know what you'd like to hear more of. And of course, as we've discussed in recent episodes, we've also received a fair number of messages sharing different viewpoints than those that I have shared. I want to reiterate my gratitude for these messages to. Hearing your diversity of opinions enriches our discussions and motivates us to look at the data with different perspectives.


Dr. Osterholm: All of your feedback, positive and negative challenges us to reflect, refine, and evolve, ultimately making this podcast a more inclusive and thoughtful space. A place where you can find reliable information that hopefully is beyond just the facts, but it's also what it is that's doing to our life. So as I say this, thank you so much for your engagement with Chris and me and the rest of the team at the CIDRAP that works on this podcast. Thanks for being part of the podcast, family, for your enthusiasm, your interest, your commitment, and your support. We appreciate it so much in that regard. In two weeks we will have a survey on the podcast website link where you can go in and provide us very specific information about the format of the podcast, the content, what we cover, how we cover it, the frequency. Maybe you're going to tell us you don't need it anymore and you don't want it, uh, whatever. But we'll have that survey available and we will look carefully at how we shape these podcasts going forward in all regards. So I do hope that you'll consider filling that out in two weeks. Now, let me just conclude by saying, hopefully, by now it's obvious who I'm dedicating this podcast to. I'm dedicating it to you, to the listeners, to the people who have been with us for these four years, to the people who have been challenged by our comments but hung with us, or have found support in the content that we've shared with you, we dedicate this to you.


Dr. Osterholm: Now, I have to say that this is a very special week for the podcast. With regard to the light issue, uh, we're here the spring solstice. Uh, we have just passed it in the last two days. Uh, as you know, actually, on Tuesday of this past week, uh, we finally hit the spring solstice in the Northern hemisphere. And I'm happy to report in Minneapolis today, the sun will rise at 7:13 in the morning, set at 7:27 for 12 hours, 14 minutes and 24 seconds of sunlight. And we will continue to see that sunlight increase right into the summer solstice. Now, in terms of our dear, dear colleagues in Auckland at the Occidental Belgian Beer House on Vulcan Lane today, you are about like us. You have, uh, sunrise at 7:24, sunset at 7:30 for 12 hours, six minutes and three seconds of sunlight. Almost identical to ours. Yes, we know we have the good fortune of ours, will. Continue to get lighter, yours will get darker. But to all of our dear friends in Auckland, we'll be sending you our sunlight as we have an overabundance of it coming into the months ahead.


Chris Dall: So, Mike, let's start with the latest COVID data. What are you seeing on the domestic and international fronts?


Dr. Osterholm: Good news, not great news. Great news would be where I have nothing to report this happening out there in the COVID world. But what we're seeing happen right now in terms of the trends is good news. Overall, things seem to be improving on both fronts, nationally and internationally, at least according to the somewhat limited data that actually is now available here in the US. We've seen wastewater levels on the decline since the start of the new year. Based on the latest national numbers, wastewater activity is at the lowest levels reported since last August. That's now more than six months ago. And according to the CDC website, US viral activity is considered low. That is, again, according to the wastewater data, these declines are happening in all regions of the country, including the South, which for several weeks had seemingly been dealing with stubbornly high levels compared to other regions experiencing improvements. That being said, there are eight states where wastewater levels are still considered high. Alabama, Arkansas, North Carolina, Kentucky, Missouri, Virginia, Illinois and our home state here of Minnesota. So the virus is still out there in throughout the country and particularly in these states. Now, I wish I could equate the actual virus levels we see in wastewater to some sense of risk, meaning how many cases are occurring in the community we're missing based on these data. As I've shared with you before, we're still trying to interpret wastewater data.


Dr. Osterholm: Does a certain level of activity in wastewater denote certain numbers of cases, or could, in fact, as variants change, see a big increase in wastewater levels and yet not have any additional new cases? Just some people are excreting more virus. We're still trying to learn about that. Apart from the wastewater data, we're fortunately watching hospitalizations also continue to decline. After peaking at just over 30,000 in early January, the number of Americans hospitalized with COVID has dropped for nine consecutive weeks, reaching 12,300 the week of March 9th. Likewise, deaths have also continued to fall after reaching a peak over 2500 deaths a week in January. They've decreased now for five consecutive weeks and sat just below 1300 a week as of mid-February. This is the latest week for which we have complete data, so again, there's plenty of room for improvement, but let's just keep improving. As I've said many times before, this surely beats the alternative. And for those of you who are trying to incorporate this sense of risk into your life, particularly for those who are older, who have underlying immune conditions, who may be at increased risk for serious illness, I know these numbers do not really give you a road map. We must never forget these numbers again are our mothers and our fathers, our grandfathers, grandmothers, our friends, and unfortunately, even sometimes our kids.


Dr. Osterholm: But let me just give you some sense of where we're at in terms of everyday risk in our lives. So this is not to minimize COVID. Not at all. But we're trying to learn how to live with it in the sense of how do we adjust risk in our everyday lives. If you look at the most recent numbers of deaths per week, this would equate to about 68,000 deaths per year from COVID. Now, hopefully those numbers will continue to decrease for some time, but right now, let's accept the fact that this is still a very large, very difficult number to put your arms. Around 68,000 deaths this past year we had 43,000 deaths due to automobile accidents. So there's still about 1.6 times more deaths due to COVID than automobile accidents. But I think most of us would not find ourselves not getting into a vehicle or driving somewhere or riding with someone because we were fearful of an accident that might happen. We've just basically taken that 43,000 figure and internalized that into our lives. I think that's where we're going with COVID right now. Again, this does not minimize for a moment even one death. But how do we live with COVID? And if that number continues to come down, and let's say it is similar to what we see with automobile accidents, some will ask, well, does that mean then I can just go and live my life like I'm driving a car? The answer is actually no, because with automobile accidents, it's most likely that unless you're intoxicated, impaired somehow, you basically have an equal risk across ages, across, uh, racial groups, across geographic areas.


