Episode 155: Brighter Days Ahead

Chris Dall: Hello and welcome to the Osterholm Update, a podcast on COVID-19 and other infectious diseases with Doctor Michael Osterholm. Doctor 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, Doctor 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, Senator Bernie Sanders of Vermont introduced a draft of proposed legislation that would earmark 1 billion per year over ten years for long COVID research and create a centralized, long COVID research coordinating body within the National Institutes of Health. Congress must act now to ensure a treatment is found for this terrible disease that affects millions of Americans and their families, Sanders said. Far too many patients with long COVID have struggled to get their symptoms taken seriously. As with all things that happen in Washington, it could be a while before this proposal becomes law, but it's a sign at least that long COVID is being taken seriously by our nation's policymakers. On this April 18th episode of the podcast, we're going to talk about that proposal and the latest long COVID news and research after we examine the latest data on COVID-19 here in the United States and elsewhere. We'll also provide an update on measles in the US, examine the ongoing avian influenza outbreak, discuss a recent New York Times article that reexamines how countries fared during the COVID pandemic, and fill you in on the results of the survey. We asked our listeners to fill out, and we'll bring you the latest installment of This Week in Public Health history, along with our third segment marking the four year anniversary of the podcast. But before we get started, as always, we'll begin with Doctor Osterholm opening comments and dedication.

Dr. Osterholm: Thanks, Chris, and welcome back to all of the podcast family. We so appreciate having you with us. Uh, by chance, this is your first time on the podcast. I hope that we provide you with the kind of information you're looking for that is helpful to you. In that light, I want to thank all those who have filled out the survey. We'll be talking more about that in a moment. But your feedback has been so important to us, and we really did receive some very thoughtful, wonderfully helpful feedback, uh, relative to what this podcast should be all about. And so I just want to thank you very, very much for that. This episode marks a very meaningful anniversary to me. It was four years ago on episode five where I began this dedication segment. I dedicated that episode to a very, very dear friend of mine, Doctor Allen Kind, who had recently passed away. Allen was, by every description of the word, a wonderful man. He was a physician who ended up becoming a physician to a lot of other physicians, which tells you about the ability he had as a clinician. But more importantly, just as his last name indicated, he was a very kind, kind man, and I was moved by the fact that he had just died and without really planning on it, had added that dedication at the beginning of episode five. And it made me realize when I did that, that all the episodes should have that kind of connection back to the people that we all love and care about, and not just the science and the facts and and the strategies as such.

Dr. Osterholm: It should be both. And so, Allen, thank you. Your influence in this world continues. And to your family I again say, thank you so much for sharing, Allen with us all those years, and I hope that his influence on this podcast has been one of the reasons why a number of you may actually come back to us every other week. Since that first dedication, we've dedicated episodes to a lot of really remarkable and wonderful individuals and groups of people today. I thought it would be fun and actually meaningful to dedicate this episode to a hero of mine. Iowa basketball legend Caitlin Clark, a 22 year old young woman who demonstrates such poise and thoughtfulness well beyond what her 22 years should give her credit for. Even if you're not a fan of basketball, you've probably heard of Caitlin, who has become a household name after leading the Iowa Hawkeyes to back to back national championship games. She's racked up an impressive list of records and accomplishments, including the NCAA Division one all time scoring record, the NCAA tournament three point and scoring career record, and twice awarded title of National Player of the year. Among Caitlin's accomplishments is the fact that she brought such excitement to women's sports as a whole.

Dr. Osterholm: The spotlight that she's helped shine in women's basketball has led to higher viewership, greater investment, and increased recognition of the incredible talent that has always existed in the women's game. And as you also have likely heard this past week, she was drafted first in the WNBA draft, now going to play with the Indiana Fever. I know I will be eager to follow her career there, and I don't think it's just the impressive shots. Anyone who has seen her shoot that one from 35ft out, no, that's impressive. Or the broken records that make Caitlin so inspiring. The real reasons why I think we're all so excited about her as an athlete are the joys that she shows for the game her dedication to self-improvement, her commitment to teamwork, and her humility. It's seen how much her confidence and passion inspire young athletes to play fearlessly like her, and hearing the way her coaches and teammates say she motivates them to reach new levels of success. There is nothing that warmed my heart more than after a major game, watching her sign autographs for so many young girls who all had signs saying, I want to be like Caitlin, we need more people like Caitlin in all facets of our communities who uplift others, who inspire excellence and at the same time is humble and kind. When you watch her on Saturday Night Live last week, you saw a woman was so poised.

Dr. Osterholm: But what impressed me was she made sure her teammates came with her to that show, and the fact that she still continues to give credit for having broken open the door on the WNBA by a number of previous stars, that made it possible for her to be where she's at. Caitlin. Thank you. We all at CIDRAP dedicate this podcast to you. Now again, you know, I'm in a pretty darn good mood. Uh, as we look at that whole sunlight situation, here we are in April 18th today in Minneapolis. The sun rises at 6:22. Sunset is 8:03, 13 hours, 40 minutes and 49 seconds of sunlight. I can feel it. Today we will gain a two minutes and 57 seconds of additional sunlight, and those increases will continue right up through the June 20th. And so between now and then, we're in a really wonderful ride now. To our dear colleagues in Auckland, New Zealand, particularly those with the Occidental Belgian Beer House on Vulcan Lane. You're still seeing a lot of sunlight. But yes, it's true. Your days are getting a little darker today. Sunrise is at 6:49, sunset is at 5:49, ten hours, 59 minutes and 41 seconds of sunlight. You're losing sunlight at two minutes and nine seconds a day. But as I said, as it gets darker there and lighter here, we are very, very happy however we can to share with you the beauty and the warmth of that sunlight.

