Episode 211: A System Held With Duct Tape

Chris Dall: Hello and welcome to the Osterholm update, a podcast about infectious diseases and public health featuring Dr. 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, Dr. Osterholm draws on over 50 years of experience in infectious disease epidemiology to provide straight talk on the latest infectious disease outbreaks, counter misinformation and disinformation about vaccines, and distill the complex and ever evolving public health threats facing our world. 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. You probably don't need me to tell you this if you're a long time listener to the podcast, but there's a lot going on in the world of infectious disease and public health right now. We have a growing Ebola outbreak in the Democratic Republic of Congo that appears to have started months before it was officially recognized and could become much larger, a resolving but still unsolved hantavirus outbreak, and now the first detection of the parasitic infection, New World screwworm  in the US in decades. You can also throw in the beginning of the World Cup, which will bring more than 6 million fans to cities in the US, Canada and Mexico over the next month and has public health officials working overtime to prevent those fans from infectious diseases like measles, COVID 19, flu and norovirus, just to name a few.

Chris Dall: Disease surveillance is disease surveillance every day of the week, Philadelphia's deputy health commissioner told CIDRAP news reporter Meghan Holohan. What is changing in terms of the World Cup is how intense that disease surveillance is going to look. The public health preparations for the World Cup will be among the topics we cover on this episode of the Osterholm update, episode number 211. We'll also bring you the latest on the Ebola outbreak in the DRC. Provide an update on the hantavirus outbreak, explain what New World screwworm  is and the threat it poses to US livestock. Review a new report that suggests why the US is likely to lose its measles elimination status and give you an update on COVID and other respiratory infections. And of course, we'll have the latest installment of This week in Public health history. But before we get started, as always, we will begin with Dr. Osterholm's opening comments and dedication.

Dr. Michael Osterholm : Thanks, Chris, and welcome back to the podcast family, to another edition of this podcast. As I will note in a moment, this podcast has taken on a life, at least in my world, far beyond what I ever imagined. As I was realizing, today will be the podcast associated with the seventh consecutive summer solstice podcast since we started. Seven of those. Hard to believe, isn't it team? I also want to acknowledge those who might be joining for the first time, or who have only been infrequent visitors to the podcast that we welcome having you here. We always look forward to your feedback. In fact, I got some this past week from someone that was very thoughtful and please let us know what it is we can do to help improve these podcasts, to deliver to you the kind of information that you're looking for. This week, I want to dedicate the episode to everyone involved in the Special Olympics USA games, which kicks off this Saturday, June 20th, right here at the University of Minnesota. The Special Olympics are something that means a great deal to me, and I'll explain more in a moment. Yes, this year's games are hosted right here in the Twin Cities, with many of the events here at the University of Minnesota.

Dr. Michael Osterholm : The games will bring together around 3000 athletes, 1500 coaches, 10,000 volunteers, and 75,000 fans from all across the country. There are a variety of events, including swimming, soccer, tennis, gymnastics and powerlifting. There's even bowling, pickleball and corn hole. The Special Olympics was founded back in 1968 by Eunice Kennedy Shriver, who wanted to give people with intellectual disabilities a chance to be active and build community through sports. We have seen how sports can unite all of us, from the recent Knicks win to the World Cup. The Special Olympics is no different. I encourage everyone to check it out this coming week. And again, to all the athletes, coaches, families, and volunteers. This episode is dedicated to you. We are cheering you on. As I just noted a moment ago, this podcast episode is very special to me as I always look forward in tracing the sun through the sky. Sharing with you each and every podcast the amount of sunlight that we share here in Minnesota with each other. And now to actually hit the summer solstice. Yes, indeed it will happen. In fact, this Sunday and Monday we will see the longest day of the year here in Minnesota. Today, on June 18th, we'll have sunrise at 5:26 a.m., sunset at 9:02 p.m. That's 15 hours, 36 minutes, and 45 seconds of sunlight.

Dr. Michael Osterholm : But we're still gaining about 13 seconds a day through the end of this week, which will then get us to 15 hours, 36 minutes and 50 seconds. Hard to believe. And it's so remarkable to trace this podcast history by the number of summer solstices, as we've had. As I've mentioned, this is our seventh one that we've actually been on the air for. Now for our dear, dear friends and colleagues in Auckland, New Zealand, at the Occidental Belgian Beer House on Vulcan Lane, you will see your darkest day of the year this year. But this is where it gets good, because then you turn the corner and you're on your way up. Unfortunately, as we're on our way down today in Auckland, sunrise is at 7:32 a.m., sunset is 5:11 p.m. That's nine hours, 36 minutes and 11 seconds of sunlight. But next Tuesday you then begin to climb out of the darkness with your first positive sunlight day while you're increasing sunlight by three seconds. And then, of course, that will continue to accelerate right up through September. So for all of you who only tolerate our sun information, thank you for sticking with us. For those that find it quite interesting and enjoyable. Wow, what a day we've got.