Dr. Osterholm: With COVID, we know that the primary risk for serious illness, hospitalization, deaths still remains among those who are over 65 years of age and older, those who have underlying immune conditions. So there we'd say you have a riskier ride if you go out in terms of the COVID world right now. But the point being is, is that we can start to take this risk and contextualize it with what else is going on in our lives. What else do we deal with? With risk every day. So I hope that this is helpful in terms of just looking at where you're at. If you're one of the high risk people for COVID, you're going to say, hey, seatbelts. Airbags are not enough for me right now in terms of an analogy to automobile accidents and COVID, but for many people, they'll say, well, hey, you know, this is a risk I accept every day. And I don't think twice about therefore, you know, how do I now take COVID and put that into my life? Let me just finish off here with a brief update on the international data.


Dr. Osterholm: And I say brief, because what we're seeing around the world right now is less and less reporting of any kind of activity, which I do not believe reflects what's actually happening. It's just what's getting reported. So what we do see right now is consistent declines across almost the entire world in COVID activity. That said, there are still some countries, like Chile, where activity has been on the rise for the past several weeks. Otherwise, I will note that the Who's latest COVID surveillance report, which was published monthly with the latest edition posted on March 15th or last Friday, once again highlighted the challenges of international case reporting. According to that report, during the 28 day period, the span from February 5th to March 3rd, less than a third of the world's countries reported even a single case of COVID to W.H.O. Likewise, just 1 in 5 countries reported even a single COVID death in that 28 day time span. So although I do my best to share with listeners what I'm seeing with COVID in terms of activity, just know there's a whole lot that we're not seeing. Having said that, I want to be really clear. I do believe we're in a much, much better spot today than we have been in many months, and I can only hope that that trend continues.


Chris Dall: So let's turn now to long COVID. I mentioned the launch of two phase two trials for possible treatments of long COVID symptoms in the intro. Mike, what more can you tell our listeners about those trials and what are we learning from some of the latest published long COVID research?


Dr. Osterholm: Well, I have to start out this segment by just acknowledging it was one year ago. Right now, as I just mentioned, that I had my COVID infection, for which I then went into a four months of what you might call early long COVID. Fortunately, as you know, I've fully recovered since that time, but there were weeks in that time where I didn't think I would recover and that I was experiencing what I had heard so much about for so many months, and now fearing that this was my future course. So, Chris, this is an issue that's highly important to our listeners and of course, me. And I'm really glad that we're able to report some hopeful information this week. As you mentioned, the NIH will be launching two phase two clinical trials to test three treatments for autonomic dysregulation associated with long COVID. For listeners who are unfamiliar with autonomic dysregulation, it refers to a dysfunction in the autonomic nervous system, which is that part of our nervous system that controls involuntary functions of the body, something like breathing. Autonomic dysregulation can cause a number of issues that can contribute to long COVID symptoms, including digestive problems, increased heart rate, and blood pressure issues. These trials are specifically focused on a form of autonomic dysregulation called postural orthostatic tachycardia syndrome, or POTS, which causes dizziness and rapid heart rate upon standing and can be debilitating for many long COVID patients. I remember feeling those very symptoms. As I just mentioned, these trials will test three different treatments. The first of these treatments is a drug called gleemonex, which is a form of intravenous immunoglobulin currently used to treat immune deficiencies.


Dr. Osterholm: The second treatment that will be tested is an oral medication called ivabradine, which reduces heart rate and therefore may help to relieve some of the symptoms associated with POTS and other autonomic dysregulation following long COVID. The following treatment being tested is a coordinator guided Non-medication care protocol. This actually means wearing a compression belt and consuming high salt diets, both of which are common recommendation given to Pots patients to counteract the loss of fluid that can occur with the condition. I am optimistic we may see patients improve with one or more of these treatments, and we will certainly keep you updated when the results of these trials become available. As for other long COVID research, I want to briefly discuss the study that was published earlier this month in Nature Immunology. The study looked at blood samples from 214 COVID-19 patients categorized by disease severity. The researchers collected these samples from patients six times over the course of a year following their acute infection, and compared their blood samples to those of healthy controls or people who did not have COVID or long COVID. The researchers found that low iron levels were common among patients with long COVID compared to healthy controls. That is not entirely surprising, as we know how low iron can occur following infections due to inflammation. The researchers found that patients with more severe acute infections had elevated C-reactive protein levels for several months after their acute infection, as well as elevated levels of an iron regulating hormone called hepcidin, suggesting that they were experiencing inflammatory anemia. Increased C-reactive protein levels are an indication of inflammation. We'll link this study in our episode description for those of you who are interested in more technical aspects of this, but I want to focus for now on what this means in terms of long COVID symptoms and treatment.


Dr. Osterholm: It is possible that inflammatory anemia could explain certain long COVID symptoms, including fatigue and exercise intolerance. Because of this, the author stated that it's possible that iron supplementation during an acute infection could reduce the risk of long COVID, and that iron supplementation could be a possible long COVID treatment. That said, a lot more research is needed before we can conclude that this is the case. And I want to remind everyone that this is just one piece of a very complex puzzle. As I've said before, I wish that we could have a single study, give us all the answers, but unfortunately, that just won't be the case with long COVID. But I hope that these findings and potential new treatments can provide hope to those listeners who are suffering from long COVID. We are slowly getting closer to getting you the answers you need. And again, let me just come back at a very personal level and say, like me, many of you will get better over time. Regardless, in those first few months, I didn't think I'd ever recover, but I did. For those that don't recover on their own, who continued to maintain the terrible symptoms of long COVID, I promise you we will not forget you. We will continue to follow this issue closely. We will continue to advocate very, very strongly for the kinds of studies that can. Provide answers that change you from that long COVID world to one of smiles and happiness.


Chris Dall: So Mike, even though we know many of our listeners remain concerned about COVID and particularly long COVID, as you noted, a recent survey from the Pew Research Center found that only 20% of Americans viewed the coronavirus as a major threat in only 10% are very concerned that they will get it and require hospitalization. Now, we followed these Pew surveys pretty much since the beginning of the pandemic, and Pew is very well regarded. So I think these results are probably pretty accurate. What do you make of this?