Chris Dall: So let's start with the latest COVID data, as sparse as it may be. Mike, what are you seeing here in the United States and elsewhere around the world?

Dr. Osterholm: Chris. As anyone who has followed this podcast know, we always lead at the top of the show with the information on the current status of COVID. And I always remind us at the time whether they're getting to be darker numbers, lighter numbers, they all still represent people in our communities, people who we love, people who we know, people who we care about. And today, I just want to remind us all because I'm about to say things are looking a lot better, but I don't want for a moment anyone to take that as meaning we're done. In the US, apart from declining activity, there isn't a whole lot to report. And when it comes to COVID, which of course is a good thing, wastewater levels nationally have continued to fall, reaching the lowest levels recorded since this past July. In terms of hospitalization, it's a similar story. We've now reached 13 consecutive weeks with declines, and in that span, the number of Americans hospitalized with COVID has gone from just over 30,000 to less than 6600 as of the week ending April 6th. So we're getting closer and closer to that. Record low of 5400 Americans hospitalized last July. I believe we will hit that within the next several weeks, and I can only hope we continue to drive it down. And finally, COVID deaths have also decreased, going from more than 2500 a week in January to 961 a week in mid-March, which is the latest we have for complete data that officially ends our streak of 29 straight weeks where COVID deaths topped a thousand.

Dr. Osterholm: So at least things are improving in that regard, too. Still, that's 961 Americans lost in a single week to this virus, and so I'd surely like to see more improvements with this area. But I do believe this is happening. I also just want to add perspective. We all are trying to wrestle with risk. And what does it mean and how does it relate to COVID in our everyday lives? On an average week right now in the United States, about 890 individuals are killed in automobile accidents, close to the number that we're now seeing for COVID deaths. I think within the next month, we'll actually see COVID deaths drop even further below that of the automobile accident number. Now, that doesn't minimize these deaths. That's not what this point is about, but it's to help us individually gain some sense of how do we live our lives. Do we get in cars? Are we fearful of getting in cars because of automobile accidents? Um, how should we live our lives with COVID? If you're an individual at increased risk for serious illness, hospitalization, or death, if you've got your most recent vaccine dose within the last 2 to 3 months, no matter what age you are, you still have some pretty darn good protection against serious illness. And that's what we want to highlight today. Let's keep these numbers going down. But at the same time, knowing that we have to keep one eye open because we don't know what's around the corner.

Dr. Osterholm: And that leads me now to the variant issue. In terms of national variant trends, the CDC shows a slight rise in JN.1.13, with the weighted estimate clocking in at about 9% of the total sequences. Remember, we've said over and over again it may be a new variant that will make us go back and relook at where we're at with COVID independent sources. Tracking variants have also noted the rapid acceleration of JN.1.11.1, which was likely driven by an emerging sublineage, what we call CP2. That being said, the majority of cases nationally are still attributed to the JN.1, which has been around for a number of months due to the overall lower COVID activity and therefore sampling. There's only one CDC, HHS sector, which sequenced the minimum of 300 isolates to report their regional variant data, which closely resembles the national picture. Like we discussed last episode, it's unclear when and to what degree the variant soup with 30 mutations will change the downward trajectory we're in, but rest assured, we will be closely monitoring this issue. This is also true internationally. Based on this month's edition of the W.H.O. COVID Situation Report, which was published last Friday, JN.1 Remains on top of the variant picture, accounting for 95% of the sequenced samples. However, I might add that monitoring data globally for COVID continues to be a real major challenge.

Dr. Osterholm: According to the same W.H.O. report, just 42% of countries reported even a single case of COVID throughout the 28 day period of March, and only 17% reported a death. In fact, if you look at the reporting regionally, you can get a sense for how big these gaps are. For example, in Southeast Asia, five of ten countries are half of them reported a single death in March, and that was the highest percentage documented regionally. Elsewhere, it was even lower Europe. 22 of 61 countries reported a single death in March. In the Americas, six of 56 countries reported a single death. The Western Pacific. Four of 35 countries reported a single death in the eastern. Mediterranean region. Two of 22 countries reported a death, and in Africa there were no reported deaths in 50 different countries for the entire month of March. So I think you can see here that we, in fact, are in a situation where we don't really know what's going on internationally. However, I would say that it does reflect a much, much decreased risk of transmission and serious illness. Surely in the United States, that's what we're seeing now. This is good news. It is good news. And I think with that, we can hope that this continues this trend for some time. But as I said, I promise you, we will always sleep with one eye open and make sure that, you know, should there be any potential changes in this risk picture.

Chris Dall: So let's turn now to long COVID. Mike, before we get into the latest research, do you have any comment on the proposal from Senator Sanders? Again, we know how Washington works. This could be a long time before it becomes law. But does this idea of creating a centralized, long COVID research coordinating group within NIH make sense to you? Is that something that's needed?

Dr. Osterholm: Chris, I have to say that I was impressed with the proposal from Senator Sanders and frankly, I support it. The proposal was for $10 billion in long COVID research, 1 billion per year over ten years, which would be used to create a centralized, long COVID research group within the NIH. Their proposal also sought to establish new grant processes for clinical trials related to long COVID treatment, establish a long COVID Advisory Board consisting of scientists, health care providers and long COVID patients, and require the NIH to establish a long COVID database and finally require federal groups to provide continued long COVID education and support to patients, providers and the public. Now, 1st May say this is a lot of money. Why would we want to do that? We're over the hump of COVID. Not true. The most recent CDC national survey data estimates that 6.8% of all adults were experiencing long COVID as of late October 2023. That is over 17.6 million people. And to think about the impact that that has on the health of those individuals is surely a major issue. But think what it does to our economy. Think what it does to our economy and the workforce. So this investment of what would be $10 billion over ten years seems like a small price to pay for helping us understand and hopefully treat successfully long COVID patients.

