Joe Rogan Experience #1779 - Michael Osterholm

1. 0:00 – 4:33

   Two years later: what we got wrong, and the need for humility

   1. MOMichael Osterholm0:00

      (drumbeats) Joe Rogan podcast, check it out. The Joe Rogan Experience.

   2. JRJoe Rogan0:06

      Train by day, Joe Rogan podcast by night. All day. (instrumental music) Dr. Osterholm, welcome back.

   3. MOMichael Osterholm0:14

      Thank you very much, Joe.

   4. JRJoe Rogan0:15

      Very good to see you again.

   5. MOMichael Osterholm0:16

      Good to see you.

   6. JRJoe Rogan0:16

      It's been basically two years, uh, from the day. And I think when you were on the podcast, for a lot of my friends, that was the first real fear that they felt about the pandemic. You scared the shit out of a lot of people.

   7. MOMichael Osterholm0:30

      (smacks lips) Well, you know, my job is not to scare anyone out of their wits. It's to scare them into their wits.

   8. JRJoe Rogan0:35

      Ah.

   9. MOMichael Osterholm0:35

      And to do what they can to, uh, deal with the situation. As you know, at that time, March 10 of 2020, no one wanted to believe this was going to be a pandemic. And so-

   10. JRJoe Rogan0:45

       Yeah, there was a lot of denial about how it was gonna play out, and people were thinking that it was inflated or it was not that big of a deal. And then, like I said, when you came on the podcast, that, like I got a bunch of calls from friends, like going, "Jesus."

   11. MOMichael Osterholm1:00

       (smacks lips) Yeah, I think the understanding of where we've been, where we're at, and where we're going still I think isn't really completely clear.

   12. JRJoe Rogan1:07

       (smacks lips) Yeah, where we're going in particular, right? Now, um, as an infectious disease expert, it's very rare that you have an opportunity during your lifetime, during your career to examine a pandemic and to be through it and examine the responses to the pandemic. You know, h- how, when you look back at it, what mistakes do you think were made and what do you think was done correctly?

   13. MOMichael Osterholm1:36

       (smacks lips) Well, first of all, let me just say that one of the things I think has been missing from a lot of the response that we've had so far is an incredible sense of humility.

   14. JRJoe Rogan1:48

       Humility.

   15. MOMichael Osterholm1:49

       Every day when I get up, the first thing I do is I look over at my nightstand and I see this crystal ball. It has five inches of caked mud on it, and I try to scrape it off (laughs) and then decide what do I know for the rest of the day. And I think that we've had far too many answers before we really had the answers. And while we always wanna use that term, quote, follow the science, I think we didn't do a good job sharing with the public and even within ourselves what did we really know and not know, and what did we have to do to learn more? So I'd say it's humility.

   16. JRJoe Rogan2:21

       Uh, do you think that it's overwhelming, like the, the reason... Is there a reason why they didn't do a good job sharing the information with the public? And do you think that some of that might be just the fact that being involved in something w- th- that has such a massive footprint, something that literally-

   17. MOMichael Osterholm2:40

       Mm-hmm.

   18. JRJoe Rogan2:40

       ... overwhelmed the entire planet Earth, that there's so many variables, there's so many things to deal with, there's so many things to manage, that that became part of the problem?

   19. MOMichael Osterholm2:51

       Well, you know, Joe, I think that, uh, if I had to look at it, there were days that I felt like I was trying to plant my petunias in a Category 5 hurricane.

   20. JRJoe Rogan2:59

       (laughs)

   21. MOMichael Osterholm2:59

       I mean, it was just one of those situations where there was so much going on. Look at the politicization.

   22. JRJoe Rogan3:04

       Yeah.

   23. MOMichael Osterholm3:04

       Look at the, the misinformation/disinformation. I mean, look at the debates. They often weren't really about the substantive issues of what was happening. And so we had a lot of these countercurrent issues, and the question was what do we really know or not know about this virus? I mean, I'm sure there are people after I'm on here today that are not gonna be happy at all with what I have to say, because I don't think we're done yet. And as I said a year ago right now, a year ago right now, when the world was basically seeing the curve come down from that early January peak and vaccines were flowing that we were done, everyone wanted a declared independence from COVID. And I said, "No, I think the darkest days of the pandemic could still be ahead of us because of variants." These variants are really challenging. We don't know what they're gonna do. They're kinda like 10, 110-mile-an-hour curveballs. And so I think that even going forward, we surely are in a better place right now, and we're gonna be this for a while. But I don't know what the next variant's gonna bring. And will it evade immune protection? Will it mean that the antibody, the immune response we've had so far, the vaccine protection we've had so far, what will it be like with the next variant? I don't know that. Maybe it's going to be fine. Maybe we're gonna see it become a regular old flu-like illness every year, but maybe not. And I think that that's the challenge we have is that kind of humility to say we don't know. And that's what's been a real problem trying to help the public understand it, because we've had far too many answers when we really didn't.

2. 4:33 – 5:44

   Why “Omicron is mild” can still overwhelm hospitals

   1. JRJoe Rogan4:33

      There's an inclination to think that because Omicron is so much more mild than Delta, that this is where the direction of the virus is going. Is that correct?