Dr. Osterholm: Well, I think these are very important results. And let me just set the stage for this. As you noted, this research was conducted by the Pew Research Center and just released this past week. For those who don't know, the Pew Research Center is really one of the most well recognized and appreciated groups in the country in terms of survey information and then interpreting that into findings. The Pew Research Center conducted this study to understand Americans views of the coronavirus and COVID-19 vaccines. For the analysis, they surveyed 10,133 US adults from February 7th to February 11th of this year. Everyone who took part in this survey is a member of the Center's American Trends Panel, an online survey panel that has been recruited through a national random sampling of residential addresses. This way, nearly all US adults have a chance of selection. The survey is weighted to be representative of the US adult population by gender, race, ethnicity, Partizan affiliation, education, and other categories. In short, this really is a model type of approach. Now, what they found is not fully surprising, given with what we've seen expressed in the public about the current situation with COVID. The survey documented that 20% of Americans view the current coronavirus as a major threat to the health of the US population, and 10% very concerned they will get it and require hospitalization. The flip side of this, though, is that means that 80% of Americans do not view this as a major threat, and 90% of the population are not concerned they will get it and require a hospitalization, as stated in the summary of the study.


Dr. Osterholm: These data represent a low ebb of public concern about the virus that reached its height in the summer and fall of 2020, when as many as two thirds of Americans viewed COVID-19 as a major threat to public health. One other finding in this study that I think is very important to highlight is that just 28% of US adults say they've received an updated COVID-19 vaccine, which the CDC has recommended to protect us against serious illness. This stands in stark contrast to the spring and summer of 2021, when long lines and limited availability characterized the initial rollout of the first COVID-19 vaccines. A majority of US adults, 69%, had been fully vaccinated by August 2021, given the number of doses required at that time. And what's notable about the data on COVID vaccines is that this is perceived as different than influenza vaccines. The survey looked at who had received one, both or none, and what they found is that a larger share of US adults say they've gotten a flu shot in the last six months than updated corona vaccines 44% versus 28%. And despite a public health push encouraging adults to get both vaccines at the same time, almost half of those who received a flu shot from a health care provider chose not to get the updated COVID-19 vaccine. Now, there were some very interesting findings when they actually dug down into potential reasons why people may not be availing themselves to these vaccines.


Dr. Osterholm: For example, when it comes to vaccination, those who identified as Democrats or Democratic leaning independents remained more likely than Republicans and GOP leaners to say they've received an updated COVID-19 vaccine 42% versus 15%. This 27% gap in recent vaccinations is about the same as in January 2022, when 62% of Democrats and only 33% of Republicans said they were fully up to date with their vaccines. We all understand that these differences have continued to occur. And yet, when I look at the risk of serious illness, hospitalizations and deaths, we have to keep asking ourselves ideologically, why is this happening? Why? Why are we continuing to see the challenges in getting Republicans vaccinated? It was also interesting in terms of looking at those 65 years of age and older by party. In the survey, they found that 66% of Democrats aged 65 years of age and older said they had received the updated COVID-19 vaccine, which to me, of course, is not necessarily a great news because I would like to know whether that other 34% are at. But when you compare it to what they found with the Republicans, with only 24% of Republicans aged 65 years of age and older have received an updated vaccine, literally one out of four. Unfortunately, this 42% Partisan gap 66% versus 24% is now wider than at any other point since the start of the pandemic. For instance, in August of 2021, 93% of older Democrats and 78% of older Republicans say they received all the shots needed to be fully vaccinated.


Dr. Osterholm: Only a 15 point gap. And here we are now at a 42% gap. Finally, if we look at how the public perceives the issue of COVID right now, as I noted in the opening, 1 in 5 Americans now say the coronavirus is a major threat to the health of the US population, down from a high of 67% of July 2020. Concern about the coronavirus as a major threat to the US economy is also declined. Today, 23% of Americans say it's a major threat to the economy, compared with 88% in May of 2020. Again, the pandemic is in the rear view mirrors for many, many people for various reasons. We have linked this report in the podcast website area. I urge you to go take a look. You can download it free of charge. I think it really highlights points that we've been trying to make on this podcast for the past several weeks. With regard to how do we perceive, uh, the everyday lives of people getting infected, who gets tested, who then isolates, etc.. We have to understand today that in the US, no matter what kind of public health recommendations we put forward, if people do not believe that this is a challenge, if they think that it's unnecessary to change any aspect of their lives for protecting themselves or others, then our recommendations will only be as effective as that situation. And so we have to find ways to help support, uh, individuals getting vaccinated, individuals having access to Paxlovid.


Dr. Osterholm: I continue to really regret the fact that we're seeing this, an ever growing schism between Democrats and Republicans as self-identified. And how can we can we can change that? Uh, we're beginning to see the trend of more and more of the deaths right now in this country are occurring in red counties and red states than we're seeing in blue counties and blue states. And that's unfortunate. That is so unfortunate. And all we can do, I think, is continue to pursue that issue today. If we could get most everyone vaccinated 65 years of age and older, uh, at least every six months, and make sure they have ready access to Paxlovid should they become infected, we could do so much more to drive down those numbers of deaths that we're seeing now, or even, for that matter, the number of people in hospitals. So we'll continue to push that. That, to me is very, very important. Again, respiratory protection is critical for those who are at increased risk. If you're in public places, uh, or in situations where you think you might be exposed, do not hesitate for a moment to use your N95. And I want to emphasize N95 that is your right. And you can also do a lot to protect yourself, but just know that mainstream America has moved on. They're not going to change. And this report summarizes that. So we now must protect ourselves.


Chris Dall: Turning now to some other infectious disease items. Mike, what is the latest on flu and respiratory syncytial virus?


Dr. Osterholm: Well, Chris, as I said in our last episode, respiratory virus season is mostly winding down in the United States. Rsv cases continue to decline across all regions of the country, with cases for the week ending in March 9th. The most recent data available is 1.5 times lower than one week before, and three times lower than four weeks before. As for influenza, hospitalizations and outpatient visits for respiratory illness were both down during the week ending in March 9th compared to the week before. There was a slight increase in influenza mortality, with 0.68% again, 0.68% of deaths occurring due to influenza, compared to 0.63 during the previous week. Though it should be noted, this is still lower than what we're seeing three weeks prior, when 0.73% of deaths were due to flu. Additionally, we're seeing just over half of the weekly mortality that we were during the peak of the season. So overall, I think it's still safe to say that the worst is behind us on a national level. That said, there are some states, most of which are in the Midwest, that are still in the thick of their influenza seasons. Nebraska, Ohio and the District of Columbia are currently experiencing very high levels of influenza activity, and 12 states and the city of New York are experiencing high levels of activity. It's not surprising that we're seeing activity persist in these states, as most of them had a later start to their influenza season. Similarly, most of the states that have returned to low levels of influenza activity had earlier starts to their influenza season. The one outlier continues to be my home state of Minnesota, which is now reporting low levels of activity for only the second time this season. All the other weeks, the state has reported minimal activity. It is still unclear why we haven't had influenza seasons more similar to what our neighboring states are experiencing. As always, we'll keep you updated as this influenza season continues to unfold. But now again, in general, the news is good.