Dr. Osterholm: While it is incredibly promising to see this as a priority at the federal level, I was really most excited by to see that the funding extends well into the future because we all know long COVID research is a marathon, not a sprint. I was also happy to see such a patient centered approach being taken with this proposal. Senator Sanders has requested input from the long COVID community, which includes patients, health care providers and research on how to strengthen this proposal even further. If you have been affected by long COVID and there is something you'd like to see included in this proposal, please email long COVID comments at helped Senate.gov to provide your feedback by April 23rd. I hope that we can see this legislation pass and as always, we will keep you updated as this progresses. Please know that we will continue to follow long COVID and each podcast. We will share with you some nuggets of what's happening in the scientific world or the political world with regard to COVID. We see you, we hear you, and we're with you.

Chris Dall: So there were two studies published last week on long COVID in the US and an article in the journal science. But a number of clinical trials aiming to get some answers on the cause of long COVID and some potential treatments. Mike, can you share some of the highlights?

Dr. Osterholm: Chris, it seems like every week there are more and more long COVID studies to cover, and this week is certainly no exception. I'm going to share some of the highlights from the two long COVID studies you mentioned. And also, of course, I just shared data from the CDC survey study for listeners interested in learning about these studies a bit more in depth. I'll also include a link to the CIDRAP news article about the studies, and a link to the science article in the episode description. The first study I want to cover was published in Critical Care Medicine in April 10th. The researchers conducting the study surveyed 156 individuals who had been hospitalized with severe COVID-19 to assess their health. One year later, these patients had spent an average of two months in the hospital and one month on a ventilator. Of the 156 study participants, 64% said that they had some type of persistent impairment. One year after their hospitalization, 57% reported a physical impairment, 49% respiratory, 24 psychiatric, 15% cognitive and 47% reported having more than one type of persistent impairment. 19% of respondents still needed supplemental oxygen, and only 60% of those previously employed had returned to work. In addition to COVID related problems, respondents said they were still affected by hospital acquired complications like bedsores and nerve damage. There were a few limitations to this study, though, that I must briefly address first.

Dr. Osterholm: Their sample size of 156 participants was really quite small. Additionally, the researchers did not compare those findings to those in a comparison group. This was important in that there could be a number of underlying health conditions here that would be no different than if someone was hospitalized for two months in the hospital, a month on the ventilator, but did not have COVID. So we really need that comparison group. Still, these findings echo what other studies have found previously, which is that long term complications among those who have experienced severe SARS-CoV-2 infections are unfortunately all too common. The second study I want to discuss is one that was published in Jama on April 10th. The researchers that conducted this study analyzed data from over 1.1 million veterans, nearly 190,000 of them of whom were diagnosed with COVID, sometimes between March 1st, 2020 and April 30th, 2021, and over 940,000 of whom were not diagnosed with COVID. During that same time frame, the researchers found that those who had COVID had three times greater risk of potentially preventable hospitalizations within 30 days of their acute infection and a 40% greater risk of potentially preventable hospitalizations with one year of their acute infection compared to those who did not have COVID. This study population consisted of 89% men and had an average age of 60.3 years, which significantly limits the generalizability of these findings. But this study, too, adds meaningful information to the growing body of evidence that SARS-CoV-2 infection can increase the risk for a number of adverse outcomes in the months following the acute infection.

Dr. Osterholm: In the previous question, I was asked about the legislation proposed by Senator Sanders, and I referred to the CDC study that had been conducted looking at the frequency of long COVID related activity in our communities. The researchers found that among US adults who had been infected with SARS-CoV-2, 3 in 10 have experienced long COVID, 1 in 10 currently have long COVID. This means, as I shared with you, that approximately 17.6 million Americans currently have long COVID. Among those 17.6 million people, 79% reporting having some activity limitations due to their long COVID and 25% reporting have a lot of activity limitations due to their long COVID. Similar to many other studies, they found that females and people with disabilities are more likely to have long COVID than males and people without disabilities, respectively. I know that the results of these studies may not seem particularly hopeful, but studies like these that help us understand the extent to which long COVID is impacting our society are critical for justifying the use of the large amounts of funding for long COVID research, including the $10 billion proposal from Senator Sanders. With that in mind, I'm happy to share that there are also a lot of promising clinical trials happening right now in the long COVID world.

Dr. Osterholm: As I mentioned a moment ago, many of these trials were highlighted in a recent science article, which we have linked in our episode discussion. Most of this research in these trials is based on the theory that viral persistence following SARS-CoV-2 infection is triggering a sustained immune response in patients, resulting in long COVID symptoms. Some of these trials will be targeting immune dysfunction, while others will be trying to directly target lingering virus in the body. For trials will be looking at Paxlovid and how it might be used. Another trial will be testing broad spectrum antivirals, which are used for HIV and different from Paxlovid, in that they don't require the targeted virus to be rapidly replicating. A trial out of the Massachusetts General Hospital, both enrolling pediatric long COVID patients and using a drug to prevent SARS-CoV-2 protein from entering the blood and other tissues, preventing symptoms from worsening. And then finally, another trial will treat patients with monoclonal antibodies to target and destroy lingering virus in the body. A treatment that proved highly effective in three long COVID patients last year. We should expect to see results from these trials later this year into 2025. I hope they can offer new insights into successful treatment regimens for long COVID, and finally, results in some answers for the millions of people who are suffering. These results cannot come soon enough.

