Episode
175
Episode 175: Drinking From a Fire Hose: Are We Drowning?

In "Drinking From a Fire Hose: Are We Drowning?" Dr. Osterholm and Chris Dall discuss recent actions taken by the Trump administration, most notably the decision to leave the World Health Organization. Dr. Osterholm also shares his thoughts on the developing H5N1 crisis and provides an update on respiratory virus transmission in the U.S. and around the world.
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 Dahl, reporter for CIDRAP news, and I'm your host for these conversations. Welcome back, everyone, to another episode of the Osterholm Update podcast. When I initially wrote the intro script for this episode, my plan was to focus on the H5N1 outbreak in the United States, which, as our audience knows, is an issue we've been covering since the very beginning. But with the with the inauguration of President Trump on Monday and his administration's immediate release of an executive order calling for the United States to withdraw from the World Health Organization, it quickly became clear that we would have a new focus for this episode if the Trump administration follows through and does indeed withdraw from the WHO. What would that mean for the United States and the world? And how would it affect the ability to monitor and combat infectious disease outbreaks? Those are some of the questions we'll be asking on this January 23rd episode of the podcast, as we assess the Trump administration's public health moves in its first week in office. We'll also review the latest COVID, flu and RSV data and discuss the continuing H5N1 avian flu outbreak. And we'll bring you the latest installment of this week in public health history. But before we get started, we'll begin with Doctor Osterholm's opening comments and dedication.
Dr. Osterholm: Thanks, Chris. It's great to be with all of you again. I want to welcome back the podcast family to any of you who may be joining for the first time, I hope we're able to provide you with the kind of information you're looking for. And I also want to acknowledge the work of our podcast research team. Thank you for all you've put into this. As Chris noted, things are breaking literally by the minute right now. And so, we're going to try to give you as most updated information we can and put that into context of what it all means. Needless to say, we live in interesting times, challenging times, and in some cases very distressing times. Today we'll try to make sense of all of this. I will not promise you that we'll have all the answers, that's for sure. But we'll lay out what I see as the future challenges in public health with the new administration, with H5N1, and all the other aspects of what we cover on this podcast. So, stay tuned for that. But before we get into all of that, I want to talk today about something that has been obvious to everyone in this country over the course of the recent weeks. I want to dedicate this episode to the people affected by the recent wildfires in Los Angeles. I'm thinking especially of the first responders and of course, all the individuals who have lost their homes, businesses or community spaces. And finally, tragically, even those who have died. It has been shocking to see the extent of destruction caused by these fires.
Dr. Osterholm: I know the damage will be felt for years and years to come. These devastating reports of loss and grief coming out of L.A. echo the suffering from the many natural disasters in recent memory. In 2024 alone, NOAA reported $27 billion disasters, individual weather and climate disasters in the US, with at least $1 billion in damages. These costly disasters include winter storms, hurricanes, wildfires, tornadoes, droughts, flooding, tropical cyclones, and other severe weather events and caused at least 568 direct or indirect fatalities. The frequency and cost of such disasters are steadily increasing. Human caused climate change is driving the increase in frequency and intensity of extreme weather, and population growth is also contributing to the cost and death toll. Beyond the dollar signs and statistics is the harsh human reality that an increasing number of people around the world are becoming vulnerable to severe natural disasters. There will be the immediate consequences lost homes, damaged property, disrupted services and loss of income, and there will also be some long-term consequences. Trauma and mental health challenges. Lingering health threats from inhaled smoke or contaminated water, and loss of a community that is so vital for well-being. Devastation from disasters such as the L.A. fires will linger in our populations for lifetimes. My heart, and that of all of the members of the of the podcast team here goes out to all of you who have suffered loss and grief from fires, floods, drought, storms and heat. Such events are sobering reminders of the importance of combating climate change, investing in resilient infrastructure, and taking disaster preparedness work seriously.
Dr. Osterholm: They're also reminders of the importance of building systems of community care. We need to look out for each other and extend generous compassion to those in need. As we move forward. In this episode, let's keep in mind the resilience of those facing these challenges and the urgent need for action to prevent and mitigate future disasters. Our work today is part of the larger effort to protect public health and ultimately to protect one another. Moving now from that little, somewhat difficult dedication, let's move into something that for many of you, you enjoy immensely. Others may find it even harder than the dedication light. Oh, that light issue. Today, January 23rd, in Minneapolis-Saint Paul. The sun will rise at 7:41AM. Will set at 5:08pm. That's nine hours and 27 minutes and 18 seconds of sunlight. Today we've gained two minutes and 13 seconds of sunlight, and we will continue to see the increase in sunlight occur right up through March 13th to the 25th, when at that point will be at three minutes and nine seconds of increasing sunlight each day. I can feel it. It's getting there. And for those of our dear, dear friends at the Occidental Belgian Beer House on Vulcan Lane in Auckland, New Zealand, your sunrise at 6:26AM and your sun set at 8:38PM. That's 14 hours, ten minutes and 17 seconds of sunlight. Unfortunately, you lost one minute and 41 seconds of sunlight, but you still got a bright, bright day ahead of you. Hopefully all of you will appreciate what the warmth of that sunlight can do in the days ahead.