   2. MOMichael Osterholm4:44

      That is the sense. But there's a couple of assumptions there that I think really deserve comment. Number one, the term it's a milder disease was really unfortunate in the sense that it gave everybody the sense that across the population, it's a milder disease. If you actually look at what happened, let's say you had 1,000 cases of Delta and 100 of them would show up in the hospitals, have severe illness, and die. Some of them would die. Well then along comes Omicron, instead of 100, only 10 people get serious illness or hospitalized, and you say this is a much milder disease. The problem was you have 20 times as many cases occur. So actually, your healthcare systems are much more overwhelmed. I mean, it wasn't just the total number of cases. It was the severe cases. And the last 12 weeks have been among the most severest weeks of the pandemic. And it's just because the sheer number. And so I think that that's one thing. First of all, this was a mild disease for a lot of people, but for a whole lot more, it wasn't.... I think number two is the fact that, uh, you know, we don't know what

3. 5:44 – 12:00

   Variant unpredictability and animal reservoirs (deer, mink, pets)

   1. MOMichael Osterholm5:44

      these variants are gonna do. They could be milder again. But, you know, we're in a very amazing place right now with the virus, where when you look at its original source, from a human to another human, uh, e- early on in Wuhan, but, you know, it had to come from an animal of, of, at some point. Well, now, we're seeing all kinds of animal species infected with this virus. Look at what it's doing with white-tailed deer.

   2. JRJoe Rogan6:07

      Mm-hmm.

   3. MOMichael Osterholm6:07

      I mean, in my 46 years in the business, I've never seen data like I've watched the emergence of this new variant, uh, in, in wild deer.

   4. JRJoe Rogan6:15

      Yeah, it's very strange, right?

   5. MOMichael Osterholm6:16

      I mean, it's-

   6. JRJoe Rogan6:16

      Yes, some, in some places, as many as 50% of the deer have antibodies.

   7. MOMichael Osterholm6:20

      Yeah. Well, in fact, even if you look at studies like in Iowa, where they followed it and actually looked at roadkill deer, so that was really random across the state, they actually found looking for the actual virus, which was a Delta-like virus, that it actually paralleled the exact experience in humans. So, as the numbers in humans went way up, the number in deer went way up. Where are they getting it?

   8. JRJoe Rogan6:39

      Yeah, that's the question, right? Are they getting it from the capi- captive cervid industry?

   9. MOMichael Osterholm6:43

      Well, I don't think it's there. I think it's, uh, pa- uh, something, 'cause it's a statewide. Even where you don't have captive cervids, they were seeing the same increase and decrease in cases. So, I think what it's really pointing out, though, is, is that if you look at all the other animal species that get infected, and then you look at the potential for humans to continue to get infected, I don't know what the next variant's gonna bring, and no one can tell you that, and if they do, be careful 'cause they probably have a bridge to sell you.

   10. JRJoe Rogan7:07

       Yeah.

   11. MOMichael Osterholm7:07

       So, you could have one, it gets milder, and we surely have four coronaviruses right now that typically cause milder disease, cold-like symptoms. Maybe it'll go that way. On the other hand, it may reassort, meaning that it swaps out its genetic material, like a flu virus does, with other, uh, coronaviruses, and we could see a new punch. It could actually evade immune protection. We don't know that. So, I think the challenge we have is just being honest with everybody. This is the guardrail. One side is, it could go back to another Omicron-like experience, or that may be the last one. I hope for the (laughs) last one being the mild one, but hope's not a strategy. So, you gotta look at what do we need to do to be prepared? And right now, everybody in this country wants to back away, back off, and say, "We're done," which I want to, too. I feel that. But at the same time, I have to say, I don't know w- that we're done. Just like I said a year ago, I thought the darkest days were still ahead of us.

   12. JRJoe Rogan8:02

       Now, when you say the, the, so Omicron is far more contagious than Delta and far, far more contagious than the original variant.

   13. MOMichael Osterholm8:10

       Yes.

   14. JRJoe Rogan8:11

       Right? Now, when you say that, um, maybe, you know, wha- whatever numbers that you used-

   15. MOMichael Osterholm8:16

       Yeah.

   16. JRJoe Rogan8:16

       ... that it's, uh, less likely to cause hospitalization, but because it's infecting so many people, you actually get more hospitalizations.

   17. MOMichael Osterholm8:23

       That's exactly right.

   18. JRJoe Rogan8:24

       So, what are, what's the cause? Like, why are some people getting badly hit by it, whereas other people, it's just a runny nose?

   19. MOMichael Osterholm8:33

       Well, and we don't know. Uh, we do know a couple of things about protection. Number one is if you've been vaccinated, particularly if you've had the third dose, if you've previously been infected, which also does add to your immunity, clearly, those obviously work in your favor. If you have some of these underlying health issues that we've talked about, which, you know, it's not just about being in shape or not, you know, people with diabetes, people with asthma, people who are immunosuppressed. There are 7.5 million Americans right now that are immunosuppressed, either because of the disease they have, they're o- c- being treated for cancer, all those people are at much higher risk of having severe illness. And even what we saw with kids, we had never seen this level of activity as we see with Omicron with kids. And so, I think the challenge we have today is-

   20. JRJoe Rogan9:21

       For hospitalizations?

   21. MOMichael Osterholm9:22

       Yes, even for hospitalizations.