Chris Dall: In a recent piece in The New York Times, writer David Wallace-wells examined some new data on how different countries fared during the pandemic, and the data he looks at puts the US performance in a different and much better light. Mike, what did you make of this piece?

Dr. Osterholm: Well, first of all, Chris, let me just say that, uh, I have truly appreciated the work of David Wallace-wells in The New York Times over the course of the pandemic. He is often highlighted critical issues with regard to the COVID pandemic that other journalists have not addressed. And I've always appreciated what I think is his science based approach. Now, what he was really talking about was the fact that when we look at measuring the impact that COVID has had on any one country and the people who obviously live in that country, it often comes down to raw numbers. How many people died, how many people were hospitalized, when in fact that is really a very, very crude way of understanding the true impact that COVID has had on these countries. For example, as he points out, one of the issues depends on how much COVID testing was being done. Countries with better disease surveillance tended to register more official COVID deaths, but less aggressive places registered far fewer deaths from it. So right there, if I actually had a response you could make the case was inadequate. I would actually have fewer deaths, but it made me look better. It made me look as if somehow, as a country, I did much better than that. Second of all, he points out that COVID deaths really were also all about the age structure of the country's population, because COVID was so much deadlier for the old and especially very old than for the young and middle aged.

Dr. Osterholm: And from that perspective, again, uh, you need to adjust on the age of the population to understand, was it really worse in that country, or was it just that they were the beneficiary of having a much younger population? And then finally, it really gets back to the issue of how much vaccine was available when. So don't tell me you had X number of doses, but they didn't arrive until the third year, versus how many had those doses in that first year that vaccine was available. So to really look at this in a much more comprehensive way, David used a document by The Economist that is available, and we will provide a link to you on the website for that. In that piece, the economists, researchers who have done a remarkable job actually have calculated what the real impact was in a country adjusting for all of those areas that I just talked about so that in fact, they could look at was it a function of age? Was it a function of recognition of cases and surveillance? Was it a function of availability of vaccine? And as he detailed and I quote, and though the public began to tune out as vaccinations spread across the wealthy world, this phase of mortality analysis gave rise to a number of different claims about the pandemic.

Dr. Osterholm: For instance, it allows you to see much more clearly the brutality of India's 2021 went from the beginning of April to the middle of June. Perhaps 2 million Indians died of COVID ten times the official number, and this study raised big questions about Sweden, which was initially derided as a reckless experiment and do nothing public health. And it appeared in this context, if not vindicated, then at least unfairly maligned, meaning that in fact, the Sweden ultimate outcome after four plus years of the pandemic looks very similar to what many of the countries in Europe also experienced and what The Economist's analysis really emphasized. And I quote when you control for demographic differences, the pandemic was bleakest, not in the rich countries of the Western hemisphere or the middle income ones in Eastern Europe. But in the poorest countries of the world, particularly across sub-Saharan Africa, just as one might have predicted in early 2020, the worst hit was Uganda, which registered a demographic adjusted mortality rate seven times that of the United States. The next hardest hit country in the economist table is Zambia, then Chad, Zimbabwe and Mozambique. Two more African countries follow Ethiopia and Malawi. Before the first non-African countries, Bahrain and Afghanistan, show up. Early in the pandemic, there was a lot of talk about the unusual light burden of COVID in the developing world, which was often ascribed to some combination of the age structure of the societies, which are very young overall, and what was taken to be a striking efficacy of low cost public health interventions.

Dr. Osterholm: In retrospect, it seems to have been more age driven, especially once a year or more, of the vaccines. Apartheid meant the poorest countries of the world suffered a much longer pandemic emergency than did the rich countries, they conclude. In the end, everyone got it. And probably the most important factor shaping national death totals was how many people were vaccinated before their first infection and how many weren't. The United States could have done much better on that test, given more Americans have died of COVID since the vaccine was made available to anyone who wanted them, then died to that point. But by some estimates, those vaccines also saved more than 3 million American lives. I think this analysis is really well done. I think it really goes to the heart of what really happened, and it reminds us that we are a one world issue when it comes to public health, and if we're going to be better prepared for the next pandemic, which could be the big one, one much worse than we had, we have to address these issues of why, in the low and middle income countries, we saw these incredible death rates and what we could do in every country to improve upon that outcome of the next pandemic.

Chris Dall: Now it's time for our ID query. And this week we're actually going to talk about the results of the survey we asked our listeners to fill out on our last episode. Mike, what was the verdict?

Dr. Osterholm: Well, first of all, as I noted in the opening, I want to thank all of you who responded back. We received hundreds and hundreds of responses and they have all been individually read, considered, and put into the mix of how we can improve on this podcast. So thank you, thank you, thank you. And I also want to encourage you, we'll leave the link to the survey up for another two weeks. And if you haven't yet responded please do. We would find that very, very helpful. In terms of the summary of what we found, 80% of you indicated that you like the every other week frequency of episode, so we will be sticking with that for the foreseeable future. 56% of you said you like the one hour long episodes, followed by 28% of you who said you'd prefer 45 minute long episodes. So we will continue to do our best to keep our episodes at or under one hour. 82% of you felt there was an appropriate bAllence between COVID and the non COVID information on the podcast. I'm glad to hear that because for me, much of the non COVID information is just as important as is the COVID. There wasn't any existing segments that a majority of listeners found. Not at all meaningful or helpful, so we won't be getting rid of any of our current segments for the time being, even for those of you who have to suffer through the sunlight segment.