Chris Dall: Mike will start this episode with the latest on the Ebola outbreak in DRC, which has now grown to more than 820 cases and nearly 200 deaths, and is likely much larger. In fact, the CDC recently published a modeling study that estimated this outbreak could be bigger than the 2014 to 2016 West Africa outbreak, which is the largest Ebola outbreak to date. If that projection is accurate, we're talking about more than 28,000 cases and 11,000 deaths. Mike, do you fear that this outbreak could be that large?

Dr. Michael Osterholm : Chris, I remain very concerned about what's going on with Ebola. I want to start by giving listeners a quick update of what we know about the outbreak. Before I get into my thoughts on the modeling study from the CDC and where I think this outbreak could be headed. I also want to emphasize that we've linked an article from Stephanie Soucheray on the CIDRAP news team from June 16th, summarizing the comments from the head of the African CDC as to where things are going. I think this also provides very important context. This outbreak, which is caused by the Bundibugyo virus. As you noted, Chris has reached a total of 827 confirmed cases and 194 confirmed deaths, a case fatality rate of about 23%. The actual number of cases and deaths is likely much higher due to underreporting and delayed reporting. The outbreak is primarily occurring in the northeastern part of the Democratic Republic of Congo, though 19 cases and two deaths have been identified in neighboring Uganda. There is no approved vaccine or treatment for Bundibugyo virus, which means we're relying entirely on public health efforts like contact tracing and isolation, as well as using protective equipment in healthcare settings in order to control the spread of the disease. This is a significant challenge considering the fact that the resources in the DRC are already very strained. There's also been reluctance within the community in the DRC to accept the public health guidelines, which has further limited the effectiveness of these efforts. To give you all some context, this region of the DRC has faced a significant amount of violence and conflict in recent years and also is home to diamond mines, where workers, which include children, are subjected to very dangerous conditions while making just a few dollars per day.

Dr. Michael Osterholm : It's understandable that many individuals in this community feel that there have been failed repeatedly by government and global organizations, and are therefore skeptical of their efforts to curb this outbreak. Sadly, this does not change the real public health ramifications that result from not following recommendations for isolation or the use of protective personal equipment. There is general distrust also from the locals with regard to what it means to have an Ebola outbreak. And what do I mean when Ebola occurs? We see assets or resources from numerous organizations arriving in areas to address Ebola. Meanwhile, for the months and years between outbreaks, there is very little attention paid to the public health efforts in those same locations. For example, when many of these villages, four out of five individuals do not have access to safe water ever. So now suddenly they come sweeping in to deal with Ebola, and that leaves locals with great distrust. So, Chris, this brings me back to your question. How big is this outbreak going to get? I'll first address the CDC study. You mentioned the CDC study involved modeling several different projections based on different numbers of deaths as of late May, as well as varying levels of adherence to isolation guidelines. The estimated numbers of cases and deaths varied significantly based on those two factors, and in some cases, that exceeded what we saw in the 2014 2016 outbreak in Western Africa. Though it's worth noting that most of the simulations produced estimates of cases and deaths that were lower than the 2014 outbreak. That said, I am somewhat skeptical of these types of models that try to predict specific numbers of cases and deaths when there are so many unknowns as to how the locals will respond.

Dr. Michael Osterholm : These models rely on so many different assumptions won't necessarily hold true in the real world. In fact, during the 2014 2016 outbreak, a CDC modeling study distractingly overestimated cases and deaths, suggesting that 1.4 million people may become infected rather than the actual number of approximately 28,000. This incorrect prediction got a lot of media coverage and contributed to the significant feelings of hopelessness around the world in regards to what we could do to combat this outbreak. So what does this mean? Well, again, I refer you back to the piece that we have linked in the show notes from the interview with the director of the African CDC. I think you'll find some very important perspective there. So does the model CDC proposed hold? I don't know. It may it may not. But the bottom line message is any experienced public health professional who's ever worked in this area of Africa realizes this is a huge challenge. And also, it's notable that without any vaccines or treatments for the virus and a lot of hesitancy from the public on adhering to infection control guidelines, these all contribute mightily to the challenge in trying to bring this outbreak under control. Those factors, along with substantially reduced support from the U.S. due to cuts to USAID, PEPFAR and other programs make me very concerned about the possibility that this could be worse than we saw in 2014. But only time will tell. As always, we will keep you updated as this situation unfolds.

Chris Dall: Mike, getting to that issue of distrust that you talked about, and this was highlighted in an interview that WHO Director General Tedros gave to Helen Branswell of STAT News. And the attitude he described among people in DRC is that we're dying every day from violence, from malaria, from unsanitary conditions. And you only come along when there is a disease that you think is going to affect you. And that is that is understandable.

