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Joe Rogan Experience #1439 - Michael Osterholm

Michael Osterholm is an internationally recognized expert in infectious disease epidemiology. He is Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP), Distinguished Teaching Professor in the Division of Environmental Health Sciences, School of Public Health, a professor in the Technological Leadership Institute, College of Science and Engineering, and an adjunct professor in the Medical School, all at the University of Minnesota. Look for his book "Deadliest Enemy: Our War Against Deadly Germs" for more info. https://amzn.to/2IAzeLe http://www.cidrap.umn.edu/

Joe RoganhostMichael Osterholmguest
Mar 10, 20201h 34mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:02 – 0:27

    Osterholm’s role and why COVID-19 is “just beginning”

    1. JR

      All right, here we go. Uh, so what you said when you sat down was absolutely perfect, that the timing could not have been better. Well, tell everybody what you do, Michael.

    2. MO

      Well, thank you. I'm a, for a lack of a better term, a medical detective. I've spent my whole career tracking infectious diseases down, trying to stop them, trying to understand where they come from so we can make sure they don't happen in the first place, but most of all, trying to respond to situations just like this.

  2. 0:27 – 3:59

    How bad could it get? Comparing COVID-19 to seasonal flu with concrete projections

    1. JR

      Just like this. And, um, just o- off the bat, how serious is this? Is this something that we need to be terrified of or is this overblown or... ho- how do you stand on this?

    2. MO

      Well, first of all, you have to understand the timing of it in the sense that it's just beginning. And so in terms of what hurt, pain, suffering, death has happe- happened so far is really just beginning. Um, this is gonna unfold for months to come yet and that's, I think, what people don't quite yet understand. Um, what we saw in China, uh, I'm convinced as are many of my colleagues, as soon as they release all of these, uh, social distances, these mandated stay in homes, haven't left their home in weeks and weeks kind of thing, when they go back to work, they're on planes, trains, subways, buses, crowded spaces, manufacturing plants, even China is gonna come back again. And so this really is acting like an influenza virus, something that transmits very, very easily through the air. We now have data to show that you're infectious before you even get sick and in some cases quite highly infectious. Just breathing is all that you need to do. So from this perspective, I can understand why people would say, "Well, wait a minute, flu kills a lot more itself every year than this does." And I re- remind people that this is just the beginning. Probably the best guesstimate we have right now on what limited data we have would say this could be at least 10 to 15 times worse than the worst s- seasonal flu year we see.

    3. JR

      10 to 15 times worse in terms of fatalities or...

    4. MO

      Yeah, yeah. And, and just illnesses. In fact, I just, I brought some numbers. We, uh, conservatively estimate that this could, in, uh, require 48 million hospitalizations, 96 million, uh, cases actually occurring, over 480,000 deaths that can occur over the next three to seven months with this situation. So this is not one that to take lightly, and I think that's what I can understand if you say there's only been 10 deaths or 20 deaths or 50 deaths. Just remember, two weeks ago, we were talking about almost no cases in the United States, and now that we're testing for it and watching the spread as it's unfolding, uh, those numbers are going up astronomically. Three weeks ago, Italy was just living life just fine. Now they're literally in a virtual shutdown in the northern parts of Italy. And that's the challenge with an infectious disease like this. It can spread very quickly and it also can infect people. I think maybe to put this into modern terms, because this is something we think of often when we think of, of, you know, pre-antibiotic days, you know, the old time medicine. Um, we have an employee at our Center for Infectious Diseases Research and Policy at the University of Minnesota, and she has a dear friend who lives in Milan, Italy, and she works at a hospital there. And she texted us to... this employee of ours last night, and this was an email that came out yesterday from one of their physicians in Milan at the largest hospital there. He said, "I just got a very disturbing message from a cardiologist at one of the Milan's largest hospitals. They're deciding who they have to let die. They aren't screening the staff anymore because they need all hands on deck, and they have very small areas of the hospital dedicated to non-COVID patients where they still screen doctors. Everybody else is dedicated to COVID patients, so even if they're positive, meaning that they're sick, they don't... and, but they don't have a severe cough or fever, then they have to work." Uh, he says that, that they're seeing an alarming number of cases in the 40-something range, and it's h- these are horrible cases. So we need to stop thinking that this is only an old person's disease. This is what's going to unfold not just in Wuhan, it's unfolding in Milan, it's unfolding here in, in Seattle, and this is what's gonna continue to rollingly unfold throughout the world.

  3. 3:59 – 5:16

    Who is at highest risk—and why U.S. risk factors differ from China’s

    1. JR

      Yeah, where did this rumor come from that it's, uh, an old person's disease? Is it just because the majority of the people that have died from it so far have been older?

    2. MO

      Yes, in fact, that's the primary risk factor for dying is being old and then having certain underlying health problems. For example, in China, uh, those men over the age of 70 who also smoked were 8 to 10% of them died. 65% of older Chinese men smoke. The, uh, case fatality rate or the percentage of people who die in women in that same age group was only about 2%. In that case, w- very few women smoke. Now, the challenge we have is that that's the Chinese data, but there are a series of risk factors that we worry about that if they overlay on this disease are gonna cause bad outcomes, and we happen to be right at ground zero for one of the major ones here in this country, and that's obesity. Uh, we know that obesity is just like smoking in terms of its ability to really cause severe, life-threatening disease and 45% of our population today over the age of 45 in this country are obese or severely obese, and it's men and women. So one of the concerns we have is we're gonna see more of these, uh, what I guess I would call very serious and life-threatening cases occur in our country because of the set- different set of risk factors than we saw in China.