Chris Dall: Mike. We should start by noting that the executive order to withdraw from the W.H.O. was not a complete surprise. This was a move President Trump made late in his first term. Quote, due to the organization's mishandling of the COVID-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adapt urgently needed reforms and its inability to demonstrate independence from the inappropriate political influence of W.H.O. member states. Unquote. So, there's a lot to cover here. But let's start with the question of logistics. Does this happen immediately, or is this a process that will take time? And then to the bigger questions, what does the US lose by leaving the W.H.O.? And on the flip side, what does that mean for the W.H.O.? The US government is one of the largest financial supporters of the organization. How much would the loss of that funding impact the organization's ability to do its job?
Dr. Osterholm: Chris, we have a lot to lot to unpack here, but let me start out by just reminding everyone of a statement that I made in a podcast prior to the election, in which I noted that famed late Maya Angelou once said that if someone tells you who they are, believe them. Well, in this case, we shouldn't be surprised by what's happened this week. In fact, Mr. Trump had signaled all along that we would be pulling out of the World Health Organization. But there's been much more that's happened since then. So let me try to walk through first the issues and then let me share with you. In addition, other actions that have occurred that I think also are very concerning and bear on what we might expect for the future. Let me begin by making it very clear that I do believe that pulling out of the W.H.O. will have devastating consequences, both here in the US and internationally. And let me also be very clear. I, for one who have worked extensively with W.H.O. over the years, find that it is an organization like many that can always be reformed, it can always be improved. And I'd be the first to say that. And we have pushed W.H.O. on a number of different issues, but at the same time, they have been the one single organization that has made it possible for many critical public health advances to take place.
Dr. Osterholm: Before I get into the question about logistics, let me just note the United States is required to give the W.H.O. a year's notice before withdrawing and is required to pay all outstanding bills to the organization. However, the way that that executive order is written implies that the Biden 2021 letter reversing Trump's decision to leave the W.H.O. is no longer valid, which would mean that the US is actually given over four years of notice. So, until there is more clarity on whether the argument will be legally accepted, it is unclear when the US will officially leave the organization. I'll talk more about the US leaving the W.H.O. means to the rest of the world in a moment. But for now, I'd like to focus on the consequences that this will have for the US. Contrary to what President Trump and his supporters believe, the United States benefits greatly from being part of the World Health Organization. The W.H.O. conducts extensive global health surveillance around the world, and this informs public health efforts in all countries, including the United States. Leaving the W.H.O. will dramatically reduce our ability to combat the next pandemic. And as listeners of this podcast know, there will be another pandemic at this point. Other benefits that we receive from being part of W.H.O. is we actually have boots on the ground in areas around the world, providing us with important information that otherwise likely would not occur.
Dr. Osterholm: What I mean by that is that we have an entire team of public health experts, many of them CDC employees who are actually stationed at the World Health Organization and work as part of that effort in that process? They are on the ground in many locations around the world, where otherwise we would not have the kind of information that we need to understand what the challenges are with public health. Also, we benefit immensely from other activities that the W.H.O. conducts. Twice a year, the World Health Organization hosts influenza experts at a meeting to determine what antigen should be included in the annual flu shot. Without that kind of information, we would not be in a position to update our flu vaccines as we need to do so. So, as we look at all these different issues, we see many benefits to the US. Remember, fighting measles in some low-income country around the world is also about fighting measles here in the United States. If we don't have cases entering this country from some parts of the world, then we benefit from that. I could go through a laundry list of activities over the course of recent decades that the W.H.O. has provided absolutely critical information in terms of stopping outbreaks on their tracks, where they occur, and not allowing them to spread around the world. Now, do we still have challenges about what happened with China and the issue of COVID? Yes, we do.
Dr. Osterholm: We know that. And W.H.O. didn't do everything we believe that it could or should have done to address the pandemic in the most effective way. But they did a lot right. They did a lot right. And now is not the time to take your ball and go home, because you didn't like the way a file got called. I think at this point, we really should be investing in trying to reform W.H.O. to be even a better organization than it has been. Now is not the time to leave. But our fate is before us. I can't imagine what it's going to be like. In my 50 years of public health, I've never experienced anything like this. To think that we would not be part of the World Health Organization now, in terms of what this does for the rest of the world. Let me also say that, you know, we have been a critical member of W.H.O. and therefore have helped the world achieve a better public health status in their country. It's often stated that we cover the most of the costs of the World Health Organization activities. We are important supporters. We cover about 18% of the organization's budget. Now, will the W.H.O. be able to function without us? Of course, it will be. And they are going to be looking for additional sources of support.