   22. JRJoe Rogan9:24

       Now, the kids that were hospitalized, did all of them have comorbidities?

   23. MOMichael Osterholm9:27

       No. Mo-

   24. JRJoe Rogan9:28

       None of them?

   25. MOMichael Osterholm9:28

       Many, many of them did not.

   26. JRJoe Rogan9:29

       So, ma- some of them were not even obese?

   27. MOMichael Osterholm9:31

       Yep.

   28. JRJoe Rogan9:31

       And they were hospitalized?

   29. MOMichael Osterholm9:32

       Yes, absolutely.

   30. JRJoe Rogan9:33

       Really?
4. 12:00 – 20:02

   Variant family tree: Omicron dominance and the BA.1/BA.2/BA.3 battle

   1. JRJoe Rogan12:00

      And the variants, uh, as they... Like, so there, there was the original version, then the Alpha version is the first variant that was discovered?

   2. MOMichael Osterholm12:07

      Well, the, yeah. That's, they, what they've labeled them by is the Greek alphabet. So, Alpha was-

   3. JRJoe Rogan12:12

      Right.

   4. MOMichael Osterholm12:12

      ... kind of the first one there, and then we've had subsequent s-

   5. JRJoe Rogan12:14

      But not, not, not a, not the original virus, but the first variant of the virus?

   6. MOMichael Osterholm12:18

      Yeah. Well, what's really interesting with this virus is the fact that if you look at we call the ancestral variant, the one that originated in Wuhan, all the subsequent variants we've seen have actually all gone back and their roots are in that ancestral variant. It doesn't mean that if you had Alpha it turns into a Delta, with a little bit more changes it turns into Omicron. Every one of them have a distinct line back to the original variant. And that's one of the challenges we have, because that's gonna continue to happen, where we're gonna continue to see these new variants show up.

   7. JRJoe Rogan12:50

      And, uh, as far as the, the variants that are in play right now, like, what percentage of the, the infections right now are Omicron? What percentage are Delta?

   8. MOMichael Osterholm13:02

      Yeah.

   9. JRJoe Rogan13:02

      Is there any of the original variant left?

   10. MOMichael Osterholm13:04

       V- well, the original variant surely is out there, because we keep seeing these new variants come from it, so it has to be somewhere. I can't tell you where it's at, but it's surely-

   11. JRJoe Rogan13:11

       The variants don't come from, like, Delta creating a new variant? So, it's-

   12. MOMichael Osterholm13:16

       It's, it's actually takes, take you back to the original variant.

   13. JRJoe Rogan13:19

       Oh.

   14. MOMichael Osterholm13:19

       So, the question on Omicron's in issue, and right now in the United States virtually 100% of the, uh, variants we see are Omicron. They've taken over.

   15. JRJoe Rogan13:26

       100%?

   16. MOMichael Osterholm13:27

       100% in the US, and virtually around the world. It's beaten out Delta completely. Uh, if you look in the United States, there are three sub-lineages of that variant, what we call BA.1, BA.2, and BA.3, and we're watching a battle go on right now between the, those sub-variants. And it turned out BA.1 was the original one. We first saw kind of the original Omicron. But BA.2, which appears to be more infectious now, is beating out Omicron. In some countries in the world it's become the dominant variant.

   17. JRJoe Rogan13:56

       And-

   18. MOMichael Osterholm13:56

       In the United States, it's still a, a, a small percentage, but it's growing. Last week it was 4%. The previous week it was 1%. So, we don't know what that's gonna mean in terms of seeing more of the, uh, uh, BA.2 variant emerge.

   19. JRJoe Rogan14:11

       How do they make the distinction between Omicron, Delta Omicron, and then BA.1, BA.2? Why do they decide that this isn't another variant? Why do they just keep calling it Omicron with-

   20. MOMichael Osterholm14:22

       Yeah. And, and, and this is one of those questions where I clearly, I'm not the world's expert on the, uh, overall genetics of this virus. But I'll tell you that the mutations that occur surely can accumulate. If you look right now, for example, there's more difference genetically between BA.1 and BA.2 than there is between the ancestral virus and Alpha.

   21. JRJoe Rogan14:43

       Really?

   22. MOMichael Osterholm14:43

       Yes. So, it has to do pretty much how it evolved out of that ancestral virus tree, and is it different enough? And so, uh, you know, there's been discussion that there may actually be some effort made to consider BA.2 as a new variant of concern by itself. So, but, but this is, I think, the message here, is this is what we have to continue to be mindful of. I know everybody wants me to say today we're done, and I hope we're done. But as I said just a moment ago, hope's not a strategy.

   23. JRJoe Rogan15:12

       Right.

   24. MOMichael Osterholm15:12

       I think that we could still see the emergence of new variants that could challenge the immunity that we have already, which is what makes this virus so difficult and so different than we've had before. When you see influenza, pandemic influenza occurs because a bird virus finally evolves out of the bird, gets into particularly a pig, because a pig has lung s- has receptor cells for both human viruses and bird viruses. And when they get into a pig cell in particular, they combine, they mix up, uh, the flu viruses are very promiscuous, and they come out with this brand new strain that causes the next pandemic. Well, when that spillover occurs into humans, that's kind of the s- the seminal event. The rest of it emerges pretty much in humans. We don't necessarily see us go- giving it back to the animals, they give it back to us, we give it to the animals, they give it back to us. With, looking at SARS-CoV-2 and the, and this particular coronavirus, we don't know what it's gonna do. Is it gonna go back and forth between animals? I mean, I could line, list an entire set of all the animals that are now infected with this virus.