  4. 5:16 – 7:52

    Incubation, presymptomatic spread, and why this virus is hard to stop

    1. JR

      Now, y- you mentioned that there's some sort of an incubation period before people become sick, they're still contagious. What is this incubation period and how do we know about it?

    2. MO

      When we call something an incubation period, we're talking about from the time you and I got exposed, meaning I was in a room breathing the air that somebody else who was infected, uh, with the virus was expelling out, I breathed it in. How long from that time period till the time period that you get sick...And what is that? It's, that's what we call the incubation period. So that's when case numbers can double or triple in every so many days. In this case, it's about four days. So... And we actually have data there from people who are exposed one time or one time only, and we know when they were exposed, where they were exposed, and how soon do they get sick afterwards. So the chauffeur in the car where an individual was sick or showing symptoms, then the chauffeur gets it four days later. You know, they were there one time and one time only.

    3. JR

      And if the chauffeur does not show any symptoms, he's still contagious? He could still give it?

    4. MO

      He could, he could also-

    5. JR

      ... give it.

    6. MO

      ... be contagious too or he... And that's one of the things that's challenging here, is you and I might get exposed to somebody who is totally asymptomatic, no symptoms. That virus that appeared, "Well, that's not a very strong virus." But in fact when it infects us, it could kill us. So we've seen cases of, of fatal disease that were exposed to people that had minor symptoms themselves.

    7. JR

      Wow.

    8. MO

      And this is what's unfolding here, and, you know, and this is where I think is such an important... And, you know, I said why the timing is so important 'cause, you know, Joe, we've really gotta get information out to the public. There is so much misfor- information right now and, you know, we're gonna be in this for a while. This is not gonna happen overnight and I worry... I keep telling people we're handling this like it's a corona blizzard, you know, two or three days-

    9. JR

      Mm-hmm.

    10. MO

      ... we're back to normal. This is a coronavirus winter. And we're gonna have the next three months or more, six months or more, that are gonna be like this. And, you know, so far this thing has been unfolding exactly as we predicted it. We in our center put out a piece, uh, on January 20th and said this is gonna spread worldwide. At the time people said, "Ah, no, it's just China." We put out a piece the first week of February and said this is gonna pop probably the last week of February, first week of March 'cause what happens is it has what's called an R naught or a doubling time of, of, of these every four days. So two, two... The increase is doubling every four days. So if you go from two to four to eight to 16, it takes a while to build up. But when you start going from 500 to 1,000 to 2,000 to 4,000, that's what we're seeing happen in places like Italy, we're beginning to see it in some ways up in Seattle, it's what happened in China. And, uh, you know, when people are confronted with that, suddenly this low risk phenomena that everybody talks about isn't so low anymore. And that's what we need to prepare people for.

  5. 7:52 – 9:23

    Public behaviors (masks, gloves) vs. what actually helps: distancing and exposure reduction

    1. JR

      Now what can be done? Like, what, what can the average person do? I see people walking around with masks on, wearing gloves. Is that nonsense?

    2. MO

      Largely. Yes.

    3. JR

      Yeah.

    4. MO

      First of all, um, let's step back. The primary mechanism for transmission is just the respiratory route, it's just breathing. Um, in studies in Germany which just have been published literally in the last 24 hours, um, they actually followed a group of people who had been exposed to somebody in a automobile manufacturing plant, and then they had nine people that, with this exposure, they said, "If you have any symptoms at all, contact us. We wanna follow up." And they all agreed. Well, they got infected and so in the very first hours, just feeling bad, sore throat, they went in and sampled their throats, their, their saliva, their nose for virus, they did blood, they did stool, they did urine, and they found that at that very moment when they first got sick, they had incredibly high levels of virus, sometimes 10,000 times that what we saw with SARS, in their throats, meaning they were infectious at that point already and they hadn't even had symptoms yet of really any nature. They weren't coughing yet.

    5. JR

      Wow.

    6. MO

      And, and that's where we're concerned because that's the kind of transmission that's tr-... You know, I always have said, trying to stop influenza virus transmission is like trying to stop the wind. You know? We di-... We've never had anything successfully do that other than vaccine and we don't have a vaccine here. So what's happening is that people in public spaces are getting infected and the way you need to address that is, unfortunately, if you're older, over 55, you have some underlying health problems which, unfortunately, a lot of Americans do, we have, uh, obesity, then right now

  6. 9:23 – 12:10

    Schools, cruise ships, and the real tradeoffs of containment measures

    1. MO

      you don't wanna be in large public spaces and trying to potentially get infected. So you can take care of that part. As far as what can public health do, we're not gonna... We can talk about this, we're not gonna have a vaccine any time soon. That's happy talk. Um, what we... You know, we can close schools. One of the big challenges we have right now, if we close schools, what do we accomplish? In influenza virus, when you, we close schools during outbreaks because it turns out kids are, get infected in school and they're like little virus reactors. You know, they come home and they transmit it to mom and dad and brothers and sisters and, uh, so we close schools sometimes and s-... Christmas breaks are always great for kind of putting a dampening effect on flu. In this case, kids are not getting sick very often at all, which is one of the really good news features of this disease. In Ch- China, only 2.1% of the cases were under age 19 years of age. And-

    2. JR

      Why is that?