Dr. Osterholm: Will they be able to carry out the recent priority programs they've outlined? In fact, the agenda for the 2025 to 2028 time period outlines six strategic objectives for W.H.O.. First, to respond to climate change. Two to address health determinants and root causes of ill health in key policies across sectors. Number three, to advance the primary health care approach and essential health system capacities for universal health coverage. Four. To improve health service coverage and financial protection. To address inequity and gender inequalities. Five. To prevent, mitigate and prepare for risks to health from all hazards. And six. Finally, to rapidly detect and sustain an effective response to all health emergencies. Their ability to achieve these objectives in the face of such a major loss of funding and collaboration, will severely compromise the health of the world. Let me also say, it's been often suggested that somehow by us pulling out, countries like China will be punished. That's absolutely just the opposite. What's going to happen is in what we call public health diplomacy, we as a country have benefited immensely from doing the kind of basic public health work in many countries around the world providing safe water supplies, reducing vector borne diseases like mosquito related encephalitis cases, on and on and on. There have been many such public health activities that the United States is responsible for, and countries appreciate us for that.
Dr. Osterholm: This is not often seen as foreign aid, but in fact it is. It's the kind of thing that basically makes our country able to function even more effectively throughout the world than not. We won't be there anymore. And I am convinced that China and Russia will fill in behind us, and they will have the allegiance, the appreciation and the support of these countries. This, to me, is just shooting ourselves in the foot with regard to global public health diplomacy. So, in this sense, right now, we're going to all have to figure out what this is going to mean to public health. At this point, it's all speculation. We don't know how W.H.O. will actually respond to this and what that will mean. We don't know what other countries will actually consider in terms of how they interact with us on public health issues. At this point, I wish I could give you more information about what this means, and I can't, but we will stay on top of this 24/7 and as soon as we have more information to share with you, we will. And if at any time, any actions that citizens can take to help respond to this issue, we will make certain that you are aware of those. But for now, we're in a new historic period of public health practice in this world, and one that I must say saddens me greatly.
Chris Dall: So, Mike, you mentioned at the top of your answer there that there are other issues that you were concerned about that have occurred during this first week of the Trump administration. As I think most of our listeners know, there were a slew of executive orders issued. So, what were some of the things that you think could have a negative impact on public health?
Dr. Osterholm: Chris, there's several things that I think are really important right now in the first days of this administration. First of all, on Tuesday, the president fired the head of the TSA Coast Guard and began gutting key aviation safety advisory committees. This is just one example of what's happening right now in agencies throughout the government. This is something that I had alluded to again in previous podcasts. We expected to see a number of government employees basically be removed from their positions, and the potential also to impact on key advisory groups to the federal government. The fact that the president actually eliminated all members of this key Aviation security advisory group is really, I think, a warning shot about what's going to happen with other advisory groups throughout government. Does this suggest some kind of outcome we might expect to see with the Advisory Committee on Immunization Practices or the ACIP? We don't know. Each day I think we're going to see another shoe drop. So right now, we're all looking at what does this mean for who is employed at a given agency, what their responsibilities are, and how will this impact on the many very critical advisory bodies to the federal government? Stay tuned on this one. In addition, another one that is surely challenging us, and I think we have to be careful not to overinterpret it. But on Tuesday night, The Washington Post broke a story about the fact that the Trump administration is pausing all public health agencies communications, citing a review. Now, what does that mean? Basically, they've instructed all federal health agencies within HHS to pause all external communications, such as health advisories, weekly scientific reports, updates to websites and social media posts, all the kinds of things that we count on organizations like the CDC, the FDA, and others to be able to provide us in times of crisis.
Dr. Osterholm: For example, if one looks just at the CDC, the pause on communications includes the MMWR, the Morbidity Mortality Weekly Report. It also includes all advisories sent out to clinicians on CDC's Health Alert Network about public health incidents. It includes all data updates to the CDC website and public health data releases from the National Center for Health Statistics. I can't even imagine what this all means yet. Now, maybe this will be very short lived and they just are looking to see what is being provided, but I don't see any reason why we would need to have a total pause in the sharing of information to accomplish that. So, in two weeks, we're going to have more updated information for you. And I hope by that time that this pause has been lifted. If not, this puts us in serious jeopardy in responding, as public health agencies to what we know will be the emerging crisis of the day, of the week, of the month. I can't imagine having a situation where the CDC, the FDA and others cannot respond. This will be absolutely tragic and people will lose their lives because of it. So, stay tuned on that one. We will see what in fact happens with it. But I can tell you right now, this is by far one of the most stunning announcements I've ever seen in all of public health history.
Chris Dall: Mike, are there any updates on Robert Kennedy Jr. and the Trump administration's other nominees for health-related cabinet positions.