Chris Dall: Another viral infection we've been following lately is measles. Although the CDC won't officially release data until later this week, it's been reported that there have now been more cases this year than there were in all of 2023, and the latest outbreak is in Chicago. Mike, what can you tell us about this outbreak and about the measles situation in general?


Dr. Osterholm: Well, first of all, let me begin by saying that I think I knew more about measles, uh, a couple of years ago than I do now. And, uh, I think you were at a point in what's happened with measles around the world that really requires us to take a step back and ask ourselves what is happening with it. Make no mistake, measles is a bad disease. Make no mistake about it. Vaccine can do a great deal to protect us from that disease. So let me first just highlight what is happening in the United States and then make some comments that I'm sure for some in public health, they're going to be challenged by these comments. Nonetheless, I think they're important to begin considering. First of all, the spotlight has turned to Chicago, where they're now dealing with a handful of cases. It was reported on March 8th that a child staying at a migrant shelter in the city had developed measles. In the following days, several additional cases in both children and adults reported at the same shelter. This week, a team from the CDC arrived in the city to help local officials manage the outbreak and limit additional spread. Local officials are encouraging Chicagoans to check their vaccination status and get the MMR vaccine, if they haven't already. Chicago joins an unfortunately growing list of cities around the US who are dealing with measles cases popping up in recent months. The CDC recently issued a health advisory notice in response to the rise in domestic cases, confirming that as of March 14th, there have been 58 confirmed cases in the US across 17 jurisdictions, including seven outbreaks in seven jurisdictions.


Dr. Osterholm: This is as many cases as we've seen in all of 2023. This has clearly become a global issue and with many other countries also seeing outbreaks, the CDC's notice also mentioned that 54 of the 58 cases seen so far this year in the US have been linked to international travel. To give you some sense of what we're talking about, even when we look at countries like the United Kingdom, we're seeing increased cases of measles. This international picture is not just related to low and middle income countries. In the UK, from October of 2023 to now, there have been 730 cases of measles, most of them in the Western Midlands. The global increase in measles cases is a situation where following closely and we plan to continue to provide updates, as well as offer deeper analysis on the issues in coming episodes. We've already seen a variety of responses from local health authorities from different jurisdictions, and it's clear that the conversation around the epidemiology and control of measles will only be gaining more traction. I think it's really important that we in public health consider all the lessons to be learned from dealing with COVID-19 and other threatening infectious agents that are cropping up recently, and take special care with how we approach the concerning rise of measles.


Dr. Osterholm: So stay tuned for more on this important topic. But let me just leave you with one perspective. I, for one, have always appreciated how infectious measles is. We know it is kind of the ultimate airborne virus, and yet I'm struck by we have as few cases as we do in the United States. And why do I say that? Well, yes, we know we have pockets of under-vaccinated kids and and even in some cases potentially young adults throughout the country. But what really I find fascinating is that if you think about how many kids are born in this country, every year, it's about 4 million. And we know that measles vaccine is about 95% effective. At least that's what the historic data has shared with us. So that means that if you vaccinated all 4 million kids every year, and we know we don't accomplish that, but if you did, 5% of that number is 200,000 each year would be children who are vaccinated but did not get protection from the vaccine for whatever reason. Now, add that 200,000 up year after year after year in this country, and you start to realize those are large numbers, more than I think we often think about in terms of kids not getting vaccinated. But of course, then you add those on. We have potentially many hundreds of thousands of kids under age 18 who do not have protection against measles, and we're not seeing more cases.


Dr. Osterholm: I would not be surprised in a setting where you might have 5 to 10% of your population not protected, you could be seeing thousands and thousands of cases. So I only raise this not to cast doubt on the vaccine. Maybe it's working a lot better than we think it is, but it does raise the question of what are we trying to accomplish today with measles elimination in the United States? Remember, elimination was a concept brought forward when we knew we couldn't eradicate it from the world. It was going to continue to transmit around the world, but we could try to put up an immune wall around the United States. And with every introduction of measles from a foreign country, we would do everything we could to squelch it quickly and to make sure that it didn't spread. And I'm just somewhat dumb. We're not seeing more cases based on the percentage of people who might not be protected after vaccination, plus those who are not being vaccinated. So stay tuned. We're going to have a lot of additional discussions about measles. It is a very important public health disease. It's one that is so avoidable with vaccination. But why are we where we're at right now? And what does that mean for our future efforts in terms of elimination of measles in the United States and other high income countries?


Chris Dall: We're going to turn now to a bacterial infection that is becoming a growing public health issue due to antibiotic resistance. In late December, the United Kingdom and the European Center for Disease Prevention and Control issued simultaneous reports about growing outbreaks of strains of multidrug resistant and extensively drug resistant Shigella. Mike, I think most of our listeners, if they have heard of it, probably associate Shigella with food poisoning, but the epidemiology of this infection is changing. What should our listeners know about Shigella?