    3. MO

      You know, we don't completely know. Uh, and, and I'm gonna come to that in a second because they're getting infected, it turns out. One study showed that they still get infected with the virus but they don't get sick. And we have that happen. There's a disease called infectious hepatitis, hepatitis A, where we have outbreaks in daycares. And the way we know we have an outbreak is 'cause it's transmitted through the stool, fecal-oral, is mom and dad and the daycare providers all get sick and the kids, those symptoms, we go in and test the kids, they're all positive. So some diseases will manifest mi- primarily when you're an adult but not as a child. This one appears to be the same. So do we close schools or not if we're not really spreading the disease? Because it turns out that if we close schools, we... A recent study done showed that 38% of nurses today in this country who are working in the medical area have kids in school and if suddenly we're closing schools for two or three months, who's gonna take care of those kids? One fourth of the American population has no sick leave. If we close schools, they don't get paid if they have to stay home. So when you ask what can we do, we have to really be thoughtful about what we do. Are we doing more harm than good by closing schools, for example, even though everybody will say, "Oh, we gotta do everything we can." Or do we just tell people, "You know, it's gonna be limiting your contact as much as you can." And that's really about what we can do.

    4. JR

      And limiting the contact, is that really gonna help?

    5. MO

      It does because it's like putting rods in a reaction. If you, if you don't have as much close contact, you can, you know, not transmit as much. If I'm, if I'm sitting in a room with 100 people and we're kind of sharing air, the transmission's remarkable.... right here, you know, off the coast of California, you've got your cruise ship. Cruise ships are-

    6. JR

      Mm-hmm.

    7. MO

      ... notorious for recirculating air inside the inner cabins. We've had a number of outbreaks, a lot-

    8. JR

      That's why they're having these outbreaks on cruise ships?

    9. MO

      Yeah. And then you leave them on there. I think the, uh, the cruelest human experiment we've done in a long time with humans-

    10. JR

      Yeah.

    11. MO

      ... is leave them on these ships. Get them off right away.

    12. JR

      Should they get them off right away?

    13. MO

      Oh, absolutely. Get them on-

    14. JR

      And what should they do with them?

    15. MO

      Well, they can put them in quarantines of some kind if they want and follow up on them, but you're guaranteed they're all gonna keep getting infected day after day.

  7. 12:10 – 15:21

    Why we weren’t prepared: supply chains, stockpiles, and critical drug shortages

    1. JR

      It seems like we're not really prepared for something like this, although the, uh, the, the CDC has been telling us for a long time that we should be.

    2. MO

      You know, we are, uh, not prepared at all in the sense... You know, I, uh, wrote the book, um, Deadliest Enemies that was published in 2017.

    3. JR

      Right here, ladies and gentlemen.

    4. MO

      Thank you. Uh, th- uh (laughs) . Thank you.

    5. JR

      Go get it. Read it.

    6. MO

      Now, and-

    7. JR

      Panic.

    8. MO

      ... in, uh, Chapter 13, the title of the chapter was SARS and MERS: A Harbinger of Things to Come. You know-

    9. JR

      Oh, boy.

    10. MO

      ... we predicted this. And then I wrote a chapter on there what a flu pandemic would look like if it emerged in China. And if you read it, it's exactly what's happened. The supply chains went down, China locked down the country, it spread to other countries. People all pointed fingers. And, you know, it's, it's the kind of thing where we hear it and hear it, but we don't get prepared. You know, five years ago, I gave a talk at the Mayo Clinic. Uh, I have a r- first time I talked about this, I've talked many times afterwards, and I showed a slide of Puerto Rico, a picture of Puerto Rico, and then I showed the map and then I showed a picture of a building in Puerto Rico, a nondescript building, and I said, "This is our next big disaster." It turns out that 85% of all the world's production of IV bags, s- with saline that we need desperately, were made in these plants in Puerto Rico, and all we needed was one, one Category 5 hurricane to come through and take it out. Maria came through a year and a half ago, and the world went into a major crisis with a shortage of IV bags. Now, that was so obvious that was gonna happen, and yet we don't prepare.

    11. JR

      That's so foolish.

    12. MO

      I know. I agree. And that's what... Hopefully, this is a wake-up call. The business community, I hope we will wake up. You know, one of the other things we're doing right now, uh, Joe, this is really... One of the things that has me most concerned about this whole situation is our group has been studying for the last year and a half, uh, with support from the Walton Family Foundation, um, looking at critical drug shortages. It turns out that we identified 153 drugs in this country that people need right now or they die. I mean, it's on the crash card, it's acute critical drugs. 100% of them are generic. All of them basically are made offshore of the United States, and a large part of them are made in China and India. And at this point, we have shortages anyway every day, just before this crisis happened. Now these supply chains have gone down. Our group is actively helping the United States government try to figure out, you know, where they can get these drugs. Now, just think of this, if I came to you and said the Defense Department was gonna outsource all its munitions production to China, you'd look at me and say, "Come on." You know what? The US Defense Department has no more access to these drugs than anybody else. They are beholden to China for these drugs. 690,000 Americans have end-stage renal disease right now. M- most of their primary drugs are coming from China. And now with the shutdown and what's happening with this, and this is what I talked about in the book why I was so concerned, because we are at risk. So even as the situation is to unfold, it's not just about what the virus does to you, it's about what the entire system is rigged up to be and what this virus does once it gets into it.

    13. JR

      Jesus. You're making me nervous.

    14. MO

      Well, but that's... Before we get done here, we're gonna talk about what we can do to get people not nervous, because this is-

    15. JR

      What? It's too late. (laughs)

    16. MO

      No, no, no. What I mean is we're, we're gonna, we're gonna bring you around to take... You know, it's, my job is not to scare you out of your wits, it's to scare you into your wits.

    17. JR

      Let me ask-

    18. MO

      What can we do about it?

  8. 15:21 – 18:01

    Debunking viral claims: sauna ‘cures’ and other misinformation dynamics

    1. JR

      Sorry. Let me ask you something-

    2. MO

      (laughs) .