Dr. Osterholm: Well, Chris, at this point, there really has not been any indication when confirmation hearings will occur for Mr. Kennedy. I think that relates in part to the fact that there's still a lot of investigation going on in terms of his background, conflicts of interest, etc., etc. we have seen a number of senators issuing statements of concern, and some senators have provided detailed documents of questions they're wanting to ask Mr. Kennedy. So, at this point, I can say none of us know what's going to happen, whether he'll be confirmed or not. We talked about that before. Um, you know, you can't assume that he will be confirmed. Although at this point, I know that the president is getting behind him in a big way. We'll have to see. Now, there are some other issues, though, that have come up that actually bear comment. First of all, I covered in previous Podcast. My concern about one of Mr. Kennedy's colleagues, Aaron Siri, who is a lawyer who is responsible for filing a number of petitions to the FDA to take certain vaccines off the market, requiring further study. Well, he no longer is part of the vetting team at HHS. He was removed from that along with one other of Kennedy's colleagues. I think this is good news that some in the Trump administration recognize the challenges of having people like Mr.
Dr. Osterholm: Siri and Mr. Kennedy there. And it's also worth noting that Health and Human Services is now being led in a temporary basis by Doctor Dorothy Fink. Doctor Fink is an endocrinologist and a leader of the Office of Women's Health. I'm relieved to say I don't have any major concerns about this, and I'm glad that the interim leader is someone with a strong medical background. I also want to note, again, as I have in previous podcasts, Jim O'Neill has now been named the HHS Deputy Secretary. He held a very important position in the George W. Bush administration at HHS, and as someone who has received high marks from many of us in public health for his activities, the fact that he is going to be the deputy secretary also does speak well. So as much as I'm concerned about the World Health Organization membership status, the issue of communications, what can be done, whether or not there will be influence and advisory committees, at least the fact that Doctor Fink and Mr. O'Neill are both in very senior leadership positions at HHS, I think is good news. So, stay tuned. We'll keep you posted on what happens with all of the vetting activities and who's in and who's out. And hopefully within the next two weeks we'll have a better handle on that.
Chris Dall: So, Mike, as noted, we still don't have a date yet for the confirmation hearing for RFK Jr. But if you were a senator on the Senate Committee on Health, education, Labor and Pensions, which is the committee that will be holding his nomination hearing, what would you want to ask him?
Dr. Osterholm: You know, Chris, I've been asked this question by several other reporters, and I think they all look somewhat surprised when I answer it. And I may create a little bit of that moment here. I don't care to ask him any questions, and I don't for one reason. I don't believe anything he says. If you look at his track record, he has been inconsistent on every issue that relates to public health. I mean, he's the same person who even when a video captures a statement he made, he has denied he made the statement. Or then he comes back later and says, well, I really meant this. He has been so inconsistent, even if in fact a fact a senator asked him a tough but very thoughtful question, he could answer it. But tomorrow it would be a totally different answer. And so, to me, that's one of the challenges in leadership with him, is that I don't know what he believes. I don't know what he really will get behind. And the challenge we have today is, is that when you have a leader like that, what good does a hearing do? It doesn't really provide you with any assurance that this is how that person is going to perform in the future. So that to me is the real concern. I can easily relate to people who I don't agree with, but I feel very confident that they are truthful in what they're saying. They just have a very different point of view. And that same point of view will be today, tomorrow, next month, next year with Mr. Kennedy. There's no hope for that. So, whatever the hearing brings out, I don't know what it will mean.
Chris Dall: Now let's turn to H5N1 avian flu. As I mentioned in the intro, H5N1 was initially going to be the focus of this episode because while there continues to be concerned about what happens if H5N1 mutates to become more transmissible in humans and whether we're prepared for that scenario. You mentioned in our podcast meeting that you're now looking at a new mode of transmission for H5N1 that could present new and different challenges. Can you elaborate on that?
Dr. Osterholm: Well, Chris says many of the podcast listeners know I have spent much of my public health career neck deep in influenza related research and outbreak response. And as I have said time and time again, I think I know less about influenza today than I probably did 10 or 15 years ago. As I've learned more, I realize how much we really don't know. Or at least we thought we knew. But it turns out not to be true in terms of the science. So, let me first just give us an update on where we're at today, and then I'll dig in deeper to that point you raised about, might we be seeing real changes in what is occurring in influenza epidemiology, both in animals and in humans? As of this past Tuesday, the national total of H5N1 infected dairy herds is now 929 across 16 states. The total number of infected herds in California is 712, although 128 herds in the state have now been released from the mandated quarantine since testing positive, meaning that in fact, the virus has now gone through those herds and there is no evidence of ongoing transmission. Additional states continue to join the USDA's National Milk Testing strategy, and four states of the 38 have been deemed affected by H5N1 thus far. California, Nevada, Texas, and Michigan are characterized as stage three in a five-step roadmap to virus elimination in an infected herd. I think the important information here is that if you look at the additional testing, they're now doing in states not previously reporting cases, that testing is affirming that there is really no evidence of any ongoing transmission in those states.