Dr. Osterholm: Well, I'm always a fan of plugging the excellent work of CIDRAP, and we can certainly do so on this topic as Shigella. For listeners that aren't aware, Chris not only works on this podcast, but is also a lead reporter for CIDRAP news who covers stories related to antimicrobial resistance. We will link articles in the show notes. But Chris, you've written a couple of excellent pieces, especially on this issue since last December. For background, Shigella is a bacteria that causes gastrointestinal illness known as shigellosis. Like many diarrheal illnesses, it is typically acquired through consumption of contaminated food and water, and we commonly think of as foodborne disease. But in recent years, the epidemiology of this bacterial infection is changing. More on that in a moment. Now, shigellosis can typically be treated with a number of front line antibiotics. However, in recent years the bacteria is becoming extensively drug resistant, leaving only very few options available for those infected. Chris, your article from December touches on the spike in extensively drug resistant Shigella in the UK and Europe. Another important CIDRAP activity is the launch of the fourth season of our podcast, Superbugs & You. The first episode, which will be released next Tuesday, March 26th, focuses on drug resistant Shigella and interviews a number of the people mentioned in your article. Chris. I don't want to give away too much, since I hope our audience will listen to the full episode and releases, but I'll touch on a few key messages. One is that diarrheal disease, which certainly is uncomfortable, can also be a very serious health issue, especially in young children in low and middle income countries, early infections can affect the gut in such a way that impacts on a child's growth and development for the rest of their lives.


Dr. Osterholm: And as I mentioned, the epidemiology of shigellosis is shifting while it is still transmitted through contaminated food and water, especially in low and middle income countries in the US, UK and Europe, it is increasingly being seen in men who have had sex with men, specifically those who have had multiple partners and who have a more dense social network. This can be a difficult topic to broach without increasing stigma for certain populations. However, I think you'll find the speakers on the podcast do an excellent job of defining why it is important to provide information with the greatest level of detail, so as to inform and protect those at highest risk. Finally, there are some great conversations about the role of vaccines to prevent Shigella infections, as well as other enteric pathogens like cholera and typhoid. I think this has incredible potential to not only reduce disease and death from these infections, but reduce the volume of antibiotics being used and hopefully slow the resistance that is occurring. I hope you will stay tuned next Tuesday for the launch of the Superbugs in You podcast. You can find it on the CIDRAP website as well as on Apple Podcasts, Spotify, and anywhere else you listen to your podcast. There will be four episodes in total, one released each week after the episode on Shigellosis. There will be an episodes on the upcoming G7 meeting in Italy, and it's focused on microbial resistance, cystic fibrosis and challenges battling resistant lung infections, and an episode on the One Health approach to antimicrobial stewardship in food and the environment. It will be another great season, and I look forward to hearing each of the episodes in the coming month.


Chris Dall: Now for this week in public health history. And today we're taking a moment to commemorate what is both a notable moment in public health history and a remarkable life. Mike, some of our listeners may have heard or read about this story, but for those who haven't, who was Paul Alexander?


Dr. Osterholm: Chris, this story is truly an incredible celebration of life, and it's also a reminder of what the world was like before we had vaccines for childhood illnesses like polio. On Monday of last week, Paul Alexander, one of the last known individuals living in an iron lung, died at the age of 78. For listeners who aren't familiar with iron lung machines, there are seven foot long metal cylinders that stimulate breathing by varying air pressure and were once a commonly used treatment for patients with paralytic polio. They're unable to breathe on their own. These were individuals that not only had damage to the nerves in their limbs, but also into their autonomic nervous system, and therefore were unable to breathe without the assistance of this type of machine. Paul developed polio at the age of six in the summer of 1952, as a result of his infection. Paul was paralyzed from the neck down, unable to breathe on his own, and was placed in an iron lung. Though many scientific innovations for people with respiratory problems occurred during Paul's lifetime. His lungs were too damaged to use portable ventilators or other machines to assist with his breathing, forcing him to spend most of his past 70 years in the iron lung. Paul learned breathing techniques that allowed him to literally swallow air, much as a fish might take water across its gills and be able to stay out of the iron lung for short periods of time. He eventually reached a point where he was able to leave it for up to several hours at a time to attend college and law school classes. Paul's cause of death has not been publicly stated, although he had been hospitalized due to COVID a few weeks before his passing.


Dr. Osterholm: But as I said, Chris Paul lived a life worth celebrating despite spending most of it in an iron lung. Not only did Paul long outlive the life expectancy he was given by his medical provider, but during that time he wrote an autobiography, graduated from college and law school, and practiced as an attorney for 30 years. He also became an advocate for polio vaccination, including through his TikTok account Polio Paul, where he shared details about his life and accomplishments, which is more than 300,000 followers before his death. Paul Alexander told his followers I wish I could hug every one of you and that that support makes me feel like there's somebody that really cares about me. Though Paul's death is so tragic, I'm glad we were able to remember the person that he was and celebrate the incredible life he lived. To give you a sense of who he was and what he did in this world. We've actually linked on our podcast website here, an article published in The Guardian on May 26th of 2020. The title of the article is The Man in the Iron Lung. It is simply a remarkable story. I urge all of you, all of you, please go and read this. If you ever needed a reason to understand why you are so fortunate when others like Paul Alexander, who suffered what he did, could in fact continue to live life with such gusto. It really is a uplifting, truly, truly special moment. So I hope you'll read this. And Paul, you are missed. Thank you so much for all you did for us and for showing us the quality of life as it is lived by someone like you.


Chris Dall: Mike, it's hard to believe it's been four years since the first episode of the Osterholm update aired on March 24th, 20 2013, days after the W.H.O. declared the novel coronavirus outbreak a global pandemic. Fortunately, we are in a much better place now than we were in those dark days. Over the last few weeks, we've been thinking a lot about how to commemorate this milestone, and ultimately, we've decided that this is a good time to take a peek behind the curtain and let our listeners in on how this podcast got started. Introduce them to the people who make up the podcast team, provide a glimpse into the research and production that goes into this effort, and explain how we think about the message we're trying to send with each episode. Today, we're starting off with a brief oral history on the origins of the Osterholm update. So, Mike, take it away.


Dr. Osterholm: Thanks, Chris, and for all the listeners of the podcast, this is a very, very special time for me to be able to share with you the podcast team experience and to have you become familiar with who the podcast team really is. Since the beginning of this podcast back in 2020, only one other person has ever been on it, the podcast with me, uh, and to talk about issues. And that was Doctor Jena, an intensivist here in the Twin Cities who provided us with some very stark and very important information on what was happening in our hospitals and providing us with lots of motivation to get vaccinated. Well, today we're going to actually start to meet the podcast team. This will occur over several interviews, and I have the very, very, very wonderful opportunity here to introduce to you the team that made all of this happen. Remember back in 2020, in the early days of the pandemic, uh, we were trying to get the world to understand that, in fact, a pandemic was upon us. In January 2020, I wrote a piece that was on the CIDRAP site that said, this is the pandemic. Get with it. Well, through the month of January and February, there was only limited information out there suggesting this was a pandemic. Many governments and even public health organizations tended to minimize what was happening. And then we had this very interesting, uh, opportunity, uh, we received an invitation from the Joe Rogan, uh, production team to have me come on and talk about COVID and what was happening at the time.