    3. JR

      ... about sauna use. One of the things that I read was that, uh, if you are in contact, that 20 minutes in a sauna, in a, a really hot sauna is, uh, very good for killing some of the virus. Is that bullshit?

    4. MO

      Yes.

    5. JR

      Jesus Christ, these people. Yeah. There was a, some sauna facts thing that was being, um, pushed around that it's great for flu and all sorts of infectious diseases.

    6. MO

      Actually, it's great for you. I mean, it makes you feel good, but we don't have any evidence that makes any difference in infectious disease.

    7. JR

      Why is... So it doesn't have any impact at all? The, the idea was that the breathing in of the very hot air, uh, 180-degree air for 20 minutes will kill some of the virus.

    8. MO

      See, if that temperature of 180-degree air got really into your lungs, your lungs would be fried. You'd be dead.

    9. JR

      Well, how does it... Where does it go?

    10. MO

      So, so, so what happens is, just from the time you breathe it in and what, you mix it with the air there-

    11. JR

      Mm-hmm.

    12. MO

      ... it's kind of like taking a, a cup of hot water and putting it into a bathtub of cold water.

    13. JR

      Ah.

    14. MO

      And so what happens by the time you get done, it's not that hot. And so in this case, your lungs couldn't stand even 110 to 20-degree heat without causing really severe damage. And so it doesn't kill the virus at all.

    15. JR

      So it would... The virus would have to be, like, just in your mouth or something like that? Even then, no?

    16. MO

      No. No. Wouldn't-

    17. JR

      Jesus, Michael. That's unfortunate because that was, uh, that was exciting. I was reading that and I was like, "Wow."

    18. MO

      Don't stop using the sauna. It's a good thing to use-

    19. JR

      Oh, sure.

    20. MO

      ... for your skin and everything else, but, uh, yeah, but it's not gonna help you with this one.

    21. JR

      So how does it cool the air down? What's, what's happening? Can you-

    22. MO

      I- in terms of when you, when you ingest it?

    23. JR

      It's going right into your lungs, right?

    24. MO

      Yeah. Well, you, you basically... It's a mixture of you... You know, uh, when you breathe out, you don't breathe all the air out.

    25. JR

      Mm-hmm.

    26. MO

      Okay? I mean, you're, you've, you, that would... You'd almost be dead. You couldn't do the tidal volume. So what happens is every breath-

    27. JR

      What? What are you saying?

    28. MO

      Well, in other words, you have so much air in your lungs already-

    29. JR

      Right.

    30. MO

      ... when you breathe out, you breathe just a little bit of it out, and each time you bring more in, out, in and out. And so when this mixes in, the hot air like that or the very cold air... You know, in Minnesota, when it's 45 below zero, we have the same problem, we don't freeze our lungs, okay?

  9. 18:01 – 21:05

    Lab-leak and bioweapon claims: why the evidence points to zoonotic spillover

    1. JR

      All right. Well, so much for that myth. Um, myth number two, well, I won't say myth. I should say rumor, was that this was something from some sort of a biological weapons thing that was leaked, right? 'Cause Wuhan is some area or part of China that they actually do work on biological-

    2. MO

      Yeah.

    3. JR

      ... weapons.

    4. MO

      And, uh, we've heard that loud and clear. And let me just give a, a little bit background of more of my career. Um, back in the early 1990s, I got very involved in the whole area of biodefense and bioterrorism, biowarfare. Uh, it turned out I was involved with helping to, uh, in- interview and get information from some of the Russian bioweaponers after the wall fell and Russia collapsed. We had all these experts coming out who'd been spending their whole lives making bioweapons. And it became very clear to me this was really a serious challenge. And as part of my work, I, I spent a lot of time in this area and I actually, uh, through a series of, uh, serendipitous events, became a personal advisor to His Majesty King Hussein of Jordan before he died on this topic. I got really into it. Um, I wrote a book that was published, uh, in, uh, 9/11 of 2000 called Living Terrors: What Our Country Needs To Know To Survive The Coming Bioterrorist Catastrophe and I think I bought eight of the 12 copies that were sold that year afterwards. And then, when 9/11 happened, of course, then it became really prominent. Um, and then I went on to serve on a group here in the United States that was basically the National Science Advisory Board of Biosecurity, safety issues. So I've had a lot of experience in this area, and so I bring that to the table when I tell you there is no evidence whatsoever that this is a bioweapon or that it was accidentally released from the Wuhan lab. Um, today, with the genetics we have on these viruses and how we can do testing, we can almost date them, almost like carbon testing, you know, so radiocarbon and you wanna know how old a, a block is or something like that. This thing clearly jumped from an animal species probably the third week of November to humans. And pangolins, you know, these scaly anteater-like animals are, are a very good source because we have coronaviruses just like those in these animals and it got into a human. So, you know, we've surely had a lot of challenges with that, but I don't believe that there's any evidence linking this to, uh, one, an intentional release, an ac- or an accidental release, or that it's an engineered bug. It's not.

    5. JR

      My friend Duncan and I did a show back, uh, in 2012-ish, somewhere around there, with, um, Sci-Fi, where we went to the CDC in Galveston and we talked to them about that very thing.

    6. MO

      Yeah.

    7. JR

      And they said the real concern, the real concern is just actual diseases. It's not man-made diseases.

    8. MO

      And-

    9. JR

      It's just-

    10. MO

      That's right.

    11. JR

      ... naturally occurring diseases.