Dr. Osterholm: So, this is good news. I think that, in fact, while we continue to see substantial activity in places like California, we're not seeing it throughout all 50 states, something that many people worried was happening and it was just not being picked up because of a lack of testing. The goal of the current USDA program, and specifically the stage three level, is to detect, respond and eliminate the virus is all based on identifying cases, implementing rapid response measures, initiate contact tracing of cattle and even individuals who might share a common farm exposure, and to conduct surveillance to eliminate the virus. At this point, it remains unclear how successful this program will be in the short and long term. However, at this time, we are not seeing evidence of expanding transmission of this virus in dairy cattle herds throughout the country. That's good news. Now, if we look at the poultry, that's a very different picture. In the last 30 days, there have been an additional 89 confirmed flocks with high path avian influenza. 49 are commercial and 40 are backyard flocks. The count includes the first H1N1 outbreak detection in a commercial poultry farm in Georgia. They also include turkey farms and egg producers in Indiana, Ohio and California, plus commercial facilities in New York, Minnesota, and Maryland.
Dr. Osterholm: Please note the geographic location of these states, both north and south. Occurring again in what would be the late December early January time period. If we look at other cases that have made the news in the past several weeks, as many of you know already, San Francisco has just reported an H5N1 avian flu case in a child. There has been a total of 67 confirmed cases of infection in humans, three including the child with unconfirmed exposure to infected animal. I'm going to come to that in a moment. I think that is going to increase substantially in the days ahead. We've recently seen zoos in Richmond, Virginia and Germany reporting H5N1 deaths in their captive bird populations. H5N1 virus in turkeys was genetically linked to raw pet food that caused infections in domestic cats, which prompted changes to surveillance measures in affected states. The amount of wild birds infected is largely uncharacterized. Some believe the burden in the environment is past the point of any kind of containment, which then gets me to where are we going? Well, in fact, I believe that we are going to see an entire new epidemiology of H5N1 take place. Let me just remind you that H5N1 is a relatively new player on the block in most countries around the world. This virus only emerged really in 2020, when a new genotype of H5N1 virus belonging to the clade, 2.3.4.4B, spread rapidly in wild birds from Europe to Africa, North America, South America and the Antarctic.
Dr. Osterholm: When this virus arrived, initially people thought it's going to be like the other high path viruses we've seen. For example, like H7 and H9 viruses that have showed up and then just disappeared over time. With this one, it's very different. This time, despite the major culling activities that have taken place. We've now seen over 90 million domestic bird’s positive since 2020, and the poultry outbreaks continue to be reseeded from wild birds. What do we know about wild birds and what does this mean? Well, in fact, when you look at the natural reservoir for this virus, it is largely in migratory waterfowl. That's why this virus is now spread around the world, including to Antarctica. No other animal species could move a virus around the world except humans and birds. And that's what's happening. We have best estimates of about 40 million migratory waterfowl in North America. That includes both ducks and geese. And what is turning out to be the case is that for a number of these waterfowl species, we can show that up to 90% of them become infected in a given year. That has created, for me at least, what I imagine to be a virus cloud, meaning that as these birds defecate wherever they're at.
Dr. Osterholm: And if you've ever seen large numbers of migratory birds on farm fields, you can understand how much bird feces are produced and what that means. Now, I was involved in 2015 with H5N2 work, in which we had to depopulate a number of poultry barns here in Minnesota. I also was involved with a company that is the largest egg laying company in North America. And that work convinced me that what was happening was many of these poultry production facilities, whether they be for egg laying or for actual production of chickens for slaughter, that in fact, these barns have only slats, curtains that shut, so that in fact, that is the protection against cold weather. They're not airtight at all. Many times. The slats are open in warmer days and keep the birds from contact with other wildlife or in fact, wild birds. Today, I am certain that we are seeing clouds of dust with bird feces in that, and we are beginning to see what I would consider to be almost an environmental type disease, similar to the transmission that we see with Coccidioidomycosis, what we call Valley fever, where in fact that's a fungus that grows in the environment. And then on windy days it blows with the dust and you inhale it. I think we're going to see the same thing with H5N1. That's why so many of these barns are now positive.
Dr. Osterholm: And you might ask, well, wait, if it's migratory waterfowl, why are we seeing so many states in the northern part of the country breaking in December and early January with H5N1? It's in part because we've also altered a lot of the activity of migratory birds in North America by man-made water structures. Structures that stay open year-round as a result of heating systems in rivers and lakes as a result of waste ponds, for example with large dairy operations, where because of the amount of organic material and the amount of water going into these ponds, they stay open most of the year. Right here in Minnesota, we have a number of locations where that is in fact the case. Open water year-round, these birds do not go any farther south than they need to go. In fact, in talking to one of the experts in snow geese, they used to see these large, large clouds of birds literally migrating by the millions to the southern Gulf states. Today, some of those states have very few of them migrating there because they stay in Middle America. There are so many open bodies of water. I know right here in Minnesota, one of the more famous situations is in Rochester, Minnesota, where the home of the Mayo Clinic also happens to happens to have an electric generation system, part of a river structure that results in enough warm water that the large body stays open year-round
Dr. Osterholm: Doesn't ice over. And of course, if you've ever been to Rochester, you know they're famous for their Canadian geese. And literally by the many thousands and thousands that are there. We were going to see more transmission occurring from migratory waterfowl that stay in locations that aren't all the way to the Gulf states. And I think we're going to see more and more situations with wind driven activity where you're going to see virus show up. What does that mean? I do not believe that the price of eggs is going to come down anytime soon, because until the poultry industry realizes they have to have airtight barns with HEPA filter intake, they're going to continue to see this virus show up and show up and show up and show up. Unless it changes in the wildlife. It's unless it changes in the migratory waterfowl. It's going to continue to be a problem for them. So why should the USDA continue to indemnify farmers who, after three and four times of having barns infected, depopulating, terminally, cleaning the barns, and reestablishing new birds, only to have it happen again? That's because of what this airborne situation is. That also means we're going to start seeing more and more cases in humans that have no explanation for why they occurred. And it's going to be a situation where I didn't have contact with wild birds.