   25. JRJoe Rogan16:13

       Hmm.

   26. MOMichael Osterholm16:13

       And we don't know what that means.

   27. JRJoe Rogan16:15

       The first ones that we found that trans- transmit from humans to animals, or back to, in, in terms of SARS-CoV-2, was it ferrets? Like, what was the first animal that they discovered that, uh, humans can infect and they can infect us with this?

   28. MOMichael Osterholm16:30

       Well, there was, uh, game animals, mink and so forth, in-

   29. JRJoe Rogan16:33

       Minks.

   30. MOMichael Osterholm16:34

       ... Europe that we saw that. But it became clear because we started seeing zoo animals infected.
5. 20:02 – 32:57

   Origins debate: natural spillover vs lab accident, and what evidence would count

   1. JRJoe Rogan20:02

      Now, in the beginning of the pandemic, you were of the opinion that this was from a natural spillover, from the, the origin of, uh, SARS-CoV-2 was most likely from an animal, that it, uh, it spilled over into human beings. Do you still have that opinion?

   2. MOMichael Osterholm20:24

      Well, again, let me clarify. What I said and, and have maintained all along, because I, too, have concerns about, uh, the potential for what we call gain of function or, or clearly biosecurity of laboratories, leaking out of, of labs. I hadn't s- have not seen any ev- evidence at all that would support that, number one, this was a manmade virus. Absolutely none. Zero.

   3. JRJoe Rogan20:46

      No evidence that would support that it is a manmade virus?

   4. MOMichael Osterholm20:48

      None. None whatsoever. And I, again, with my limited expertise in viral genetics, I believe the people who I work with. Now, the question is could it, however, been in that lab and spilled out because somebody got infected, there was a lab accident, which surely can happen? And again, we don't have, uh, any conclusive evidence that that happened. I think even anecdotal evidence we've had has been very short. But I'm the first one to say I wish we'd had a much more exhaustive investigation into what happened at that laboratory with much more transparency. I don't think we've had that kind of a transparent investigation yet, uh, to see were there sick people at that time? Because if it was gonna spread out into the population, there would be sick people. On the other hand, I'm not surprised that it might have emerged in Wuhan, because here's a, you know, an area of over 40 million people living in that whole area, for which their food sources come from hundreds to up to 1,000 miles away, of which the open markets there are ripe with the kind of animals that very well could've brought the virus there. And when you look now at the ease at which this virus goes between animals and humans, at least, uh, initially, or humans or back to animals, it's not surprising that it might have emerged there. And so I am still open to the fact that was it a laboratory accident? I don't have any reason to believe it was an intentional one. I know it was, based on everything we have, it wasn't manmade.

   5. JRJoe Rogan22:13

      But I don't think anybody thinks it's an intentional release. Do they?

   6. MOMichael Osterholm22:16

      No. Well, some people have. No, some people think-

   7. JRJoe Rogan22:18

      Well, of course, I shouldn't say anybody-

   8. MOMichael Osterholm22:20

      Yeah. Yeah. Yeah. Yeah.

   9. JRJoe Rogan22:20

      ... 'cause s- some people believe the world's flat.

   10. MOMichael Osterholm22:22

       (laughs)

   11. JRJoe Rogan22:22

       Right? There's-

   12. MOMichael Osterholm22:22

       That's absolutely true, too.

   13. JRJoe Rogan22:23

       ... people who believe some wacky stuff.

   14. MOMichael Osterholm22:24

       That's absolutely true, too. Um, so I think, no, th- but I think that it is fair to say that, uh, there still remains this question could have it leaked out of that lab. And I continue to say I wish we would have an exhaustive, comprehensive investigation, which the Chinese government would agree to.

   15. JRJoe Rogan22:42

       Is that part of the problem, a lack of transparency?

   16. MOMichael Osterholm22:44

       I think it is, but let me, let me paint a picture here that also helps explain the situation. Imagine a brand-new virus emerged in the Caribbean. Okay? I mean, it came from nowhere. It might be mosquito-borne, something. Okay? Where do you think they might find that virus first? Atlanta. Why Atlanta? Because it's the indus- it's the transportation hub for the Caribbean.

   17. JRJoe Rogan23:06

       Hmm.

   18. MOMichael Osterholm23:06

       And they have the sophisticated laboratories there, not even at the CDC. I'm just talking about universities, et cetera, clinicals. Imagine if that virus was found in Atlanta, a brand-new virus. The assumption would be made immediately it came from the CDC, because it's there. It's geographically there. It's in Atlanta. That has to be the source.

   19. JRJoe Rogan23:25

       I see what you're saying.

   20. MOMichael Osterholm23:26

       And so if that were the case, imagine the Russians and the cr- Chinese saying, "Wait a minute. This was a lab leak out of CDC. We wanna come and investigate."... we're gonna come in and see.

   21. JRJoe Rogan23:37

       Mm-hmm.

   22. MOMichael Osterholm23:37

       Do you think the US would just willy-nilly open up the lab at the CDC to the Russians and the Chinese?