Dr. Osterholm: But since 79% of you would like to see a regular review of journal articles, and 76% of you would like to see a regular long COVID segment, we will do our best to incorporate these into most of the future episodes. I'm happy to see that so many of you wanted to subscribe to some of our newsletters at CIDRAP. Remember, they're free! Our team is working on adding all of you to these lists, so if you indicated that you wanted to receive these newsletters, you should be starting to see these emails in your inbox soon if you haven't already. I wish we had the time to follow up with each of you individually to thank you for your kind words and constructive comments, but unfortunately, that was not possible due to the number of responses we received. Please know that even though we were not able to respond, we have read each and every one of your responses and we've taken your comments into consideration as we decide what this podcast will look like in the months ahead. As always, I personally and the entire podcast team cannot thank you enough for being part of this podcast family.

Chris Dall: So let's take a look now at some of that other non-COVID news. And there is a lot of it. On our last episode, we discussed the first few US cases of highly pathogenic avian influenza in dairy cows, and since then there have been more cases reported. So can you give us an update on where that outbreak stands, Mike. But also, do you feel like the agencies responsible for responding to this issue are doing enough?

Dr. Osterholm: Chris, I really wish I had a more clear and compelling update, but we're not getting much data out of the USDA. I'll dive into that more in just a second. But what I can tell you to date, and of course this will continue to change by the day. There are eight states that have reported cases of what has been called avian flu in dairy cows. I like to consider it H5N1 virus infection in dairy cows. These states include Idaho, Kansas, Michigan, New Mexico, North Carolina, Ohio, South Dakota and Texas, and there are at least 26 herds affected among these eight states. Other than the single case we reported in the last episode, there have been no additional human cases of H5N1 infection reported, whether they be conjunctivitis or otherwise. Now, beyond that brief picture, we don't know that much more. I understand why the USDA, in the mode that they come from, in terms of protecting the producers and the concern that there could be a substantial decrease in milk consumption if people believe that this is now a risk for transmission. And so therefore, any statements that are made need to be carefully crafted. But at the same time, we are trying to understand what the impact of this virus will be in mammals, which we now over 200 species have been infected. We know that a large number of bird populations have been infected, and we don't know what necessarily is happening in swine. As you know, this isn't the animal species that I'm most concerned about, as they both have receptor sites for human flu viruses and bird viruses, and often can be co-infected at the same time, resulting in a new and potentially much more dangerous virus emerging.

Dr. Osterholm: I wish we knew more about that. I wish we understood what is the mode of transmission in the dairy cattle? Is it really from milking? Meaning the contaminated milking equipment and the actual multiplication of the virus is in the udder, not a systemic infection? We don't know. It is going to take some time for us to get the kind of information that will give us the answers to the questions like how is the virus being transmitted, what farm animals are being infected, and how that might impact transmission to other farm animals or humans, and even to the extent to which milk pasteurization can be confirmed as an effective means to eliminating the risk of transmission of an influenza virus by a milk consumption. Remember, again, it would have to be an ingestion issue, not an aerosolization issue. And at this point, I think the data supports that. What we do know about pasteurization would mean that we would be able to eliminate any infectious doses of virus that might show up in the milk system. We'll keep you posted. At this point, I remain convinced that this virus poses only a very low risk to humans in terms of infection or of human to human transmission, and of course, from becoming a pandemic related flu virus. I can't say the same about in the wildlife kingdom that I think is going to continue to play out and may have very substantial impact on a number of animal species. We'll keep you posted. Stay tuned. This one's not done. But right now I don't see us at the edge of the cliff in terms of human disease.

Chris Dall: Now for an update on measles. Well, we haven't yet seen a major measles outbreak in the US. According to the CDC's latest update on April 12th, there have been 121 measles cases reported in the US since the beginning of the year, which is more than double the number reported in 2023. And it's only the middle of April. And the CDC is warning that the rapid rise in cases is threatening measles elimination status in the US. Mike, what do you make of what we're seeing with measles?

Dr. Osterholm: Well, Chris, listeners may remember in the episode before Last, we had a discussion about the looming questions I have about the ongoing situation with measles. Remember, if the vaccine is truly 95 or even 97% effective, why are we not seeing more cases in exposed vaccinated individuals? On top of the wave of cases emerging from the other vaccinated communities? Just to remind everyone what I'm talking about, let's look at what that means for a five year age cohort of children in this country. Each year, about 4 million children are born in this country. If every one of those children were vaccinated and 95% were then protected, that still results in 200,000 kids who would not have protection from the vaccine. It was 97% effective. It would mean 120,000 kids each year who were vaccinated would not be protected. Now, 95 and 97% is surely a gold standard outcome from a vaccine perspective. But what does that mean? In a five year period, those 200,000 children a year who would be unprotected at 95% vaccine efficacy would add up to 1 million children in five years, would be 600,000 children for the 97% effective vaccine. That's a lot of kids. Now, why are they not getting infected? Because we see very, very few of these.

Dr. Osterholm: I can only conclude that either the vaccine is much more effective than 97%, or there is still infection going on, but potentially at an asymptomatic level where we're not picking it up, meaning that the kids still get infected but are not evident with that infection. I don't know what the answer is there, but it surely gives me pause to believe that, in fact, there could be a much larger potential for measles transmission in countries like ours because of the combined not getting vaccinated or getting vaccinated with a vaccine that is 95 to 97% effective. So where are we at right now? The increase in volume of cases is surely concerning, especially as a former state epidemiologist. It's a real concern to me. And when will potential outbreaks begin to occur more frequently in our country? When will the pockets of children who are vaccinated but not yet protected become more common? Will that happen? It's not clear to me. We have not seen any signs of cases slowing down, and I fear we won't without a quick shift from reaction to prevention. The picture of measles in the U.K. is unfortunately much worse. There have now been over 4000 cases reported in 2024 alone. Obviously, this represents a much higher incidence rate, but we cannot assume the situation in the US doesn't have the potential to escalate.