Dr. Osterholm: I didn't have any contact with domestic birds. It's you’re breathing. And grant you the infectious dose is likely such that it's not going to be a common occurrence, meaning that, you know, for every 100 people exposed, 90 get infected. But if even if it's one out of every thousand or 2000 or 10,000, the whole population in North America right now is at some risk for this. So don't be surprised to see more and more of these sporadic cases. I know this may sound difficult for some to hear, but I'm more convinced now than ever that the poultry production challenges we have today really are illustrating what I'm talking about with this virus moving as much as it is for all these recent operations that have just broken with H5N1 in the last several weeks. I am sure that this was airborne transmission infecting those barns. There were humans who breathed in the virus. Many of them may not have ever become severely ill, but in fact, I think they're out there. So, we'll see. I hope I'm wrong, but I don't think I am. And I know this will challenge people who say, there he goes again. But I am convinced that at this point, this H5N1 is here to stay. Whether it will become a pandemic virus, I don't know. But I do know that at this point it's going to be a to be a lot more transmission.
Chris Dall: So, Mike, I think we've set a record for the latest we've ever gotten to COVID on our on a podcast episode. But let's take a look now at COVID-19, flu and RSV because respiratory virus activity is high across the board right now. In fact, the Minnesota Department of Health last week noted on social media that Minnesota hospitals had hit a record number of hospitalizations in a single week due to flu. And it's not just this country. Hospitals in the United Kingdom have also been packed with flu patients. What's going on?
Dr. Osterholm: Chris, I don't think anyone listening is surprised to hear that respiratory virus activity is high across the board, because if you haven't had some type of respiratory infection yourself in the past few weeks with both you and I have, I would almost guarantee you, you know, at least one other person who has had a respiratory illness. And this isn't just in the US. Like you mentioned, the UK has seen its hospitalization rates skyrocket over the past several weeks. Fortunately, we are starting to see some signs of decline overall, which would mean that this elevated activity may be this season's peak. Let's start with influenza, because as you mentioned in the question, Chris, it's caused the most hospitalizations here in the US. Currently, the percentage of outpatient visits for influenza like illness is considered high, but is decreasing, with 5.4% of visits last week, down from 6.8% of visits reported in our last episode two weeks ago. Activity remains the highest in the south and the West, and lowest in the northeast, but every region has seen declines in activity. Nine states are experiencing very high flu levels. 24 and the District of Columbia are high. Eight are moderate. Six are low and two are minimal. Vermont had insufficient data and was not included in the count, according to the CDC's flu surveillance report.
Dr. Osterholm: And let me let me just parenthetically add, I wonder if it'll still be around for us in the next couple of weeks. There were 31,379 patients admitted to hospitals with influenza last week. Again, 31,000. This is a 16% decrease from week one or the first week of the year, but a 20% increase compared to our previous episode. Two weeks ago, the first week of January, there were more than 19,800 influenza patients occupying inpatient beds in the 87.8% of hospitals that reported data, and there were 3127 occupying ICU beds. Unfortunately, since our last episode, there has been 16 pediatric deaths, bringing the total for this season to 27 pediatric deaths, which has contributed to the 6600 deaths so far this flu season for all ages. To wrap up our influenza discussion for now, I'll just add that as far as subtyping is concerned, pretty much everything is influenza A of the 1754 viruses reported by public health labs during the second week of January, 1719 were influenza A, and only 35 were influenza B. 1440 of the influenza A viruses were then subtyped and 43% were H1N1 and 57% were H3N2. Now, looking at COVID, which is currently causing the second highest burden on our hospitals of the big three respiratory viruses circulating now, the national wastewater level is considered high but is decreasing in every region.