    12. MO

      That's exactly it. I mean, look at wh- you know, we could not have crafted a virus like this to do what it's doing. I mean, we don't have the creative imagination or the skill set. If somebody said, "Okay, I wanna find a virus that will take out a lot of people," okay? This one, Mother Nature does it so much better than we could ever do it. And, you know, whether it was Ebola, whether it's this one, or it's antibiotic resistance, any of these things, I mean, you know, and Greg and I were talking earlier about the potential for chronic wasting disease to be a problem for humans. You know, Mother Nature is doing it pretty well on her own.

  10. 21:05 – 31:42

    Chronic wasting disease (CWD): prions, mutation, and the human spillover worry

    1. JR

      The chronic wasting one really scares me because there's so many people that have a vested interest in dismissing it. Um, I had, uh, our good friend Doug Duran-

    2. MO

      Yep.

    3. JR

      ... on the podcast with, uh, I don't remember the gentleman that he brought with him.

    4. MO

      Brian Richards.

    5. JR

      Thank you.

    6. MO

      Mm-hmm.

    7. JR

      Brian Richards, who, uh, explained the science behind it. And there are so many people that are dismissing this because either they enjoy deer hunting or they, they want, uh, captive cervids to be something that are, are still, uh, uh, something that you could be released on private property-

    8. MO

      Mm-hmm.

    9. JR

      ... 'cause people grow and breed deer and then sell them to ranchers who want deer in their properties, particularly large deer. And, um, I mean, guys that I have talked to that are dismissing it, I can see the chain of events that they want it to be not a concern, but if you see what it's doing to deer, it's terrifying. It's 100% fatal. Um, it, the, the DNA exists on plants for years. They, they leak it out of their saliva. They leave traces of it everywhere. And w- in Doug's area, there's some, uh, some near, somewhere near there, there's like 50% infection rate.

    10. MO

      That's right. Uh, I, listen, I think this is really a significant challenge. I, um, was involved back in the 1990s, uh, and around the 8, 1980s when mad cow first emerged in England. And at the time, uh, was asked to give an assessment when this was all, this bovine spongiform encephalopathy and other prions, it's, uh, these prions are what causes disease. And, you know, people wanted to dismiss it that the people weren't gonna get sick. Well, then we realized 10 years later all these human cases started to show up that were from those exposures 10 years before. And it took a while before those prions obviously changed in the cattle to get to the point where they'd infect humans. Well, the same thing is happening with deer. If you look back on the, uh, deer population that were infected 30 years ago and you look at it today, the prions are constantly changing. They're mutating. They're, they're new strains and they're getting more human-like all the time. And one of the things our center is doing is looking at, working on that very issue of trying to help people understand that the studies that were done 15 or 20 years ago looking at how infectious these might be for humans were really well done. They were good, but they had different strains. And over time these strains are looking to be more and more like they could infect humans or they could even infect cattle, which would be another huge challenge-

    11. JR

      Mm-hmm.

    12. MO

      ... if that happened. And so I think your point's a really good one, and we know today that there are probably at least 17,000 deer that were consumed in the past year, uh-... that were actually, uh, positive for this prion and people went ahead and ate them anyway. So I worry about that too.

    13. JR

      That's terrifying. So these people have these prions in their system now, but then currently, they're not... they're not making the jump to cause, uh, what is it? Uh, Jacob's Creutzfeldt's disease?

    14. MO

      Yeah, Creutzfeldt-Jakob disease-

    15. JR

      Creutzfeldt-Jakob.

    16. MO

      ... which is what... Yeah, it's kind of a... We don't know that humans are getting infected. One of the challenges, we don't have a test unless you die-

    17. JR

      Right.

    18. MO

      ... and then that's a heck of a way to have to get a test result, okay?

    19. JR

      Oh, boy.

    20. MO

      So one of the challenges, you don't know this until you actually show up with the signs and symptoms. And so one of the things that we're looking at carefully is doing surveillance or disease detection among people that might present with this. If it's gonna happen, uh, I suspect, uh, the naturally occurring prion-related diseases like Creutzfeldt-Jakob disease you just mentioned occurs typically in older people over 70. If you sudden... start seeing a 40-year-old or a 50-year-old, or 60-year-olds even with this disease, then you gotta start thinking what else is going on. And so that'll help us detect it in cases. But then we've already failed. You know, then we've had 10 years worth of transmission or more potentially before we get the first human cases like we did with mad cow. And so our message has been right now, hunting is really important. It is a very important part of our society. Frankly, it's, it's the way we manage deer herds, thank God. It's a huge economic boon for running the kinds of DNRs, et cetera, we have. We balance the back, as you know, from sportsmen on these licenses. And so we don't wanna stop hunting, but we've gotta make sure that we... and make sure that people aren't getting infected. And one of the things that our group at the University of Minnesota is working on is tests now that are almost like point of detection tests. So if you shoot an animal, could you know very quickly that it's positive or not? And then you'd know not to process that animal or eat it.

    21. JR

      Right.

    22. MO

      And that's what we need to get at.

    23. JR

      Well, not only that. The, the prions, what's terrifying is that... how vuln- how, um, invulnerable they are. Uh, how ridiculously vigorous they are when you-

    24. MO

      Exactly.

    25. JR

      ... you can boil them at a thousand-degree temperature for hours and hours and they're fine.

    26. MO

      That's right.

    27. JR

      When they're, when they're sanitizing medical equipment that they've used on mad cow patients or whether it's cows or, or humans with these prions, they've been able to do it three times. So try to sterilize these things. Like the sterilization process, are you aware what, what is the temperature that they do it for?

    28. MO

      Well, they do it both tem- temperature and pressure, but it's in the hundreds in degrees and it's under high pressure. And I've actually been involved with several cases where these very equipment you're talking about were accidentally used on somebody who had Creutzfeldt-Jakob disease.