   23. JRJoe Rogan23:42

       Right.

   24. MOMichael Osterholm23:43

       So, in some ways, I- I'm not being sympathetic at all to the Chinese, because I think they are continuing to make the problem worse by not providing more transparency. But at the same time, if the same thing happened in the United States, I could see where we wouldn't just open up the CDC to everybody in the world to say, "Okay. Come on in and look."

   25. JRJoe Rogan23:59

       Right. But is the CDC doing gain-of-function research on coronaviruses?

   26. MOMichael Osterholm24:03

       They're not.

   27. JRJoe Rogan24:04

       They're not.

   28. MOMichael Osterholm24:04

       No.

   29. JRJoe Rogan24:04

       Well, so if something emerged from there that wasn't something they were working on, that would probably not arouse the suspicion of the world.

   30. MOMichael Osterholm24:13

       (sighs)
6. 32:57 – 41:34

   Gain-of-function: definitions, risks, and why the debate gets stuck

   1. JRJoe Rogan32:57

      Now, when they perform gain-of-function research, can you... d- can you explain how that's done? Th- they're, they're using different coronaviruses and, and various viruses and infecting human respiratory tissue, and they're also doing experiments on ferrets because they have very similar ACE2 receptors to human beings, right?

   2. MOMichael Osterholm33:19

      Yeah.

   3. JRJoe Rogan33:20

      Is that the case?

   4. MOMichael Osterholm33:20

      I can't comment on what research they're doing. I don't know.

   5. JRJoe Rogan33:23

      You don't know?

   6. MOMichael Osterholm33:24

      I don't know that.

   7. JRJoe Rogan33:25

      But you do know how gain of function is done, right?

   8. MOMichael Osterholm33:29

      Well, gain of function, first of all, means that you're adding something to the virus, like I talked-

   9. JRJoe Rogan33:34

      Correct.

   10. MOMichael Osterholm33:34

       ... about with influenza. It was a gain of function. We were trying-

   11. JRJoe Rogan33:37

       Mm-hmm.

   12. MOMichael Osterholm33:37

       ... to see if you could make it transmissible between, in this case, an animal species and a human. Um, or you're trying to make it so that it is actually more infectious, or you're trying to make it so that it kills it. It does more damage. Um, and those are all considered parts of gain of function. In other words, trying to make it do something else. So in terms of the, uh, coronaviruses, I've not seen any evidence of, again, gain of function because this virus is pretty damn functional on its own. It's doing very well, and it's teaching us by just watching it, how it's changing to become g- uh, almost a sense of a gain of function of Mother Nature.

   13. JRJoe Rogan34:14

       Right, but, uh, the way that these experiments are done are... when they're infecting human respiratory tissue, when they're infecting ferrets, and they're doing it purposefully for these experiments, aren't they allowing selection-

   14. MOMichael Osterholm34:28

       Mm-hmm.

   15. JRJoe Rogan34:29

       ... and evolution to do the work for them? I mean, I don't necessarily think they're manipulating the virus. Aren't they-

   16. MOMichael Osterholm34:34

       Yeah.

   17. JRJoe Rogan34:34

       ... allowing the virus to go through its normal processes, but they're doing it purposely, right?

   18. MOMichael Osterholm34:40

       Yeah.

   19. JRJoe Rogan34:40

       Is that the case?

   20. MOMichael Osterholm34:41

       Yeah. F-... In the principle, what you laid out, that's the case. What I'm saying is I don't know that they're doing that. I have not seen any evidence. And it could exist. I just don't know. I c- I'm not trying not to answer-

   21. JRJoe Rogan34:52

       You don't know that they're doing-

   22. MOMichael Osterholm34:53

       ... doing any of those studies where they're trying to make it more transmissible or that they did do that. I just don't know.

   23. JRJoe Rogan34:59

       I thought that was the entire argument that, that even the NIH had laid out that they had done.

   24. MOMichael Osterholm35:06

       Well, that had come up, and as you know, uh, EcoAlliance, the group that was doing the work does still-

   25. JRJoe Rogan35:12

       EcoHealth Alliance?

   26. MOMichael Osterholm35:12

       Yeah, EcoHealth Alliance, actually just-

   27. JRJoe Rogan35:14

       Peter Daszak?

   28. MOMichael Osterholm35:14

       ... d- yeah, d- uh, disagreed with that and said that's not what's being done. Again, uh...

   29. JRJoe Rogan35:17

       They said they disagreed with it.

   30. MOMichael Osterholm35:19

       Yeah, and I... so I can't comment. I don't know.
7. 41:34 – 51:42

   Why outcomes vary so widely: comorbidities, kids, and asymptomatic infections

   1. JRJoe Rogan41:34

      Um, what about ... You ... One, one of the weird things is, of this, this virus, uh, in the early days was how many people were asymptomatic. And, you know, and it didn't matter by age. It seemed like there was quite a few older people that were asymptomatic that got it. And do you think ... What, what do you think the reason for that is?

   2. MOMichael Osterholm41:54

      I don't know.... and I can tell you right now, that is a point of discussion I've had oftentimes with my colleagues. We do know that it's not likely tied to dose. Originally, you know, I was a co-author on a paper-

   3. JRJoe Rogan42:04

      You mean by viral load?