Dr. Osterholm: The Midwest is still the highest wastewater concentrations, but is now back to being considered high. Along with the northeast. The south and the west, which is where flu activity is highest, had moderate COVID wastewater concentrations. Severity indicators. Both hospitalizations and deaths are both increasing for the most recent week of the hospitalization data, which is the week ending January 11th. 1.7% of inpatient beds and 1.7% of ICU beds were occupied by a COVID-19 patient. This is about 1270 inpatient beds and 7975 ICU beds, both of which are about 40% higher than they were in our last episode. Unfortunately, deaths are beginning to increase again. The most recent complete data we have is for the week of December 21st, when we lost 518 Americans to COVID. What a tragic time in the holiday season. Let me remind you that in episode 173, we reported that for the first time in 22 weeks, weekly deaths were below 500. That unfortunately only lasted three weeks. Since October, or roughly around the beginning of the flu season, there has been 8548 deaths involving COVID, but the CDC's preliminary estimates of disease burden estimates that between 14,000 and 25,000 COVID deaths actually occurred during this time. Yet only 23% of adults and 11% of kids are fully vaccinated.
Dr. Osterholm: I want to add one comment on this though, however, and I think these are sobering numbers. As bad as all this sounds, and it is tragic when you think about the number of deaths that are still occurring. When we look at the COVID data by year in 2020, it was the number three cause of deaths in this country. In 2021, it was number three again. In 2022, it dropped to number four. In 2023. It was the 10th leading cause of death. And in 2024, as we've closed out the year, it was the 14th leading cause of death. So, we've gone from two years of the third leading cause of death to the 14th leading cause of death last year. I expect those numbers will continue to drop some, but over time, at least as tragic as this still is, we are in a much better place than we were. Now, if we look at the actual variants of COVID, we continue to see that XEC continues to be the predominant variant, accounting for 47% of US cases, LP8.1, which we discussed previously as potentially having a growth advantage over XEC, has now surpassed KP3 1.1, though just slightly accounting for 15% of new cases where KP 3.1.1 accounts for 14%. Now, if all these numbers kind of jumble in your head and you're trying to make sense of them, let me just summarize it by saying, at this point, I don't see any of the variants having a unique advantage causing increased case numbers or causing more severe illness.
Dr. Osterholm: In this case, all the variants continue to participate in the illness occurring out there. I don't see anything that's going to drive higher COVID numbers in a way that would be considered a big spike. Finally, let's quickly talk about RSV, which is considered moderate by national RSV. Wastewater concentrations. RSV hospitalizations have increased since our last episode, with 8519 RSV patients occupying inpatient beds and 1464 occupying ICU beds. While these numbers are higher than our last episode, the emergency department visits for RSV are decreasing nationally, which could be an indicator that we are past the RSV peak. We don't often talk about RSV deaths because it's often underrepresented on death certificates, but the CDC does estimate the burden of disease and has projected that since October, there have been anywhere between 3900 and 9500 RSV deaths in the US. Bottom line message the respiratory season is here. It may have peaked. And while I would say it's probably late to get your vaccine for any real protection, there will still be cases occurring through March. If you haven't been vaccinated, please do. Please do.
Chris Dall: And finally, it's time for this week in public health history. And Mike, who are we celebrating this week?
Dr. Osterholm: Chris, I think it's fitting for us to discuss the World Health Organization just a bit more as we close out this episode. The W.H.O. is part of the United Nations, which was formed from the ashes of World War Two. Franklin Roosevelt is recognized as coming in the name in discussions with Winston Churchill in 1941, during the Arcadia Conference, a postwar planning effort between the British and Americans, a new organization was formed and led by the Allied Big Four, the United States, United Kingdom, Soviet Union and China. With the urging of Churchill, after the liberation of Paris, France was folded into the leadership, becoming part of the five countries that now represent the permanent members of the Security Council. In April of 1945, the United Nations Conference on International Organization met in San Francisco, where members recognized the importance of global health as a priority for all international leaders. By the following July, 51 countries signed the Constitution of the World Health Organization, becoming the first specialized agency in the UN to have all member states subscribe. At its onset, W.H.O. had six priority areas of work malaria, tuberculosis, sexually transmitted infections, maternal and child health, nutrition, and environmental hygiene. The organization sought to Sought to establish more robust disease surveillance systems so that health officials could evaluate progress towards goals and respond to emerging threats.
Dr. Osterholm: One of the most notable accomplishments of the W.H.O. and its member states, and what I would consider to be one of the greatest accomplishments of all of public health is the eradication of smallpox, which took place finally in 1980. The agency has continued to take on infectious disease and non-communicable disease threats over the last 76 years, including HIV/AIDS, SARS-CoV-1 and two Ebola, Zika and much more. CIDRAP has had the pleasure of working with W.H.O. on numerous projects, from designing research and development roadmaps for pathogens of epidemic potential, to surveying member countries on barriers to implementing influenza vaccines. There are some truly exceptional staff in the ranks that we've had the pleasure of working with. I'm not going to claim that I've agreed with every action or inaction taken by the W.H.O.. However, I can say with full confidence that the organization has tremendous benefits to society and works best when all countries are engaged and committed to promoting health around the world, not just in our own backyard. Infectious diseases do not contain themselves within borders of countries, and our work certainly shouldn't either. In that regard, thank you to the World Health Organization and all those who since 1945 have contributed to a better world with better health.