Dr. Michael Osterholm : Absolutely. And I think, Chris, this is one of the challenges we have is we don't have a clear cut public health agenda where locals can see that we care about all the different aspects of their lives. And that's why the loss of both USAID and PEPFAR was such a significant loss, not just in the delivery of services, but in the idea of continuity of public health care and action. And this is why when you have a population that sees an organization providing you a safe, fresh water, providing you with vaccinations, providing you with maternal child care, providing you with treatments for malaria. When you see organizations doing that, you then trust them much, much more. When Ebola happens and you then ask them to take on new and additional activities to try to stop that outbreak, when in fact there has been none of that kind of contact, and you just come in cold into a particular location. There's a lot of distrust. Why are you coming in now? As Tedros just pointed out. I applaud Tedros for his honesty and his frankness in describing the situation, and it's one that is a reality. We have to address it to not address it means that we will definitely see an outbreak that could very much rival what we saw in 2014-2016.

Chris Dall: So, Mike, as you know, the World Cup has started and the public health experts and officials that CIDRAP news reporter Meghan Holohan spoke with said they're not too concerned about the risk of Ebola during the World Cup. But their concern lies more with, quote unquote, the diseases of crowds, which includes respiratory ailments, sexually transmitted infections, vector borne infections and gastrointestinal illnesses. What are you concerned about with this World Cup from a public health perspective?

Dr. Michael Osterholm : Well, Chris, my concerns actually are somewhat different than what others have expressed with regard to this situation. As has been noted, the World Cup will bring approximately 6.5 million fans and 48 teams from around the world to the Americas to play in these highly visible games. There will be lots of cheering and close contact. There will be potential for the transmission of infectious diseases. But let me put this into perspective. As I just noted, we're talking about 6.5 million fans in 2020. For the last year for which we have complete data, there were 257 million air passengers that traveled around the world. Of those, 72 million actually were arrivals in the United States than some went on to other locations. Actually, 60 million came to the United States and stayed for some period of time after their arrival. That's 60 million. So when you look at what the World Cup is going to do, it'll surely be a bump. But it won't be the significant, overwhelming number of people that were just not able to handle. And so from that perspective, I think we have to be careful not to overplay what the International World Cup could mean. However, I am concerned that this country has done really very little to be prepared should such a problem arise, that is, either in the detection of the problem or in the response. What do I mean? In Megan's really very well done piece, she describes the Health Security Operations Center at Georgetown University that's been set up to try to monitor what's happening in the World Cup locations to understand, is there an infectious disease outbreak emerging? What isn't stated is that the Health Security Operations Center at Georgetown is really run on volunteer work by someone who I have a great deal of respect for Dr. Rebecca Katz.

Dr. Michael Osterholm : For example, Rebecca is the one who reached out to MedStar health, the group working with wastewater sampling to actually bring together the information. There has been no formalized, major coordinated effort in the US by any of the federal agencies. While CDC is surely monitoring issues there, the Department of Defense is monitoring issues, etc. and there is no central coordinated effort. This is really unfortunate, and it speaks to the fact that this government doesn't really appreciate what must be done from a coordination standpoint. For example, there has been no additional funds supplied to state and local health departments in those locations hosting games so that they might have additional surveillance activities in place to understand what could be happening, whether it's business as usual. And often that means limited business because of a lack of support. So it's great to see the team at Georgetown rise to the occasion. My hat's off to Rebecca and her team, but it's really disappointing that it took someone outside of government to bring together basically a system that's largely been a system put together by duct tape. And I say that with great compliment to Rebecca and her team. Not in disrespect. I can only hope that this illustrates just how poorly prepared we are in this country for a major event, given that we can't even do a better job preparing for the World Cup.

Chris Dall: And Mike, it should be noted that not only are states not getting additional funding, but state public health departments are preparing for this event amid large funding cuts from the federal government.

Dr. Michael Osterholm : And, Chris, this is a point that we emphasize often on the podcast, this whole concern about the access to resources and the fact that today in this country, 92 to 94% of all the funding for local and state public health activities around infectious diseases actually results from federal support. And so when that federal support is pulled, it really is a challenge in terms of supporting infectious disease surveillance and follow up.

Chris Dall: And Mike, while we're talking about CIDRAP news stories, I'd like to take a moment to tell our listeners about a terrific new series of stories by CIDRAP news reporter Liz Szabo, marking the 20th anniversary of the FDA approval of the first human papillomavirus, or HPV, vaccine. The three part series is called 20 years of HPV Vaccine Success, and you can find it on CIDRAP homepage. Liz brings a wealth of experience to this topic. She's been covering the HPV vaccine since 2006 and was writing about cervical cancer before that, and in reporting for this series is simply remarkable. So please take a moment of your time to check it out. Let's turn now to the hantavirus outbreak. Mike, the outbreak appears to be over. There have been no new cases reported in recent weeks, and many of the US passengers from the Dutch cruise ship where the outbreak occurred are now quarantining at home, except for one. But you noted in our podcast meeting that with the growing odds of a strong  El Niño season expected later this year, we could see an increase in hantavirus cases here in the US. So what's the connection between  El Niño and hantavirus?