   4. MOMichael Osterholm42:05

      Yeah, by viral load. How much virus is there didn't dictate how seriously ill you did... D- it didn't mean you didn't get infected or not. And we're still looking at that. What it does indicate is clearly having these comorbidities adds to the likelihood that once you get infected, you're gonna have severe illness.

   5. JRJoe Rogan42:23

      Right.

   6. MOMichael Osterholm42:23

      But as you just pointed out and is absolutely true, we've seen people who have comorbidities who have had mild disease. We've had people, for unexplained reasons, we don't know why, have had serious disease, younger, healthy, no underlying comorbidities, you know, physically fit. And so generally speaking though, you can say that no, in fact, if you have these comorbidities, you are much more likely to have severe illness, but it's not totally the rule. There are those exceptions we see and as I just mentioned, these kids. You know, a number of these kids did have comorbidities, but some didn't. And why they got infected and died, I don't know.

   7. JRJoe Rogan43:01

      Is it a... Is there a parallel to any other disease wh- that you've ever studied before or that scientists have studied?

   8. MOMichael Osterholm43:07

      (sighs)

   9. JRJoe Rogan43:07

      Like is there any disease that behaves this way?

   10. MOMichael Osterholm43:10

       Well, clearly there are a number of viruses where the seriousness of the illness can vary a great deal by age, for example. Let me just take one that is not a respiratory transmitted agent, but the virus that causes hepatitis A or infectious hepatitis. In young kids this is often a very mild, totally asymptomatic infection, and is transmitted from fecal oral, you know, if you have diaper changing, et cetera, it's not, you know, hygiene's not there. We would often pick up outbreaks of hepatitis A because parents would come down with it and they'd get really sick. Their livers would be in trouble, you know, they'd get very yellow and jaundiced. And we'd go back and test the child and sure enough the child had been infected already and brought it home to mom and dad. And so in a disease like that, the percentage of people who have serious illness, who get infected and have illness in general, is much higher than the older population than it is in the younger population where it's almost a mild disease. So we have examples like that that do happen. It's not as if it's, uh, an unusual situation. And for some diseases, the vast majority of illnesses are mild, asymptomatic. You only pick them up by doing blood studies in populations. For other diseases, well, rabies is of course the (laughs) classic example. It's virtually 100% fatal.

   11. JRJoe Rogan44:25

       Mm.

   12. MOMichael Osterholm44:25

       And so it, it varies across all the viruses we have.

   13. JRJoe Rogan44:29

       So is the high, the, the percentage, uh, unusual of people that are asymptomatic with this disease?

   14. MOMichael Osterholm44:36

       Well, you know, I think, Joe, that's, uh, uh, one of those questions again that, that kind of begs the very issue of what is this SARS-CoV-2 virus all about? Because if you go from the beginning of the COVID pandemic to now, look at how different the ancestral variant illness was to Alpha, to Delta, to Omicron, uh, just in a matter of two years.

   15. JRJoe Rogan44:57

       Right.

   16. MOMichael Osterholm44:57

       I mean, it's amazing how cha- how much sh-... And the, and the question you asked me earlier about the issue with Omicron, you know, why do we see so many infections out there? Well, 'cause it's much more infectious. Um, and I think that what we're watching here is a really real-time evolution (laughs) of a virus that, you know, we could never, you know, suggest for a moment that the measles virus is gonna change a whole lot in two years. It hasn't changed basically in decades and decades and decades. So I think this is one of the challenges we have is th- and when I answered your question earlier about what is the future of this pandemic, it's 'cause this virus keeps throwing 10, 200 10-mile-an-hour curveballs at us.

   17. JRJoe Rogan45:34

       Mm-hmm.

   18. MOMichael Osterholm45:34

       I don't know what the future's gonna bring yet. Maybe one of these variants is gonna spin out of this that is gonna again cause various, uh, a large number of cases, some of it severe, and is gonna evade the immune protection that we have already.

   19. JRJoe Rogan45:50

       I've read some articles that seem to indicate that there, uh, there may be some immunity that certain people have because of previous infection for other coronaviruses.

   20. MOMichael Osterholm46:02

       Yep.

   21. JRJoe Rogan46:02

       Other coronaviruses meaning common coronaviruses.

   22. MOMichael Osterholm46:05

       Yep, yep.

   23. JRJoe Rogan46:05

       That somehow or another that may have imparted some, at least some kind of either immunity or some kind of protection from SARS-CoV-2.

   24. MOMichael Osterholm46:17

       And that is currently being studied. And in fact, if you look at the issue of just take immunity from SARS-CoV-2, if you look at the data for D- Delta, you could actually show that basically those people who had previous infection did better than those who hadn't had previous infection and were vaccinated. Mean, they actually had more protection. But if you go back to Alpha, people who had previously been infected were more likely to get re-infected than people who were vaccinated.

   25. JRJoe Rogan46:53

       So people who caught the Alpha variant could catch it again?

   26. MOMichael Osterholm46:57

       Yes. Well, everybody. Look at Delta. Uh, Delta's the same way. People... We know-

   27. JRJoe Rogan47:01

       We've got Delta more than once?

   28. MOMichael Osterholm47:02

       Oh, well, it's n- I'm sorry. I'm talking about when they actually had the next variant. So people have, who had had Alpha did get Delta.

   29. JRJoe Rogan47:10

       Hm.