    29. JR

      Mm-hmm.

    30. MO

      They had to landfill it. They couldn't, they couldn't even sterilize it.

  11. 31:42 – 38:31

    Straight talk about COVID trajectories: seasonality myths, best-case outcomes, and herd immunity costs

    1. JR

      Mm-hmm. Um, so for the average person that is, uh, sitting around reading these, uh, articles that say, "Don't worry," or reading these ar- these articles that say, "This is the end of humanity," what, w- what, what could these people do? Like, what, what could they do and what do they do if they get infected?

    2. MO

      Well, first of all, uh, neither of those kind of articles are correct.

    3. JR

      Right.

    4. MO

      And we have to make sure that we get that message out to people that it's there. We need straight talk right now, you know, and, and part of it is, it's so hard to... you hear from people who suppose experts, "Well, is this gonna happen or not happen?" You know, uh, and, and let me just give you an example because we've heard a lot about, "Well, it's gonna go away with..." The, the coro- uh, the coronavirus, with the seasons, okay? When it warms up, it'll go away. Well, you know, the other coronaviruses that we have, that we've had to worry about was SARS, which appeared in 2003 in China. And when that came out of China in February 2003, it took us a little while to figure out that these people really aren't that infectious till day five or six of their illness, and then they really crash and burn and many of them would die. Um, but what we did was basically, by knowing that, identify these cases and their contacts quickly, and so if they had symptoms, brought them in, put them in these isolation rooms so they wouldn't infect anybody else, and it took until June to bring that under control. That had nothing to do with the seasons. MERS, which is another coronavirus that's in the Middle East, it's in the, um, Arabian Peninsula, uh, the natural reservoir for that is, is camels. In China... and by the way, SARS, it was palm civets and we... a type of animal food, the rodent, that we got out of the markets there. In the Arabian Peninsula, we're not gonna euthanize, uh, 1.7 camels, you know, to try to get rid of MERS. And there, it's 110 degrees out and this virus is transmitted fine, thank you. I mean, it goes from animals to people, it goes in the hospitals. It... there's no evidence it's seasonal there.

    5. JR

      So that's a good myth to expose right away. This is not something that's gonna cure up when it gets warm.

    6. MO

      Uh, it, you know, if it does, it won't be because there's a model for it, it-

    7. JR

      What will it be? Because how does a... how does something like SARS run through a population and then stop being around anymore?

    8. MO

      Well, it wouldn't have but had we had good public health. Had we had, uh, you know, the same kind of transmission we're seeing with this coronavirus where you're infectious before you ever get sick, where you're highly infectious... Remember, with SARS, now, you didn't really get infectious till you were in sixth or s- you know, sixth day of illness and you knew that you were in trouble, and then you could isolate you. And we didn't understand that at first and we trans- you know, the virus transmitted. So that's why SARS stopped. MERS stops because we don't get rid of the camels so it keeps hitting humans day after day, but then when they go to the hospital, we no longer allow those individuals to transmit to others in the hospital because we do what we call good infection control. As soon as they get there, they're in special rooms with special masks and all this kind of thing. And so in that regard, uh, these coronaviruses can be stopped. This one's not. As I said at the b- top of the program, this is, uh, like trying to stop the wind. With influenza transmission, you never hear anybody saying in a bad flu- seasonal flu year, um, "You know, we're gonna stop this one." If you don't have a vaccine that works, you don't. Um, it's just breathing, that's all it is.

    9. JR

      So what's best case scenario here?

    10. MO

      Well, I think as I laid out to you before, uh, you know, this could be 10 times worse than a really bad seasonal flu year. And, uh, it... I'll grant you, it will, it will hit, you know, primarily the older population and those with underlying health problems. But as I mentioned also, you know, we have a lot of people who have other risk factors. Obesity, high blood pressure is another risk factor where you can have a really bad outcome with this. And so we don't quite know what it's gonna do yet. I think, uh, you know, we've, we've been right on the mark predicting where it's gonna be to this day. I think from here on out, I can tell you it's gonna stay around for months, it's not gonna go away tomorrow. We gotta stop thinking about if we just get through tomorrow, that's it. So if we're gonna close schools, we're gonna tell people not to go into public, we're gonna cancel big events, how long are we prepared to do that? What are we gonna do? We have to ask ourselves that. I think the big thing is, is eventually enough people will get infected where it'll be like putting reactors in the rods, you know, rods in the reaction, I should say, and then that stops it by itself. But, uh-

    11. JR

      How so?

    12. MO

      Because if you're, if, if...... two of the three of us in this room were immune right now to it because we'd had it and recovered and had protection because w- natural protection, then I couldn't transmit to anybody. So that's what's gonna happen if you get enough people who get infected, ultimately, uh, then, you know, it'll s- slow down and stop transmission that way. But that's a heck of a price to pay to get there.

    13. JR

      Is it safe to say that we're fairly fortunate that this isn't something like the Spanish flu or something that's really ruthlessly deadly?

    14. MO

      Well, uh, that's where I think we have to be really careful. Um, just to back up, about 0.1% of people who get seasonal flu die. And granted, it's mostly older or younger people, okay? That's one out of 1,000. With this one right now in China, we're seeing between 2 and 3% of the people die and some say, "Well, that's way too high. It's not gonna be that high, it's gonna be lower." Uh, but again, uh, and they say that because we didn't pick up all the milder illnesses, okay? Um, but on the other hand, we have a lot of additional people in countries like ours that have even more risk factors for having bad outcomes than China. And so, uh, Spanish flu, the one you mentioned, 1918, that was about a 3 to 3.2% case fatality rate. Now, it did preferentially impact 18 to 25-year-olds. They, they were the hardest hit group.