Dr. Michael Osterholm : Well, first of all, Chris, let me just make a quick comment about what's happened with this particular outbreak that received so much public attention a month ago and now seems to have completely fallen off the radar screen. It really hasn't fallen off the radar screen for some of us because of the fact that we still have, as of today, one of the passengers quarantined in the Nebraska facility. And largely, we believe, because of the fact that this was an individual who protested being there and wanted to basically home quarantine and cause our federal government some discomfort, you might say, and how they became very public about what was happening with their quarantine in Nebraska. It's of note that early on, passengers that had disembarked the ship before it was recognized that there, in fact, was a hantavirus outbreak going on actually had little to limited follow up, even though they were on the ship at the time when the index case and what we believe is a super spreader was in fact most infectious. So to believe that those individuals who disembarked were no longer a risk was just not the case. But there was little to no follow up. It was then, shortly after that, that the US government took a much stronger stand, at least for US residents, basically declaring that we needed to have quarantine follow up such that people, if monitored at home, would actually have a 24 hour guard outside their house, or that for those who were in a facility, such as the one in Nebraska, that they would be there for an extended period of time, may recall on May 10th, over a month ago, I was on the Sunday morning ABC talk show with George Stephanopoulos, and I made the comment on May 10th and said, this outbreak is really over.

Dr. Michael Osterholm : Maybe 1 or 2 more cases might occur from the contact with the original case, but that, in fact, we had seen largely the summary of what was going to happen in this outbreak. Ultimately, two more cases did occur. Since that time, for a total of 13 cases and three deaths. But after the original super spreader event, we saw no evidence of activity. Well, why is this important? Because as of today, we still have a situation where we have one of the patients, Angela Perryman, who remains at the Nebraska Quarantine Unit, despite even CDC saying it was safe for her to return home to the state of Florida. Miss Perryman was being held in quarantine because, as I said, she was very vocal about wanting to leave and would self-quarantine in her home as so many others had been allowed to do, or in some cases, really not even required to do. As a result of this, the administration and an administration that was so critical of the whole use of quarantine concepts during COVID now demanded that Miss Perryman stay in the Nebraska facility for a full 42 day period.

Dr. Michael Osterholm : Well, that was a 42 day period from the time that basically she was last on the ship. It is of note that five of the passengers were allowed to leave the Nebraska facility two weeks ago to quarantine in their home states, including New York and Oregon. There, they could finish out their recommended 42 day period, but Perryman was not allowed to do that. She was rebuffed as she became entangled in basically a ongoing legal debate between the federal government and her home state of Florida. It was noted at the time by HHS officials that if Miss Perryman wanted to leave, she had to have a guard stationed outside her home. Nonetheless, in Florida, they refused to meet these requirements, so therefore, they refused to oversee any kind of quarantine activity with Miss Perryman. So this left her in limbo. So what happened? She then appealed to the CDC's quarantine group, which actually has the ability to review quarantine recommendations and make a decision as to whether or not quarantine was needed or needed to be continued. In fact, CDC reviewed the case and concluded that there was no reason why she needed to remain at the Nebraska facility. However, Secretary Kennedy, again, someone who has been a very strong opponent of the type of quarantine activities that he's now enforcing, concluded that, no, she needed to stay in that quarantine facility for 42 days.

Dr. Michael Osterholm : Again, long after we had any evidence that there was going to be any transmission. This part is what concerns me. We actually had a secretary of Health and Human Services that could demand a certain kind of quarantine activity for someone, for which the public health community had already concluded, was that very low risk of becoming infected and transmitting the virus to others, and, however, was very vocal about their opposition to this. The real concern is that Secretary Kennedy's order under the Public Health Service Act declared that Perryman needed to fulfill the requirements for federal quarantine, and they needed to continue to be met, suggesting she had to stay in the quarantine unit even though everyone else had left. This really, to me, was not about protecting the public health. It was about punishing her for speaking up and speaking out. That is a real concern. Now, using public health measures to control someone's life, to me, violates the very purpose of these public health quarantine laws. And it's so ironic that it's coming from the very group that just years ago, with the pandemic quarantine issues, was so vocal about how the federal and state governments had misused these quarantine approaches. So to me, the story is the hantavirus outbreak is over. It was over, I believe, several weeks ago. And I think the data support that. The other piece to this, however, is that the US federal government has actually figured out how to weaponize the Public Health Services Act to demand that certain kind of behavior be adhered to according to what the federal government recommends or demands.

Dr. Michael Osterholm : That, to me, is a real challenge. Well, Chris, let me now answer the question that you asked in terms of the  El Niño and what this means to hantavirus. As we have discussed previously, hantaviruses are a family of viruses primarily spread by rodent carriers. Cases are extremely rare, with less than a thousand hantavirus cases in the US since surveillance began in 1993. And interestingly, 94% of these cases have occurred west of the Mississippi River, notably in the Four Corners region. Transmission to humans typically occurs via contact or inhalation of dried urine, droppings, or saliva from the infected mice or rats. This contact may occur by disturbing droppings or nesting materials while cleaning, especially in poorly ventilated areas like a shed or an attic. It can also occur by eating contaminated food or touching something contaminated and then touching your eyes or mouth. Or less commonly, it can spread via a scratch or a bite from an infected rodent. Lastly, as we have just seen with the cruise ship outbreak, the Andes virus strain of hantavirus, which is found in South America, is the only hantavirus documented to spread human to human through prolonged close contact, notably airborne transmission. And here in the US, the most common hantaviruses sin nombre, which is spread by deer mouse.