   30. MOMichael Osterholm47:10

       People who had Delta got Omicron. And it's really too early for us to say what happens with BA1, BA2. Can you get Omicron a second time? We don't know yet.
8. 51:42 – 1:02:21

   Long COVID: what it is, why it’s hard to define, and athlete performance drops

   1. MOMichael Osterholm51:42

      One of the examples we're all very concerned about today is long COVID. And with long COVID, it's clear that that is not evidence, uh, is not evidence at this point of an ongoing infection. It's not that the virus is still proliferating in you, we just haven't gotten rid of it. It's that-

   2. JRJoe Rogan51:56

      So, could you explain what long COVID is, technically?

   3. MOMichael Osterholm52:00

      You know, I can't, and, uh, the reason's I can't is not 'cause I'm not even an expert 'cause most people can't. It's a whole, uh, s- series of different conditions: the brain fog, the fatigue, uh, the cardiac involvement, the heart, you know, as we see, the heart, the lungs. Um, and it's not really clear what is going on. If you just take a step back, remember before COVID ever existed, we had chronic fatigue syndrome-

   4. JRJoe Rogan52:24

      Mm-hmm.

   5. MOMichael Osterholm52:24

      ... a real condition, and people were really suffering.

   6. JRJoe Rogan52:27

      And when you-

   7. MOMichael Osterholm52:27

      Yeah.

   8. JRJoe Rogan52:27

      ... say chronic fatigue syndrome, is that something you have a test for?

   9. MOMichael Osterholm52:31

      No, that's the whole point.

   10. JRJoe Rogan52:32

       Right.

   11. MOMichael Osterholm52:32

       Is that it was kind of a general term, a catchall, that basically covered people, and most often, it was associated with people who had had an infectious disease of some kind which may have triggered this ongoing immune response. So often-

   12. JRJoe Rogan52:47

       Is there a d- like, uh, a specific infectious disease that-

   13. MOMichael Osterholm52:50

       Well, you know-

   14. JRJoe Rogan52:50

       ... is the origin?

   15. MOMichael Osterholm52:50

       ... Epstein-Barr virus has been often implicated as being a part of this picture, but what it's really pointing out is it's really about this ongoing immune response that we don't yet understand. And I think if there is any area right now that we need tremendous efforts put into is long COVID. You know, there are these new centers starting right now to try to address this. Uh, you know, overall, we estimate that there may be anywhere from 3% to 10%, some say as high as 18% to 20% of people, without regard to whether it was serious, uh, COVID they had or milder COVID, go on and develop this long COVID.

   16. JRJoe Rogan53:27

       There's an interesting parallel with fighting. I can talk to you about this-

   17. MOMichael Osterholm53:30

       Okay.

   18. JRJoe Rogan53:30

       ... with, uh, MMA fighters.

   19. MOMichael Osterholm53:32

       Yeah.

   20. JRJoe Rogan53:32

       That, um, s- some MMA fighters who have had COVID, um, particularly ones that didn't ... I don't know, I, I don't know, I don't wanna speak that they, I don't wanna say that they didn't take it seriously. Maybe they didn't recognize that they needed to rest more and allow themselves to recover, and they trained through it. And guys that trained through COVID-19 tended to suffer long-term consequences from it.

   21. MOMichael Osterholm53:58

       Mm-hmm.

   22. JRJoe Rogan53:59

       There's several examples of this. And after those bouts of COVID-19, there's a thing that happens with fighters.... at the very highest level. And one of the things that I study with UFC is, I'm studying, like, the elite of the elite athletes, like championship level fighters. And just a small drop off of performance is m- is, is noticeable when they face other elite athletes. And you're starting to see some of these folks that have had COVID-19 then competing and not looking as good eight year, eight months later, a year later-

   23. MOMichael Osterholm54:36

       Yeah. Yeah.

   24. JRJoe Rogan54:36

       ... post-infection. And I'm wondering, like, what is this long COVID? Is this like a, a milder form of long COVID? 'Cause clearly they're in shape, clearly they look great, but when they're competing, they're not c-

   25. MOMichael Osterholm54:51

       Yeah.

   26. JRJoe Rogan54:51

       Maybe some of them are not quite at the level that they used to be.

   27. MOMichael Osterholm54:55

       Well, I think you raised two very important points. When you asked me earlier about risk of going on and developing COVID and what the long-term impact may be, here you got some of the finest fit people in the world.

   28. JRJoe Rogan55:06

       Yes.

   29. MOMichael Osterholm55:06

       So they're-

   30. JRJoe Rogan55:07

       That's why I brought it up. Yeah.
9. 1:02:21 – 1:11:47

   Treatments and the logistics bottleneck: Paxlovid, monoclonals, and testing surge capacity

   1. JRJoe Rogan1:02:21

      Um, are there any ... Uh, th- uh, I know there's some new, uh, treatments that are on the horizon that Merck has and that Pfizer has. There's a bunch of different, uh, antiviral medications and pills that they're putting forth. Is there anything else that's ... I think there's also ... Isn't there an attenuated vaccine, a attenuated form of the virus?