    15. JR

      And why was that?

    16. MO

      Well, you know, it has to do with your immune response again, we think. That, uh, what happened is when this virus got into you, it created what we call a cytokine storm, which is an antibody, uh, response in your body that's out of control and it basically, you destroy yourself and it sets this thing up to trigger it off.

    17. JR

      So the healthier people had the more adverse reaction to it?

    18. MO

      Exactly. Or the other group that has had a real challenge with that are pregnant women and pregnant women have a very unique issue. Um, one is, of course, they have some constriction of their lungs just by the very physical mass but also their immune system is really in- at a heightened state at that point. There's a part of that immune system in that woman says, "This is not all me, get rid of this." It's like a rejection of a graft. And the other part saying, "This is the most precious cargo I'll ever carry, you know, I gotta make sure I don't lose it." And when that virus got in between those two, it started again that same kind of cytokine storm. Now, the thing that concerns us about this, what we saw in, in, in 1918 and I mentioned just three plus percent, this one could be as high as 2%. So it's somewhere between a really bad flu year at 0.1% and it could be as high up here, you know, getting closer to 1918-like. And that's those numbers I just gave you a few minutes ago from the, uh, American Hospital Association of, you know, 480,000 deaths here in this country over the next 6 to 12 months.

  12. 38:31 – 47:42

    Personal health measures, handwashing realism, and mask types (surgical vs N95)

    1. JR

      What can someone do to shore up their immune system while this is all going on?

    2. MO

      Well, a couple things. Um, first of all, just being as healthy as you can be. You know, weight, weight. You know, I'm, I'm getting up there right now where, you know, it becomes more and more of a challenge to stay, you know, in good shape. You know, the more you can do to do that, um, something you know all about (laughs) , you know, is keeping in shape is really important. Uh, second thing is if you're on medications, like for blood, high blood pressure, don't, don't miss them, take those drugs 'cause they're really important. Even though they may not appear sym- you know, you don't have any symptoms of high blood pressure or something like that. And then I think just, you know, getting sleep and eating a healthy diet and that's a- about what we can do today to help get you prepared for this.

    3. JR

      Whew. Um, is there anything else someone could do? Like maybe IV vitamin drips or anything that's gonna really boost your system?

    4. MO

      No. You know, uh, when you look at all the things that might be there, and I'm happy and willing to accept any and all that might help, but we don't really have any data that those substantially impact on your, your immune system to make it that much better.

    5. JR

      Mm. Is that the case because not that many people do it though?

    6. MO

      No. Actually, there's been studies-

    7. JR

      Has it been studied?

    8. MO

      Yeah, there's been studied. And it's been studied. Uh, I mean, a g- a good example is, uh, you know, and I, and I was one of those people that thought, "Boy, this is a great thing." Probiotics, you know?

    9. JR

      Mm-hmm.

    10. MO

      Things... Turns out that we've studied this with regard to antibiotic resistance and does it help your gut, et cetera, and it turns out that the probiotic users were no different than the non-probiotic users.

    11. JR

      In terms of recovery from antibiotics?

    12. MO

      No. And the issue of if you're gonna kinda compete out the bad bugs-

    13. JR

      Mm-hmm.

    14. MO

      So by getting a good, healthy gut flora, the bugs there-

    15. JR

      Yeah.

    16. MO

      ... you would actually reduce the chance of picking up a bad bug and it turned out there was no difference. The people who-

    17. JR

      But how would they do a study like that? The only way I think they would do a study like that accurately is to infect someone that is, uh, the same person. Like, have the same person with no probiotics-

    18. MO

      Yep. Yep.

    19. JR

      ... and then have them with probiotics.

    20. MO

      Well, and, and the studies that have been done are very close to that. But what they did is they used two different groups of people. Those people used probiotics, this group did not.

    21. JR

      Right.

    22. MO

      And then they looked at all their illnesses and they got stool samples from everybody and they got samples-

    23. JR

      How large was the group?

    24. MO

      Uh, I don't have the numbers in front of me. They were pretty sizable, um, because I was disappointed. I mean, I was taking some myself. (laughs)

    25. JR

      Yeah.

    26. MO

      Yeah. So I mean, I think though... But I think the key message here is, is that, you know, we're, we're gonna get through this but right now, we do have some real challenges before us and what we can't tell people is it's all safe. You know? I, I, I, I, every time I hear people say, "The risk is low right now," it reminds me of what would happen if the, uh, there was this huge low pressure system, you know, five days off the coast, uh, the Gulf and there was 90 degree water between that system and the beach and there was no wind shears in the northern hemisphere that's likely gonna knock it off. But we tell the people standing on the beach that day, "We have low risk of anything."

    27. JR

      Hmm.

    28. MO

      Well, we know five days from now it's coming.

    29. JR

      Right.

    30. MO

      And so what we need to do is help the s- American population or the world for that matter, understand we're gonna be in some hurt for the next few months and we have got to get better prepared. How are we gonna, how are we gonna work? Where are we gonna work? We, we, we can't stop working. We need, we need to have the lights on. We need healthcare.

  13. 47:42 – 56:10

    Preparedness and policy: stockpiles, vaccine R&D priorities, and communicating risk without panic

    1. JR

      Has anyone contacted you, uh, before this or since, m- in particular, and asked for your advice as to how they can better prepare? Like in terms of like-

    2. MO

      All the time.

    3. JR

      ... the president.

    4. MO

      Uh, the president hasn't, but I know a number of the people who are working in the White House. Uh-

    5. JR

      And they've contacted you?