Dr. Michael Osterholm : The virus was first recognized in 1993 following an outbreak in the Four Corners region, with 33 cases and a 50% case fatality rate. During this time period of 1992-93, the biologists determined that the deer mouse population was tenfold higher than the previous spring. This was no coincidence. The 1991-92  El Niño caused increased rainfall in the southwest, and these wet conditions provided ideal conditions for vegetation and ultimately a food source to grow with an abundant supply of vegetation, in particular pinyon nuts, as well as additional shelter, the rodent population was able to increase exponentially and thrive. Now, what happens when there are more mice who can serve as viral hosts? There is more opportunity for viral circulation and more opportunity for human exposure. Thus, an increase in cases, which is exactly what we saw happen with the 1993 outbreak.  El Niño conditions have already begun, and climate scientists are now predicting that it may become the second strongest event since 1991. If this turns out to be the case, and we do see a wetter than average winter in the southwest, it would provide ideal conditions for vegetation to grow and the mouse population to increase. While none of this is guaranteed to occur, it is certainly a real possibility and something we'll need to keep an eye on. For now, rest assured, your risk of hantavirus infection remains extremely low.

Chris Dall: Mike. Two weeks ago, the US confirmed its first case in decades of New World screwworm  in a three week old calf in Texas. This has been a concern for US Department of Agriculture officials amid a rise in documented cases in Mexico. So what can you tell our listeners about this parasitic infection and the threat it poses to US livestock?

Dr. Michael Osterholm : Thanks, Chris. We've been getting a lot of questions about this one. Regular podcast listeners will remember we covered the New World screwworm  last December, when cases in Mexico were making their way to mainstream news coverage. As a reminder, New World screwworm  is a parasitic fly that affects any and all warm blooded animals, including humans, by laying its eggs in an open wound in an otherwise healthy living tissue. Once those eggs hatch, the larvae feed on the tissue, resulting in lesions that can lead to severe complications and death if left untreated. For decades, the US government has effectively controlled the spread of New World screwworm  by supporting the release of sterilized male flies in partnership with Panama. The narrowest bridge between North and South America. This strategy prevents the flies from producing viable offspring and hinders their ability to spread north to Mexico and ultimately, the US. In recent years, however, there has been an increased spread through Central America and into Mexico, with cases appearing in animals and humans. This resurgence is likely due to multiple factors global warming, unauthorized cattle movement, USDA funding cuts affecting programs and staff, among others. And with that in mind, the biggest concern, apart from human health is a threat to livestock, particularly cattle, including both the beef and dairy industry and domestic pets, specifically dogs and cats. Cattle make attractive hosts to the flies because they are large animals that are prone to open wounds, especially the umbilical site, and spend most of their time outdoors with exposure to insects and wildlife that may be carrying the fly larvae. Outbreaks can spread quickly through the herd and often results in significant illness and death.

Dr. Michael Osterholm : New screwworm can be devastating to producers and is incredibly expensive to manage. To date, we have seen cases in the United States, both in Texas and a dog in New Mexico. So when you look at the states that have long borders with Mexico, the amount of susceptible cattle that are at high risk is remarkable. In addition, since domestic pets can also become infected, they. To add to the concern that we have around screwworm entering our country. In response to increased detections and ongoing threats, USDA announces plans to invest $1 billion into new school remediation, $750 million of that will go to a new Texas facility capable of producing hundreds of millions of sterilized flies a week. The impact of this strategy will likely not take place for at least a year. Well, in fact, how do we get here? And we got here largely through what I would consider to be a dereliction of duty relative to the control of this particular problem. What do I mean? There are a number of actions that the federal government has taken in the past year that actually put us at great risk for this event to occur. First, the DOGE led reductions. The Elon Musk Department of Government Efficiency, or DOGE, eliminated funding for an international project tasked with monitoring and containing the New World screwworm  in Central America. Second, global health security cuts. The administration cut $250 million from projects under the Global Health Security Program, which directly impacted cross-border screwworm surveillance. Third, local office closures in 2025 budget cuts led to the closure or defunding of the regional USDA Plant Inspection Service offices in Uvalde, Texas.