Dr. Osterholm: Well, my first reaction was, Who's Joe Rogan? What's this podcast stuff about? And it was the two of our podcast team members that are here with us today that looked at me, uh, with, uh, you know, 50 years of age difference between us and like, what's wrong with you? You should know this. And I said, look, it. I'm putting my professional and personal life in your hands. If you think this is good, if this is something that can be important in getting information out, then let's do it. And it was on March 10th of 2020 that, uh, I was on the Joe Rogan Podcast in Los Angeles. Uh, one of our members you'll hear from today, Cory Anderson went with me, uh, to that, uh, interview. And it turned out to be a remarkable experience, uh, with the fact that, you know, Mr. Rogan gave me every opportunity to put the information out there that I, uh, thought was really important around the coronaviruses and what was happening. But more specifically, what really blew me away is in the next two days, there were 10.5 million downloads of that interview. And I thought to myself, oh my, this is really a public health message on a whole new level. So having said that, I came back to Minnesota, had the discussion with the two CIDRAP staff, people who you're going to hear from today.


Dr. Osterholm: And then the third one, Chris Dall, who you all know very well, got in on it and we decided to actually, uh, have a podcast done by our group on COVID on a once a week basis. And so today it's my real honor to introduce to you, Cory Anderson, the energizing force behind getting me to Joe Rogan and Maya Peters, who, uh, was our technical guru, who helped me understand also how important these podcasts could be, as well as providing the engineering framework to put these together, uh, to edit them. And then, of course, Chris Dall, who was at that time, uh, part of our CIDRAP news team and still is, but took on the additional duties of actually moderating these podcasts. Chris comes from a background in radio, and he was the perfect man for that. So first of all, let me just say to the three of you, welcome. This is a very, very special day for me. I would start out by asking each of you to, if you could just spend a couple of minutes explaining who you are, I'm going to start out with you first, Chris, uh, as kind of the senior member of the group here and someone who, uh, took on the duties as the, uh, podcast interviewer, as someone who really had a lot to do with helping to shape the information we shared. So. So, Chris, who is Chris Dall?


Chris Dall: Well. Thanks, Mike. Um, so I am a reporter for CIDRAP news, and I have been a reporter for CIDRAP news since 2016. And I came to CIDRAP news, uh, to write about antibiotic resistance. And that was what I have continued to do, uh, during the time I have been at CIDRAP. I believe it was Maya who came to me in 2020 to discuss the idea of hosting a podcast about COVID-19 with Mike. And, you know, there was talked about they knew I had a background in public radio. Um, what I didn't mention is I had never done any behind the mic work in public radio. I'd always I'd been a producer at Minnesota Public Radio, always behind the scenes, uh, you know, uh, finding people to be on talk shows and writing scripts. But I'd never done any behind the microphone work. But, uh, you know, I just acted like I had and, uh, said I would, uh, love to give it a try. And when I had been in public radio, I had never really had any interest in being behind the microphone. But I guess maybe there was a little bit of it because I responded positively to the idea, and I was excited to, uh, to be to be a part of it.


Dr. Osterholm: Thanks, Chris. And a big part you are. Well, let me move to Cory. Cory, at the time, you were a graduate student at the University of Minnesota here I was your advisor. Uh, and, uh, it was hardly anything related to, uh, the issue of a coronavirus. It was about chronic wasting disease. But you were such an energetic source of activity around this podcast, and, uh, helped me so much in gathering the kind of information that we share with this audience on a weekly and now bi weekly basis. So who is Cory Anderson and how did you ever get tangled up with this mess?


Dr. Anderson: Well start out by saying that this is a new experience for me. On being behind the mic as Chris is uh, often I'm usually more writing reports. So this is, uh, a little change of pace here. You already mentioned I was a graduate student at the time, and I would say, uh, I was just gotten into the PhD program. University of Minnesota again, you were my advisor. And I think if I had one word to describe it, um, that whole experience was a journey. Um, and it still is a journey. So, yeah, we we went from I think I started in the world of influenza, um, through a series of unfortunate events, got into chronic wasting disease, which was the topic of my master's project I previously completed. And then, of course, when COVID emerged again through a series of unfortunate events, uh, and strange happenings, you got the invitation to to go on Joe Rogan's podcast. I had obviously heard of Joe Rogan knew that he had a pretty significant platform, and I think I probably camped outside of your office trying to to pitch to you why you should do it. Absolutely. And luckily you took my word for it. And I think from there, as as you already mentioned and as Chris talked about, I think Maya and I, a week or two later in the lovely halls of the Mayo building right outside of your office, said we should start a podcast. So, um, that is the origin story as I know it. But yeah, it's it's been a journey and a fun journey at that.


Dr. Osterholm: Well, thank you very much, Cory. You have been obviously critical. And then there was Maya, for which without her expertise from a production standpoint, from a topic selection standpoint and just overall encouragement, I'm not sure we would have gone forward with this. So Maya Peters, who are you and how did you get tangled up in this mess?


Maya Peters: Fun to be back here with you guys. Um, so at the time, in 2020, I was a program analyst, I believe, at CIDRAP, and I had been at CIDRAP for about a year and a half, um, working to just help, um, management of the different research projects we had going on. Um, never had done anything with podcast production or anything like that. I just kind of liked figuring out how things work. And, um, yeah, I have a lot of the same memories of lots of discussions with Cory and my office, like, sort of plotting how we could get you interested in doing a podcast, Mike, and talking a lot about Joe Rogan, which like, even to this day, I can't believe that really happened. It was kind of a pipe dream for a while. Um, and then, yeah, just such a weird time. And I just remember once we figured out we wanted to do this podcast and thinking it would be a great sort of format for you to share your expertise. And Mike, I think we also knew right away we wanted Chris to be the host because he just has that great voice. And yeah, it was like a chaotic but fun time, scary time, all the things. So yeah.