Chris Dall: Mike we covered a lot today. What are your take home messages?
Dr. Osterholm: My first message is stay tuned. Hold on. I know you're all looking for direction about what we can do to respond to the events of this new administration, and we hear you. We will try to give you the kind of information that will help you know how to respond. But right now, we're all basically drinking from a fire hose. By the time this podcast publishes and you listen to it, it's very possible a few additional challenges will have arisen as it relates to the public health activities of this administration. So, stay tuned. Hopefully in two weeks we'll have a much clearer picture on who's in, who's out, what activities are taking place, which ones are not. And then I think we're in a much better position to focus our activities on trying to accomplish X, Y and Z. And this is how we're going to try to do it. The second thing is H5N1 is not going away. This is a brand-new type of virus activity within wild birds spilling over into domestic production and as well as into humans. I know that my description today of a world with lots of migratory waterfowl poop blowing in the wind with virus attached to it may not seem appealing to many, but I think it's real.
Dr. Osterholm: I think it's exactly what's happening. And we're going to see more human cases related to that. The poultry industry is doomed to have challenge after challenge if they don't change the way they house these birds. They're going to have to find a way to have airtight buildings with only HEPA filter air coming in the intake and HEPA filter air being sent out the backside. If that doesn't happen, I convince eggs are going to be an expensive commodity for a long time to come. Finally, I just want to say that, you know, it's a sad commentary in a way, when we can talk about, you know, 8000 deaths is just another week at the shop with respiratory illnesses. They're not, you know, again, I can't emphasize enough how important it is to stay current in your vaccinations for COVID, influenza and RSV, if it's appropriate, and to understand that, again, our ability to impact these diseases is very real with these vaccines. They're not just a one shot and done kind of picture. So, if you are behind on your vaccines, now is the time to act on that. And in particular, if you're over age 60 to 65, you have underlying health conditions. Now's the time to get your vaccine.
Chris Dall: And do you have a closing song for us today?
Dr. Osterholm: Well, of course, how could I not have that right? You know, this was a heavy, heavy, heavy podcast. I know that, I feel it, the staff feels it. Again. I want to thank the research team for all their help with this. So, I have unilaterally decided I'm going to take it upon myself to brighten the world. And you say what? Well, I've picked a song that may not appear to be related to anything we've covered today, but it is meant to leave you in a certain mindset. This is a song that I've used twice before on episode 33, A long, Long Time Ago November 25th, 2020. I used it as a Thanksgiving perspective. Then on February 3rd of 2022, an episode 89, I used it. Understanding immunity from my perspective will be a song for the ages. It doesn't matter how old you are, it doesn't matter where you've been or what you've done. It applies. So, the song I've chosen is Over the Rainbow, also known as Somewhere Over the Rainbow. It's a ballad by Harold Arlen with lyrics by Yip Harburg. It was written, as most of you know, for the 1939 film The Wizard of Oz, in which it was sung by actress Judy Garland in her starring role as Dorothy Gale. Just remember, about five minutes into the film, Dorothy sings the song after failing to get Auntie Em, Uncle Henry, and the farmhands to listen to her story of an unpleasant incident involving her involving her dog Toto and the town spinster Miss Gulch. And Tim tells Dorothy to find herself a place where you won't get into any trouble. This prompts her to walk off by herself, musing to Toto. Someplace where there isn't any trouble.
Dr. Osterholm: Do you suppose there is such a place? Toto? There must be. It's not a place you get to by boat or train. It's far, far away. Behind the moon. Behind the rain. At which point she begins singing. So here it is. Over the rainbow. Somewhere over the rainbow. Way up high. There's a land that I heard of once in a lullaby. Somewhere over the rainbow. Skies are blue. And the dreams that you dare to dream. Really do come true. Someday I'll wish upon a star. And wake up where the clouds are far behind me. Where troubles melt like lemon drops. Away above the chimney tops. That's where you'll find me somewhere over the rainbow. Bluebirds fly. Birds fly over the rainbow. Why then, oh, why can't I? If happy little bluebirds fly beyond the rainbow. Why, oh why can't I? Judy Garland. Thank you again for joining us. I hope this was helpful. A lot of information. A lot. Um, these are challenging times. Uh, and again, I come back to a comment earlier when someone tells you who they are, believe it. And right now, we're learning that in spades. That doesn't mean that we have to give in to that mindset of what many people are feeling today. I refuse to accept the fact that there's a fait accompli. What will happen now is our time to understand what's happening, and to think carefully about how we can respond and how we will respond. And I do believe it will bring the best of us all out into the into the open and will be very, very proud. Be kind right now. Boy, do we need it. Be kind and be safe. Thank you.
Chris Dall: Thanks for listening to the latest episode of the Osterholm Update. If you enjoy 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 and Elise Holmes. Our researchers are Cory Anderson, Angela Ulrich, Meredith Arpey, Clare Stoddart, and Leah Moat.