Dr. Michael Osterholm : The exact location where the current 2026 outbreak is concentrated. And fourth, and finally, according to federal records, nearly 20% of US counties that began 2025 with an active APHIS employee ended the year with zero personnel, severely weakening local tracking. So we shouldn't be surprised that we see this problem. In addition, there was a call for a need for increased production of sterile male flies long before we actually saw this spillover into the United States. So what happened because of these prior cuts, USDA Secretary Brooke Rollins has had to scramble to finance this massive $1 billion containment effort to fund the emergency deployment of millions of sterile male flies. The USDA terminated and reallocated over $1 billion from domestic agricultural initiatives, specifically taking money away from the Biden era, local foods for schools and local food purchase assistance programs. Hardly a good alternative in terms of talking about protecting the public health. So let me just conclude by saying, this really brings us to the bigger picture here. Prevention has long been the most effective and economical strategy to protect the US cattle industry from New World screwworm , which is why so much innovation has gone into the eradication of it in the first place. But as we're seeing now, once that strong barrier is weakened, as has been done over the past several years, the consequences become very real quickly. In the meantime, livestock producers are on the front lines of this battle and are tasked with staying vigilant over their herds and as well as domestic pets and following local guidelines. Awareness and early action are critical in limiting the spread while control efforts scale up.

Chris Dall: And that brings us to our ID query. And we've received several emails from listeners who want to know what level of threat New World screwworm  is for people. Mike, what can you tell them?

Dr. Michael Osterholm : Well, as I noted in the previous question and answer, in fact, the New World screwworm  can infect people. Last year, Mexico reported 141 such cases. In fact, the New World screwworm  can threaten human health in different ways one by impacting our food supply, which we've already covered. Second, there's also direct human infection, which can occur in the United States. There has only been one human case of New World screwworm  in the last 50 years, and it occurred last year in a Maryland resident that had recently traveled to El Salvador. There was no onward transmission of New World screwworm  from this case to any other people, livestock or pets. However, our listeners are right to be cautious about the potential for this to become a bigger threat to human health. If the New World screwworm  fly continues to move northward. The current outbreak in Central America and Mexico has been ongoing since 2023, causing approximately 2000 cases in humans so far and 141, as I just noted in Mexico last year alone. Human infection occurs when the female New World screwworm  lays eggs in an open wound or mucous membranes. These eggs become larvae that burrow into the flesh, causing severe, painful wounds that can leave permanent damage if left untreated. While this does not paint a pretty picture, our listeners should be assured that there are several preventive measures they can take actively to limit the possibility of infection if they live in or travel to an impacted area. First, keep open wounds clean and covered, which is broadly applicable to all infection prevention, not just related to the New World screwworm . People should sleep indoors with closed windows or inside a screen tent if outside.

Dr. Michael Osterholm : Also, people can protect their skin by using an EPA registered insect repellent. Treat clothing and gear with products containing 0.5% permethrin, and wear loose fitting clothing that covers all parts of the body to limit access to New World screwworm  flies and biting insects. It's worth noting that the impact that areas so far in Texas and New Mexico are small, and the risk to human health at this point in time remains low. However, any health care providers that suspect a human case should report it immediately to their local health department. There is currently no approved medication for human New World screwworm  infestations in humans, and treatment consists of removing all larvae from the infected sites, along with monitoring for secondary bacterial infections. It should be noted that there have been some who believe that ivermectin, while not FDA approved, can in fact be helpful in treating individuals with new screwworm infestations. We'll continue to follow this to see what kind of information we can identify that supports this conclusion. The actions US government is taking to prevent the spread of the New World screwworm  in livestock should, in theory, also prevent potential spread to humans. However, the federal response has been so slow and as I noted, actually has been far short of what is needed. New World screwworm  moves fast with a single fly capable of traveling up to 125 miles to search for hosts. So the US response needs to move much faster. We promise to keep our listeners updated as we learn more about this reemergence of a New World screwworm  in the US.

Chris Dall: As of last Friday, the US now has 2073 confirmed measles cases so far this year, and that's not that far off from the 2288 reported for all of 2025. And last week, the investigative news site ProPublica published its own analysis of measles genome sequences from the outbreak, which concluded that the genetic code of measles cases in Utah, currently home to the largest outbreak in the country, is pretty similar to cases from the Texas outbreak that began in January 2025. So, Mike, does that mean that the U.S. is likely to lose its measles elimination status?

Dr. Michael Osterholm : Well, Chris, I'd say we're at least getting pretty close to the tipping point on this one. First, it's important to understand what elimination actually means. It doesn't mean zero cases. The U.S. regularly sees travelers bringing cases of measles in from other countries. The issue is when the virus starts spreading continuously within the country. If there's an unbroken chain of transmission lasting more than 12 months, that's what would qualify as endemic spread, and that's what would trigger the loss of elimination status. This is where the recent reporting in genomic analysis come into play. Propublica looked at more than 1800 measles genome sequences and found that the virus circulating in Utah is very closely related to the strain from the Texas outbreak that began in January of 2025. On the surface, this raises a red flag if these outbreaks are part of the same transmission chain stretching over a year and across multiple states, that would surely support endemic spread. But genomic similarity is not definitive proof by itself. To make a determination like this, public health officials don't just rely on sequencing, they need epidemiology evidence such as travel histories and known connections between patients. And that's where things get messy in Utah.