Dr. Osterholm: So, Chris, what was the, uh, moments that you most remember in the podcast? If there are any, uh, after this many, uh, editions of the podcast, I'm sure they all blur together. But, uh, did you have any ones that stuck out in particular?


Chris Dall: Well, I think just it's interesting looking back on those first few months of the podcast and the early episodes is, you know, we have developed a real system around the podcast now where we have we have a meeting before each episode, we talk about the topics we're going to discuss. We talk about, uh, some I try and formulate some questions and we decide who's going to research what topic. The early episodes were not like that at all. It was I mean, we were, uh, as the saying goes, we were kind of, um, flying the airplane while we were trying to build it. And it was it was really messy. And it's interesting to see how we've kind of developed a system, uh, along the way to really kind of get the best information out. And so that's, that's kind of what sticks out to me the most. And I guess the other thing is that, um, you know, Mike, you like to talk. And I think what one of the things that I've tried to do, uh, over this podcast is frame the conversation that's been my role is trying to frame the conversation every episode and try and interject here and there so people hear a different voice. Uh, and I think that's been kind of an important, uh, part of, of this process is us, uh, the balancing act between you and me.


Dr. Osterholm: And I think you said that very well. I would agree. You have made me sound a lot better than I really am. You know, just as a note, I want to add here that this has been an evolution. You know, the first podcasts were actually really factual and basis. There was very little personal energy, personal sharing in those podcasts. And I can remember exactly the day, April 16th, 2020, when my very dear, dear friend Alan Kind, an infectious disease physician here in Minnesota, died. And I had just been with him just before that. And it was a very emotional time. And he was everything that was both, uh, wonderful about a brilliant professional, but a man with a heart as large as the mountains. And I was so moved by his death that I dedicated the podcast to him. And it was the first time I had ever dedicated a podcast or talked about personal issues. And I think that was the beginning of realizing this podcast was talking not just about the science, but talking about the lives we were living at the time in the pandemic. And I think you've helped me.


Dr. Osterholm: And this. Has the team been able to elaborate on that? How do you find the balance between what's the personal side of it and what is the professional side of it? So, Cory, if I could ask you what what moments stick out for you? And I know you probably had a lot uh, I will just say, first of all, uh, because Cory will never say this, but so in the first time I did Joe Rogan twice, he came with me both times. But the first time we were there in LA, uh, we were at Joe's, uh, you might call it large, large building, uh, for which he had all of his toys and tools and everything. And, uh, being the hunter, he was. And Cory is a hunter. After we got done, they went off and got into this long discussion about hunting, and he showed Cory around the place like, you know, he was a VIP. And, uh, it was a pretty interesting experience for me to watch Cory, uh, that experience. So but, uh, what's your experience of with the podcast?


Dr. Anderson: Where do I begin? Is the question. Um, I mean, just in reflecting back on the the first Joe Rogan appearance, as you mentioned, I was fortunate enough to tag along. I think, you know, when you got the invitation to do it, I remember, you know, being, I guess, of my age group. I know a lot of people who are very familiar with Joe Rogan. I knew he had a podcast in a very big platform. Um, and I also knew when you had the opportunity that he sort of takes the approach of long form conversations. And at that same time, I was a teaching assistant in your class and was hearing you talk about, again, this mysterious disease that emerged, um, and what it might mean for quite a long time, uh, with the extended class time. And so as soon as you got the opportunity, I said, this is, you know, a perfect venue to share, um, nuanced, in-depth conversation, uh, information just around this disease. Because, again, back then, it was confusing, to say the least. Um, but I do remember one thing that sticks out the most is, I think when we finally convinced you, um, that it was worth going on, worth taking the trip to LA. I remember the the switch flipped where you said, can you give me some more information on Joe Rogan? What? What type of questions will I be asked? And the only familiarity I have with Joe Rogan's podcast is that there is no simple answer to that question.


Dr. Anderson: So I said, how do I even begin prepping Mike for a Joe Rogan appearance? Because, again, not having listened to it all that often, I do know that his conversations can cover plenty of ground, for better or for worse. Um, and so, yeah, we I tried to prep you as well as I could and putting together reports, gathering information, but I think all that went out the window when we were talking about COVID and saunas within 30 minutes. And I do remember after that conversation with the, uh, the hunting conversation with Joe, I think we got in the vehicle to go back to the airport. And I remember we both sat down and there was a pause, and I think you turned around and said, I don't know what I said or what happened. Was it good? And I said, I think it was pretty good. And as you mentioned, the the popularity and the number of views that the video or the podcast got in the days after, I think solidified that. But yeah, it was covered a lot of ground in that regard.


Dr. Osterholm: Well, yeah, I think you shared that experience quite well. So, Maya, from your perspective, you're the one that also was very encouraging to do this and you kept reassuring me, no worries. We can handle the technology. We can do this. We know how to do this. So what was your experience like with this podcast?


Maya Peters: Yeah. Um, I'm glad that I came off confident to you, but there were many like late nights trying to edit the podcast and trying to figure something out and like, frantically texting each other. Um, so yeah, like kind of what I said before was a fun, sort of chaotic time. Um, so I just remember that especially at the beginning and then, um, just thinking about some of my favorite parts and memories or, um, like you're putting out the podcast and you see the numbers and, you know, people are listening to it. But I was just remembering when we did our first, um, live episode. That was super fun. I think that also took some convincing for you to do, Mike, but I loved that, like real time seeing the questions come in and seeing how many people were there with us. And then also, I got to see a lot of the emails that came in from listeners. And just like you said, sort of the balance of the facts and the personal having people really like relate to or grab on to certain things, certain stories you would tell Mike. Um, and seeing them send that an email was really cool. Um, so yeah, I guess the piece is where we got to sort of see the, um, the real impact with real people were cool to me.