Dr. Osterholm: Looking forward, I am concerned about our future with measles in the immediate term. I don't know from a seasonal standpoint what that means in terms of increased or decreased transmission of the virus. Historically, measles has occurred most frequently in the winter months, much like the other respiratory transmitted viruses. Will that have any impact now in the United States? I don't know, but as I said previously, I know less about measles now than I did a few years ago, and the questions just keep coming. One thing I do know is that measles outbreaks are absolutely preventable through vaccination campaigns. That's how the United States reached elimination status in the first place. We in public health have a duty to continue to educate communities, especially parents who have young children, and help them understand the importance of vaccination for their children, for their friends of their children, for the relatives of their children. And unfortunately, even in some cases for adult contacts were yet not protected from previous infection or vaccination. The measles scenario is clearly playing out globally. How it will impact us here in the United States, I think is still open to question.

Chris Dall: Now for this week in public health history. Mike, what are we commemorating on this episode?

Dr. Osterholm: For today's episode, we're connecting two events that monumentally changed the landscape of vaccination in the US and beyond. First, on April 12th, 1955, the Francis Report announced Jonas Salk's inactivated polio vaccine safe and effective for prevention of paralytic polio. This declaration represented the culmination of a multi-year, field based clinical trial, which enrolled over 1.8 million children to study participants. The groundbreaking findings meant that parents could have the opportunity to protect their children from the devastating outcomes associated with poliomyelitis. In the years after Salk's vaccine approval, massive vaccination campaigns led to dwindling US polio cases. The second feat I want to commemorate is the completion of the Human Genome Project, which was announced on April 14th, 2003. For those who may be unfamiliar, the Genome Project, which was an international initiative to sequence the human genome in its entirety along with several other organisms very commonly used as model organisms in scientific pursuits. The advancement of genomic research has been instrumental in understanding infectious and chronic diseases, plus developing more personalized approaches to medical treatment. But beyond that, the genome project represented a shift to increase transparency in biomedical research as data from ongoing work was made public. Daily work on the COVID-19 vaccination was greatly accelerated by cross-disciplinary collaboration, relationships and courage by the Genome Project. Together, these events paint the picture of a vaccine development that often goes unnoticed by the greater public. Innovation in this field continues to save hundreds of millions of lives, and these achievements are surely worthy of our recognition.

Chris Dall: And now it's time for another segment marking the four year anniversary of the podcast. On our last episode, you heard from the producers of the podcast. Today, you're going to hear from members of the team who dive into the data to help us and you, our listeners, understand what's going on with COVID and other infectious diseases. Mike, take it away.

Dr. Osterholm: We've really very much appreciated the opportunity to have you meet some of our podcast team members who are responsible for putting this podcast together and helping me sound a lot better than I really am, and two of the researchers that have joined the team later in the process, but who have made major contributions, or Clare and Leah. And we're so happy to have them with us. They are part of the Chronic Wasting Disease team working on the prion related disease, but we've been able to convince them to spend a little time with us on the podcast. So today you're going to meet both of them. So let's just start first with you, Clare. And if you could give the audience a little bit of a summary of your career and where you're at and what you're doing and why you ever thought of coming to CIDRAP?

Clare Stoddart: Sure. So as Mike mentioned, I am a scientific researcher part of the team addressing chronic wasting, disease spillover, contingency planning and preparedness. So there I conduct a lot of literature review that informs discussions we have with the experts included in working groups we assembled for this project. And following those conversations, I work on translating the topics and findings into actionable steps to better prepare for potential disease spillover. Early on working at CIDRAP, I became familiar with the podcast through talking with Cory, who listeners heard from a few weeks ago. Soon after, I started joining meetings and helping out with researching wherever the team needed me. I was drawn to this work, in part because it gave me the opportunity to stay up to date with a range of infectious disease topics and collaborate with people outside my immediate team at CIDRAP.

Dr. Osterholm: And Clare, what brought you to CIDRAP?

Clare Stoddart: I was always interested in infectious disease. Um, originally growing up, I would hear stories about my grandpa leading the clinical microbiology lab at the Mayo Clinic, and it was his data driven mentality that brought me to pursue a microbiology degree at the U of M, and eventually I started taking public health courses because I was interested and called to really the broader application of infectious disease research. So now I feel extremely fortunate to have found a niche here at CIDRAP, where my microbiology background helps inform my research pursuits and discussions of policy.

Dr. Osterholm: Great. So, Leah, the same question for you. Tell us a little bit about yourself and how did you get to CIDRAP?

Leah Moat: Sure. So I am the program manager for the chronic wasting disease. So lucky enough to get to work with Clare and Mike on the podcast and in that area. And I started working at CIDRAP last September. So I'm the newest member to join the podcast team, and I was glad to add that to my duties at CIDRAP. I'm interested, you know, also in the research and writing work of the podcast, and that's pretty different than my day to day work with chronic wasting disease. I, you know, was interested in public health in general because I was always someone who liked math and biological sciences, but I was also really interested in and equally passionate about social issues, you know, learning about different cultures, different languages, those sorts of things. And so I wanted to study and work in a field where I never had to choose between those two kind of curiosities. And I think public health is such an interdisciplinary field where not only are all of those interests relevant, but they're really needed in order to be successful. And an interesting story. Before I got to CIDRAP, I was working, um, at a in a global health fellowship with the CDC in the Guatemala field office. And when that fellowship was wrapping up and I told one of my coworkers in the Guatemala office that I had accepted the job with CIDRAP, I didn't, you know, expect him to necessarily have heard of a research center in Minnesota or anything like that. But he told me that he knew who Michael Osterholm was because he was a listener of the podcast. So it's a pretty cool, full circle moment to get to work on the podcast now.