Dr. Michael Osterholm : Investigators haven't been able to clearly identify how the outbreak started. The first known patient didn't have a travel history, and there are signs that the virus may have been circulating under the radar before it was officially detected. At the same time, there was There's incomplete data from nearby regions, including parts of Canada and Mexico, so it's hard to rule out the possibility that the virus moved outside the US and came back in. Right now, we're in this kind of gray zone. The genetic evidence makes it harder for us to confidently argue that all these outbreaks are separately imported events. But there's also not enough evidence yet to definitively say there's been a continuous chain of transmission within the country. So the bottom line is this the US hasn't lost its official measles free status. But the case for keeping it is getting harder. And perhaps more importantly, regardless of how that specific determination shakes out, these rising case numbers and complex outbreaks are a sign that the systems that once kept measles firmly under control are under real strain, and that, more than the label itself, is what has public health experts paying close attention right now.

Chris Dall: And finally, is there anything worth noting on COVID 19 flu and respiratory syncytial virus?

Dr. Michael Osterholm : Actually, I think there is something worth noting. And it's again, continued good news respiratory virus activity remains very low, with every metric either decreasing or staying the same across the board. There are still no indications of increasing COVID 19 activity in wastewater concentrations, either. While there is not anything worth noting as far as COVID 19, influenza or RSV activity, there was a preprint published that I want to make note of. The CAO lab at Peking University performed a study which demonstrated that the BA 3.2.2 variant of SARS-CoV-2 was significantly enriched in pediatric populations, indicating that children are more susceptible to the variant compared to others that are currently circulating. The author suggests that this enhanced susceptibility to be a 3.2.2 is due to a lack of ancestral SARS-CoV-2 imprinting. Imprinting is a phenomenon that occurs whereby the body's initial exposure to a specific strain of virus dictates how the body responds to future strains of the virus. Children under age of five hadn't been born yet during the early stages of the COVID 19 pandemic, so they were never exposed to the earliest version of the virus, especially if they weren't vaccinated. The good news is that vaccination is still the best method of preventing infection with any SARS-CoV-2 variant in all populations.

Dr. Michael Osterholm : The authors of this study did not see the same pattern of enhanced pediatric susceptibility among kids that were vaccinated. One of the reasons I'm highlighting this study specifically is because it's one of the first major demographic shifts we've seen with variants of the SARS-CoV-2 virus. This finding is also coming at a time in which many countries have dramatically reduced efforts to sequence and share data on currently circulating SARS-CoV-2 variant here in the US. There is so little sequencing data being generated now that variant proportion estimates are aggregated into month long intervals, so that there is a large enough sample size. During the height of the pandemic, those estimates were made on a weekly basis. While it's a good thing the case burden is nowhere near what it was during the height of the pandemic, we have to remain vigilant. Sars-cov-2 will continue to evolve whether or not we are actively monitoring it. Variant proportion estimates are also used to inform vaccine strain selection, and it's very important that those data are representative. So we can continue to have the most effective COVID 19 vaccine.

Chris Dall: Now it's time for this week in public health history. Mike, what are we commemorating this week?

Dr. Michael Osterholm : Chris, this week, I want to take some time to reflect on a moment that intersects with a couple of different things we talked about today on the podcast. I've mentioned this in past episodes, but I'm talking about the measles outbreak at the Special Olympics World Games back in 1991. An outbreak investigation that I actually led. The International Special Olympics was hosted back in July of 1991 in Minneapolis. The games brought people together from all 50 states as well as over 90 countries. There were over 6000 athletes, 40,000 support staff and around 150,000 spectators in total. In August, the Minnesota Department of Health was notified that there were two cases of measles in Minnesota residents that had been involved with the games. That was just the beginning. In total, there were 16 cases of measles reported among US residents from seven different states, with an additional nine cases resulting from subsequent transmission. The primary case was traced back to an athlete from Argentina. We're not certain how many additional cases actually occurred in those who are from outside the United States who may have actually become ill after leaving the Minneapolis location. But why is this outbreak something I'm noting today? It was a special event for me. I got to work with some of the finest people I've ever worked with in all of my public health career. Those who work with the International Special Olympics are people who are very caring and cooperative. Here we had a major event going on, but we also had to deal with measles at the time.

Dr. Michael Osterholm : Roy Smalley, a former Minnesota Twins baseball star, was actually serving as the chairperson for this event here in Minnesota. I can only tell you that Mr. Smalley could not have been more helpful to us in trying to investigate this outbreak and to make sure that we did everything we could to limit transmission during the games. I was so impressed with all the staff at the Special Olympics. I remember feeling that we were all in this together. There was no attempt to minimize the importance of what was happening. Remember, this is also the outbreak where we learned so much about what was going on with transmission. We had two cases in individuals who sat more than 420 ft away from the index cases location during the opening night session. This young boy from Argentina was the original source of the outbreak, and transmission occurred at that distance because of the airflow that we could trace from home plate to where it dumped into the stands. That was a remarkable finding, and it was one that just reminded us of the dynamics of airborne transmission. So I just want to say to all those who are part of the International Special Olympics back in Minnesota in 1991, we still remember what you did and how you did it with such fondness, and want to thank you for the service that you provide our world to support and help those with intellectual disabilities.