Dr. Osterholm: Well, to all the listeners of this podcast out there, just know that you've heard from three of the most critical voices that helped make this podcast even happen. And it was with your support, your encouragement, your wisdom. Sometimes you probably had to be a little tough on me just to get me to focus on something. But I did listen, and I came to have such respect for you and such appreciation. And, you know, I've said this before for all the things that go right on the podcast, this is a reflection of the team. And the three of you are very key piece of that for the things that go wrong, those usually are all mine. Okay. I, uh, you know, put my foot in my mouth or I didn't quite understand, uh, what I should have said or could have said that would have been more helpful. So I just want all the listeners out there to know that, uh, uh, you know, you hear this voice, but now you actually heard three more voices today who have been very, very critical of this. So I want to thank you very, very much, and I look forward to our next interview will be with another group of individuals who kind of are in the intermediate period of the podcast in those years of 2021, 2022 and, uh, how they have, uh, continued to play a role in the podcast. So, uh, next podcast, we'll have another set of interviews that I look forward to. So again, thanks, Chris. Cory. Maya, I really appreciate you more than I can put into words. Thank you.


Chris Dall: We hope you enjoyed that brief oral history on the origins of this podcast. Stay tuned for more on our next episode when you'll hear from the producers of the podcast. Mike, what are your take home messages for today?


Dr. Osterholm: Well, Chris, I have a number of them. You know, I try to keep it at three as a way to really highlight the priority issues of the podcast. But I have to say, I have actually four priorities that I want to cover today. Number one, we're improving. We are definitely improving in the COVID world. But still, vaccines, Paxlovid are critical tools that we have to use, and prevention still really focuses on respiratory protection for those who are at highest risk of serious illness, hospitalizations and deaths. As you saw in the Pew Research data, we still have big holes in vaccination among those who are at highest risk for serious illness. I wish we could do more there. I think we could bring these numbers down substantially. Number two, we are struggling with risk and those at highest risk. Make no mistake about it. For those who are at increased risk for serious illness, I understand. I appreciate your concern about what do you do to protect yourself. It would be great if the rest of the world would help. But as you also saw from the Pew Research data, the world has moved on. And no matter what recommendations we make, no matter what we ask people to do, they've moved on. And so it doesn't mean we don't keep asking. But at this point, those at highest risk can do so much to protect themselves. And that's what we need to keep working on. Number three measles. This is a bad, bad disease, and it's one that none of us should have to experience.


Dr. Osterholm: But we also have a lot of questions today in a world of what we call measles elimination in this country, what are our programs based on? What do we know about the protection of vaccine? It's an interesting situation. I'm actually putting forward the concept that rather than a vaccine, which is at 95% efficacy or protection, as it has been stated for decades, which is incredible. It's the highest we have for any vaccine. I'm actually saying maybe it's working better than that, because I can't understand why we're not seeing more infections in those cohorts each year of kids born who are vaccinated, but in the 5% that don't get protected. So stay tuned. We've got more to talk about with measles. And finally, with number four, I just want to remind everyone that next podcast, we will actually be posting a survey on our podcast website asking you for your feedback about where do these podcasts go in the future? What should they look like? How should they be structured? Should they even occur? Maybe you're all done with them and ready to say move on the piece of history. We hope that you will take the time to provide us that feedback. We obviously don't want to go to all the effort to do a podcast if they're not helpful. Uh, if they could be more helpful, then we want to do that. So we look forward to getting your feedback on the survey.


Chris Dall: And do you have a closing song for today?


Dr. Osterholm: What would a podcast be without a closing, huh? So often when we come to this final closing, either a song or a poem or something, it's clear that we are human in that we like to go where we've been before, when it feels comfortable. And this is just the case here. I picked a song today that really, I hope, reflects the message of who we all are and what we're doing, but it's one that now has taken the lead in the most number of times previously used. We had two songs that had been used five times each last week. In fact, He Ain't Heavy. The song that I closed with Last Time by The Hollies, and then A Letter to You, a song by Bruce Springsteen and the song we're using today, has been used seven times previously on May 6th of 2021, in Episode 54: Vaccines and Taking Care of Friends. On August 19th, 2021, in Episode 65: An Ongoing Tug of War. On December 9th of 2021, in Episode 81: The Early Data on Omicron. On March 31st, 2022, in Episode 97: This virus Isn't Done With Us. On July 8th, 2022, in Episode 108: Living with COVID, and on September 9th, 2022, in Episode 144: A Three Act Play and most recently on March 23rd, 2023. A year ago in Episode 127: A Tough Two Weeks, and we chose this song for this episode.


Dr. Osterholm: In light of all the support that you as a podcast family had shared with me during my COVID infection at that time. So what song is it? Well, it is Friends by Elton John. As you know, friends is a song written by English musician Elton John and songwriter Bernie Taupin, and performed by John. It was his third US hit and his second to reach the top 40 after his breakthrough success of Your Song. The song rose to number 34 on the US Billboard Hot 100 and number 17 on the Cash Box Top 100. On the Canadian Singles Chart, friends peaked at number 13. It was actually released on March 10th, 1971. My Birthday. It's a song that speaks to what I think all of us on this podcast so desperately want and need, and that is friends. So here it is Elton John and Bernie Taupin. Friends, I hope the day will be a lighter highway for friends are found in every road. Can you ever think of any better way for the lost and weary travelers to go. Making friends for the world to see. Let the people know you got what you need. With the friend at hand. You will see the light. If your friends are there then everything's all right.


Dr. Osterholm: It seems to me a crime that we should age. These fragile times should never slip us by. A time you never can or shall erase. As friends together watch their childhood fly. Making friends for the world to see. Let the people know you got what you need. With a friend at hand you will see the light. If your friends are there then everything's all right. Making friends for the world to see. Let the people know you got what you need. With a friend at hand you will see the light. If your friends are there then everything's all right. Thank you again for being with us for another podcast and hopefully it will be helpful to you. Again, I remind all of you out there that as much as we talk about numbers today and we did, uh, these are people close to us, many of them people who have been seriously ill, hospitalized, or even died. Like you. I can never forget those in my life who have been part of these numbers. And I just close with the same thought that I do so often, and follow up to actually the closing song today, be kind, be kind, Reach out to others. And this is a time when we need this more than ever. Thank you. Be safe. Be kind.


Chris Dall: 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 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 Sydney Redepenning, Elise Holmes, Cory Anderson, Angela Ulrich, Meredith Arpey, Clare Stoddart, and Leah Moat.