Dr. Osterholm: Well, and we do so appreciate what both of you do on the podcast. I must say that you give me real hope in the future of public health, as I see individuals like you who are so conscious of the importance of information and how it's shared with the public and what that means. So it's a real honor and privilege to have you. So I'll start with you, Leah. What lessons would you say you've learned in participating in the podcast work, and how might that carry through to your other work that you do within CIDRAP, or anything else you do in the future?

Leah Moat: Well, one lesson that I've learned is the podcast is a group effort and everyone can draw on their different strengths, their backgrounds, their different work experiences, and the group really comes together to make a great product. But it takes everyone contributing and and good leadership and good research. Um, inputs into that. And so that's certainly applicable in the chronic wasting disease work that we do with CIDRAP. That's certainly a group effort not only within CIDRAP, but the experts that Claire was mentioning that we've assembled, you know, with, with other, um, academic institutes and federal agencies. So I think drawing on strengths of, of everyone, uh, in order to make a really cohesive, uh, work product has been great to be part of. And and to see the success of that has been neat.

Dr. Osterholm: Thank you. And what about you, Clare?

Clare Stoddart: I think one thing that I always try to keep in mind while researching for the podcast is that science is never fully complete. The field is constantly evolving as new discoveries are made and work continues to be done and published and made known to people outside of what is sometimes a very small community of researchers. Um, as the situation evolves with chronic wasting disease as well, we always have to be cognizant that what we're communicating is just what we know right now instead of the final, the final statement that we're making to the public. And it's important to maintain trust that way and just be honest and truthful about what we know at that time.

Dr. Osterholm: I think you, as audience listeners can sense from hearing from both of these two wonderful professionals just how important the idea of gathering the science information, but how it's also delivered in the end and what it's really all about. Before we go, I understand that you both have had some questions of me, and since you've been very kind to participate in this, I'll allow you that opportunity and hopefully I won't be embarrassed and actually can answer somewhat wisely. So I'll start with you, Leah.

Leah Moat: Great. Well, Mike, we all know that you've had a really remarkable career in the field of public health as an epidemiologist. But if you couldn't be an epidemiologist or if you had to go back and choose a very different career path, what would you do instead?

Dr. Osterholm: Well, you know, believe it or not, I was actually confronted with this when I was in my younger days in college. I actually did some work in Florida on the manatee and almost went into oceanography. But the whole appeal of infectious diseases, which went back to when I was in fifth and sixth grade, clearly won out. And so I decided not to go into oceanography and be part of that wonderful emergent environment of infectious diseases at the time. I'm so very glad I did, but oceanography be my fallback career if I had the opportunity. Thank you. How about you, Claire?

Clare Stoddart: Mike, I wanted to ask you, who was your biggest professional role model early in your career and who do you look up to now?

Dr. Osterholm: Well, as I've said many, many times, epidemiology of the team sport. And you referred to that today how many people it takes to make something happen. And so I've been blessed to have an entire village to keep me going and to keep me on the straight and narrow at a very, very early age. Ironically, the person that probably launched me into this career was not themselves a part of the public health world. Rather, it was Nana, the woman who was the boss to my father at a local newspaper and who was the subscriber to The New Yorker in that small Iowa farm town, and who gave me the opportunity to read Burton Roget's Annals of Medicine articles every time one came out in The New Yorker. And I knew in reading those when I was in sixth and seventh grade, I wanted to do what I do today. Since that time, I have to say, I've had many people who've invested themselves in major ways to help me in my career path, and I would surely leave people out if I tried to name them all. So rather than say a name or two, I'll just say thank you to all of you who made the difference between starting in my undergraduate work at Luther College in Iowa, on through the University of Minnesota, and then through my time at the Minnesota Department of Health, and again, coming back to the university full time. I can never thank all of you enough. And when I think of what a mentor is like, let me just give you one example. When I was in high school, my guidance counselor said to me, you know, I really don't think your college material. And that was so discouraging to me that I almost thought, well, maybe I shouldn't go to college.

Dr. Osterholm: But there was a college professor at Luther College, David Roseland, who I'd gotten to know when I was in high school and who one afternoon in May of my senior year in high school, sat me down in his front porch as I cried my heart out, saying, I don't know what I'm going to do. And he said, you're going to go to Luther College. Two days later, I was admitted into Luther with a financial package that, because of my financial restraints, couldn't otherwise ever imagine getting. Now, that wasn't science. That was all about just caring for someone. That was all about the human touch. And so I think those of the stories of mentors or of people who have had such an impact on my life, it wasn't about being the smartest person. It wasn't about being the most connected person or the most published person. It was a story about people who cared, people who extended themselves in ways that I can only hope that academia continues to do with kindness and humility. And really sharing the personal experience of life is every bit as important as being the smartest person in the world. I hope all of us hear that, and that's one of the reasons why I am so honored to work with the two of you. You are brilliant individuals, but you're also incredibly kind, incredibly thoughtful. You fit into the team at CIDRAP so very, very well. And thank you for that. And thank you for spending time with us. And to the audience, you now have a chance to get a little further understanding of what we do at CIDRAP in terms of the pulling the podcast together, and you can see the incredible teams that we have behind doing this. So thanks, Clare. Thanks, Leah.