Chris Dall: Mike, what are your take home messages for today?

Dr. Michael Osterholm : First of all, the Ebola epidemic is a real challenge and it's growing substantially. I'm very concerned about what we're going to see over the next coming months with this situation. And unfortunately, the world still is really ill prepared to handle this kind of outbreak. In terms of resources, in terms of professional support staff and in terms of the locals believing in what must be done to bring it to a halt. The second point is there's still very good news about respiratory viruses here. We're going into the summer with minimal activity with influenza, with RSV and of course, with COVID. And this is obviously very good news. The third thing is I hope that the comments I made today, whether they be about screwworm, whether it be surveillance for illnesses associated with the World Cup or, for that matter, how quarantine activity is being handled with a hantavirus outbreak. It's fair to say our federal government right now is slipping on many different fronts and in some cases, in very big ways. And I'm going to add a fourth one to this list. I usually have my list of three. I want to remind everyone out there, this Sunday is Father's Day. For all of us who have appreciated the role that fathers or mentors have played in our lives. Now is the time to say thank you to them. And if you've had a difficult situation, your father. I wish you the best. I understand that one all too well. But for now, focus on the good.

Chris Dall: And what do we have for our closing for this episode?

Dr. Michael Osterholm : Well, let me follow on the theme here. As I pointed out a moment ago, the Special Olympics are dedicated to enhancing the lives of individuals with intellectual disabilities, A mission, as they described it, transcends the boundaries of sports to address discrimination in all its forms. Special Olympics really were started to harness the power of unification through sport as a primary platform. However, as has been described by the Special Olympics Committee, their mission extends far beyond the realm of competition. They aim to combat discrimination and promote inclusivity, ensuring that the 6.5 million people with intellectual disabilities in the United States and the 200 million globally, are no longer subjected to injustice, exclusion and discrimination. Too often, individuals with intellectual disabilities are denied their basic human rights on an issue we strive to rectify. From that standpoint, I wanted to focus on the Special Olympics as a way to celebrate the events of this upcoming event here in Minnesota, and there is one song I think that plays to this beyond almost any others. Fly is a song by Canadian songwriter Avril Lavigne. It was released in April 16th, 2015 for digital download by the Special Olympics Inc. Lavigne released the song as a charity single for the Avril Lavigne Foundation to support the 2015 Special Olympics World Summer games. All the proceeds from the single were contributed to the ongoing work being done by the Avril Lavigne Foundation, one that also addresses this very issue. Today, I'm very happy to share with you what I think is a wonderfully beautiful song at a time when we need that kind of feeling, and it so does match the moment with the Special Olympics being held here in Minnesota. So here it is, Avril Lavigne. Fly.

There's a light inside all of us. It's never hiding. You just have to light it. It's the one thing that you gotta trust. It's like a diamond. You just have to find it. So if you ever feel like giving up. Yeah. Just remember that we are all meant to fly. Spread your wings across the universe. It's your time to. It's your time to shine. There's a light inside all of us. Soon you'll find that it's your time to fly. Your time to fly. A little help is all it ever takes. Somebody else to tell you it's worth fighting. A single step becomes a leap of faith. And when you realize you start flying. So don't ever say you're giving up. No, there's no looking back. Because we're all meant to fly. Spread your wings across the universe. It's your time to. It's your time to shine. There's a light inside all of us. Soon you'll find that it's your time to fly. It's your time to fly. Just reach up. Don't give up until you've touched the sky.

Dr. Michael Osterholm : Just reach up. Don't give up until you've realized that we were all meant to fly. Avril Lavigne. Well, thank you again for joining with us. A lot to cover today. A lot of different topics. I wish I had better news on a number of these topic areas, but it is what it is. And we're here. We'll continue to be here. Please share with us your thoughts, your ideas, your feedback to all the fathers out there. Happy Father's Day to you. I know how important a father can be in one's life, or how difficult it can be without one. So don't forget to say thank you to your fathers out there who deserve such a thought. And finally, I'd like to just say, please send us your thoughts about how we can improve this podcast. What would you like to hear more about? And most of all, in a world that is in such turmoil right now, be kind, be thoughtful. Just be kind. One act of kindness a day that you hadn't anticipated will make your life much better, and it will surely improve on the life of someone else. Look forward to talking to you in a couple of weeks. It's going to be a wonderful weekend with the brightest days of the year. Don't forget to enjoy that. Thank you. Be kind. Thank you.

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.edu. This podcast is supported in part by you, our listeners. The Osterholm update is produced by Sydney Redepenning, Elise Holmes and Ruby Guthrie. Our researchers are Cory Anderson, Meredith Arpey, Leah Moat, Emily Smith, Clare Stoddart, Angela Ulrich and Mary VanBeusekom.