    6. MO

      ... and they're working ... Oh, yeah. We ... Well, you know, uh-... I've served roles in the last five presidential administrations. I worked for two Republican governors, two, uh, Democratic governors, as you appreciate, one independent wrastler I worked for too when he was governor, Jesse.

    7. JR

      Oh.

    8. MO

      (laughs) And- and-

    9. JR

      That's right.

    10. MO

      Yeah. And so, you know, I- I've never had a partisan... You know, I've, I'm just a private in the public health army-

    11. JR

      Right.

    12. MO

      ... and so I actually serve as a science envoy for this administration in the State Department last year, you know, still, uh, my, my full-time job at the university. And so I've never been... I mean, I'm there to give the best advice I can. And so I've talked to a lot of these people there at the CDC, um, at, uh, at Health and Human Services, et cetera. So yeah, we've given a lot of advice.

    13. JR

      And do you think there's anything that you could do now that could help them make sure that we don't have these shortages of masks and shortages of medicine and IV bags and something that could be done to... I mean, you obviously, you've laid out all these problems-

    14. MO

      Yeah.

    15. JR

      ... and you laid it out in your book here that people can buy right now. Go pick it up on Amazon, right?

    16. MO

      I seriously have-

    17. JR

      Is there an audio version of it as well?

    18. MO

      There is.

    19. JR

      All right. Do you read it?

    20. MO

      I d- The book?

    21. JR

      Yes.

    22. MO

      Yeah.

    23. JR

      The audiobook?

    24. MO

      In fact, you know- you know- you know, I have. Thank- I don't- I don't-

    25. JR

      No, I'm saying do you-

    26. MO

      ... know I don't read it myself.

    27. JR

      ... do you have a voice?

    28. MO

      No. There's actually a really good voice. It's not mine.

    29. JR

      Well, it should be you, man.

    30. MO

      (laughs)

  14. 56:10 – 1:08:39

    Vaccines: why they matter, plus timelines and safety hurdles for a COVID vaccine

    1. JR

      I hope this wakes people up to the value of vaccines too. There's so many wackos out there that think that vaccines are, you know, a scam or they're dangerous or that s- ... Uh, there- there's so many people out there that won't vaccinate their children.

    2. MO

      I know. And that's one ... You know, one of your best shows you ever did was Peter Hotez.

    3. JR

      Yeah, I love that guy.

    4. MO

      He's a dear friend of mine. He's a ... I do too. He's a dear friend of mine, as you ... And you know, he is one of the champions out there on this very issue.

    5. JR

      Yes.

    6. MO

      I couldn't agree with you more. I think that's really an important point, that, you know, we gotta get this idea. These vaccines can be life-saving. If we had one right now, think how different this situation would be than we're in right now.

    7. JR

      It would be radically different.

    8. MO

      Very rad-

    9. JR

      But then you see th- the measles making a comeback and, uh, di- directly attributed to a lack of vaccines.

    10. MO

      You know what? And it's not only the vaccines themselves, but it's the prioritization of vaccines. I mean, uh, well, you know, one of the real tragic stories right now in Africa is we are just finally bringing to a close this outbreak of Ebola in the Democratic Republic of the Congo, far northeast part of the Congo. You know, 20-some thou- or, uh, tw- tw- 2,800 people have died from this, okay? Bad. Been going on for almost two years. And everybody talks about that, and I understand why. Ebola is a challenge. But do you know that during that same time period, over 7,000 kids in that same area have died from measles? 'Cause everybody was preoccupied trying to deal with Ebola.

    11. JR

      Hmm.

    12. MO

      And- and th- those deaths were totally preventable.

    13. JR

      Preventable. Yeah.

    14. MO

      Totally preventable. So yeah, I mean, I- I think that's, uh ... You know, I- I have to say, and, you know, this, um ... Already on this show, so I'm not trying to ... Thank you for what you do say about vaccines, 'cause people listen to you and we need every positive voice 'cause we have so many crazy voices out there right now. So many people-

    15. JR

      That are so paranoid and-

    16. MO

      Yeah.

    17. JR

      ... delusional, and they want it all to be a conspiracy. There's been an amazing medical innovation in- in human culture, and that's vaccines. It's amazing what it's done. And ha- have there been adverse refect- effects on people? Of course, everything. Everything that people do. There's some people that are gonna react in a bad way. It doesn't mean it's not a positive thing. And there's a reason why the- the cases of polio are so tiny. There's a reason why smallpox went away. It's because of vaccines.

    18. MO

      Absolutely. And you know, it ... That's one of the challenges, as you know, today. Between the- the- the anti-science misinformation that's out there, but then when they don't see it.

    19. JR

      Yes.

    20. MO

      And the reason they don't see it is because we did vaccinate until we get enough people not vaccinated, and then look what happened. There's a-

    21. JR

      There's a famous photo of two twins, um, in the- from the, uh, early 20th century. One of them has smallpox and one of them was vaccinated. Have you seen that photo?

    22. MO

      I have. I have. I have. It's- it's-

    23. JR

      It's a black and white photo.

    24. MO

      ... a very telling-

    25. JR

      I'm sure Jamie will find it, because it's ... People need to see it. That- that- that is the difference, folks.

    26. MO

      There it is. Yep, yep, yep. There it is.

    27. JR

      That is the difference.

    28. MO

      Right there. That's it right there. That's the one. Yep.

    29. JR

      One kid whose body is just devastated by what looks like ... He's like pebbles glued to his skin all over his body, his face, his hands. And then the- his brother right next to him with nothing.

    30. MO

      And you know what's really important to note here is is that in that body, all those things are very painful, but what's going on inside the body is equally bad.

Episode duration: 1:34:10

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