Chris Dall: Stay tuned for more on our next episode when you'll hear from more members of our research team. I'd also like to take a moment to make a quick plug for the Superbugs new podcast, from our colleagues at CIDRAP's Antimicrobial Stewardship Team. Season four of the superbugs new podcast is now live. All four episodes and covers such topics as drug resistant Shigella, how antimicrobial resistance affects people with cystic fibrosis, and an episode that looks at antimicrobial resistance from a one health perspective. So please take a listen. You can find the Superbugs in You podcast on the CIDRAP website or wherever you get your podcasts. Mike, what are your take home messages for today?

Dr. Osterholm: Well, again, I have three major take home points. First of all, COVID and all respiratory infections right now are looking better and better every week in terms of their incidence in our communities. I think we have to celebrate this. This is surely, uh, the best place. I think we've been, uh, in almost a year. And I believe if the trend holds true within several months, we will be at the best we've been since the beginning of 2020. That is a very, very special consideration. Second of all, long COVID remains a public health priority. We can never forget that. And for those who have family, friends, colleagues who are suffering from it, realize that there is real efforts being made right now to understand why it occurs and what we can do to treat it, and we will stay on top of that with every podcast. Finally, as I've shared before, I still have questions about measles, why we're not seeing more transmission at this time in this country. With the number of people who are likely susceptible to the virus, I fear that that could change and we could see a major increase in cases. Or if we don't, we really have to understand why and what that means. Could we really have a vaccine that's almost 100% effective? Well, it's interesting to consider that. And finally, I do believe H5n1 will not be a major human pathogen of concern. I just don't think that's going to happen at this time. Any set of mutations could change that overnight, but I don't think right now it poses any more than a low risk to humans. But it's going to be very tough on mammals and birds, and that's going to continue. And we need to try to understand that and what that means for future flu activity, both in terms of the animals. But also would we then see a spillover into humans?

Chris Dall: And finally, what is our closing song for today?

Dr. Osterholm: Well, I have to chuckle at this one. Uh, as, uh, the podcast listeners know, if you listen to previous podcasts, several of the podcast team members, uh, specifically, uh, hit me up on my choice of songs and wanted to know when there would be another Taylor Swift song. Well, I don't consider necessarily that I'm a Swifty. I surely have great admiration for what Taylor Swift does. Uh, in some of our podcast team, they are definitely Swifties. And so today's closing song was chosen with the help of those members of the podcast team, including Syd and Elise, who were featured in our last episode two weeks ago, Clare and Leah, who were featured in today's episode, and Meredith, who you'll meet in the next episode in two weeks. These podcast team members have been discussing the use of a closing song from Taylor Swift for some time, so no better day to use one of her songs. And today, with her 11th studio album not including her rerecordings being released at 11 p.m. tonight, we've used a Taylor Swift song once before on this podcast, forever Winter on June 29th, 2023. In Episode 134: Good News in light of a dedication regarding mental health in that episode, this week, we've chosen her song Long Live, as it really captures the spirit of this episode's dedication to Caitlin Clark, who, by the way, happens to be a swiftae herself. Long live was written by Swift and was originally released as the 14th track of her third studio album, Speak Now, in 2010, and rereleased in 2023 on Speak Now.

Dr. Osterholm: Taylor's version. The original recording peaked at number 85in the Billboard Hot 100in the US, and Long Live: Taylor's Version peaked at 53. Swift stated that the song is about my band and my producer, and all the people who have helped me build this brick by brick, the fans, the people who I feel that we were all in this together. This song talks about the triumphant moment that we've had in the last several years. So in light of this incredible accomplishment and the magical impact of Caitlin Clark, here is long live. I said, remember this moment in the back of my mind, the time we stood with our shaking hands. The crowds in the stands went wild. You held your head like a hero on a history book page. It was the end of a decade, but the start of an age long lived. The walls we crashed through. How the kingdom light shine. Just for me and you I was screaming. Long live all the magic we've made. And bring on all the pretenders. One day we'll be remembered. Will you take a moment? Promise me this. That you'll stand by me forever. But if, God forbid, fate should step in and force us into a goodbye. If you have children someday when they point to the pictures, please tell them my name. Tell them how the crowds went wild. Tell them how I hope they shine. Long live the walls we crashed through.

Dr. Osterholm: I had the time of my life with you. And I was screaming. Long live all the magic we made. And bring on the pretenders I'm not afraid. Singing long live all the mountains we moved I had the time of my life. Fighting dragons with you. And long, long lived. The look on your face. And bring on all the pretenders. One day we will be remembered. Taylor Swift, thank you again for being with us this week. I hope we were able to provide you with the kind of information that you find useful and helpful. As I've said on each and every podcast, if there was ever a time to be kind, it's now. Our world just seems to get more and more mixed up and tragically in pain. And this is well beyond the world of COVID. But we also live in that world too. And so I hope that you can find it in your heart to be kind and find some way, some reason to do it and watch what it can do in return. So thank you for being with us again. I urge you to fill out the survey and submit that if you haven't, we look forward to your comments and just know that we're here. We're we're not leaving. The survey data that we've received has surely been reassuring that you still want something from us. And again, we'll try to do our best to make that something what you're looking for. So be kind and thank you so much.

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 CIDRAP.umn.edu. This podcast is supported in part by you, our listeners. If you would like to donate, please go to CIDRAP.umn.edu/support. The Osterholm Update is produced by Sydney Redepenning, Elise Holmes, Cory Anderson, Angela Ulrich, Meredith Arpey, Clare Stoddart, and Leah Moat.