   2. MOMichael Osterholm1:02:42

      Yeah. Well, first of all, let me just say, I think the treatment area right now is, um, a very exciting time and development. Um, you know, I look back to my work in the early 1980s in HIV/AIDS, and at that time, a diagnosis of HIV was a death sentence, simply a death sentence. And with the emergence of drug therapies, even in the absence of a vaccine, we've taken HIV for many people to a managed chronic disease. And I think that, you know, as we look at the vaccines, it's clear we have challenges with waning immunity, how well will they work, how many booster doses can you give, et cetera. And so vaccines remain really the foundational response for dealing with COVID, but I think the drug therapies are gonna become really, really critical. And we're learning more. I mean, for example, I know a topic that you have, uh, been of interest about in the, the show, that ivermectin. You know, there are five big trials going on right now, they're gonna be announced, the results, in the next weeks to months, that really have looked carefully at ivermectin, including high-dose ivermectin. And, you know, I've, again, as a scientist, reserved judgment. You know, I didn't close my mind and say, "No, yes, whatever." I want the data, and we gotta have these double-blind, placebo-controlled trials. You know, studies where neither the investigator or the patient know which they got, you know, and then objectively find out what's happening. I think there's a whole series of drugs coming down from several companies that surely have that potential if given very early, and the one you mentioned from Pfizer, for example, uh, Paxlovid, while it has some contraindications with underlying health conditions that might already exist, on a whole, it is really a very, very fantastic drug. But the problem we have right now with that is that we have many, many places in this country where during the surge of Omicron, I couldn't get tested for three, four or five days. And-

   3. JRJoe Rogan1:04:39

      Why is that?

   4. MOMichael Osterholm1:04:40

      Because we just didn't have the testing capacity.

   5. JRJoe Rogan1:04:42

      But doesn't that seem ... That seems like something that would be much more easily-

   6. MOMichael Osterholm1:04:46

      Well, that's what I'm going to.

   7. JRJoe Rogan1:04:47

      Okay.

   8. MOMichael Osterholm1:04:48

      Okay? That's exactly ... You, you-

   9. JRJoe Rogan1:04:49

      Okay.

   10. MOMichael Osterholm1:04:49

       ... you, you hit my line for me. Thank you. Okay. (laughs) Um, is the fact that we need a comprehensive system with surges, where in fact, when a surge occurs, you can scale up quickly. So, if I need to get a test done, I can get it done the same day and get a result back the same day, and then I can get into a system automatically that makes sure I get these drugs. You know, if you're someone in the community and, you know ... And, and, you know, one of the things that I have been so challenged by is what this has done by race. I mean, this disease has been cruel. If you look at the number of deaths, you know, if you look at Blacks, twice as likely to die from COVID as whites. Hispanic, 2.3 times as likely to die from COVID as whites. American Indian, Native American, 2.4 times.

   11. JRJoe Rogan1:05:37

       Isn't this, uh ... Hasn't there been correlations drawn between vitamin D deficiency?

   12. MOMichael Osterholm1:05:42

       There has been some. And again, this is another area of study that needs to be done. But I mean, if you look at these issues here, getting the drugs to those populations, okay, what can we do? I- i- whatever their risk is, so that if you have a community where I don't have a doc, I don't have one, I don't have access to healthcare in general, you know, I, I go to a community clinic. So, what I think this whole issue around drugs, the point you just raised, is really highlighting, is now's the time to address this issue of health disparities and just generally our healthcare system. You know, we have a disease care system, a disease care system, not a healthcare system. And by the way, it has been under attack for two years. It's, it's, it's incredible what's happened.

   13. JRJoe Rogan1:06:24

       By COVID.

   14. MOMichael Osterholm1:06:24

       By COVID.

   15. JRJoe Rogan1:06:25

       Yeah.

   16. MOMichael Osterholm1:06:25

       I mean, what it's done to f-... care in general.

   17. JRJoe Rogan1:06:27

       Mm-hmm.

   18. MOMichael Osterholm1:06:28

       And it was done to our healthcare workers, okay? So we need to take a look and step back and say, "Okay, so what could we do to improve on that?" Well, k- keep the vaccines, but we know we're hitting a wall on that, okay? Some people are just not gonna get vaccinated, no matter how we try to share the information. But we should be able to get people to understand, if you do get sick, these are the drugs that can be helpful. This is how you get them quickly. And try to reduce the hospitalizations, the serious illness, and deaths, and make this more of a treatable-type disease, like I talked about with HIV. And the impact in the communities of color, for example, um, you know, will be huge if we could do that. And it would improve healthcare in general. So to me, that's one of the things I'm working on right now, is trying to understand surge capacity for testing. Let me give you one last example I think that helps illustrate this. If you look at the fire departments in the state of Minnesota, one of the best well-funded fire departments in the entire state is the Minneapolis-St. Paul International Airport Fire Department. And thank God we have them. I support every penny we give them to keep that fire department going. B- you know, large number of units, people well-trained. We've not had a plane go down there on the airport itself since its inception, any big plane. The two that did went down in South Minneapolis in the '50s and were handled by the Minneapolis Fire Department. Well, we pay for that every day, 'cause we wouldn't operate that airport without them. We should be paying for test capacity. So if we have a lull in it, it doesn't mean that everybody gets laid off or we don't do that. We will use them for other things. But as soon as that surge occurs, we could put testing back into place so everybody can get a test that first day, and I don't care where they live, I don't care who they are, they can get on those drugs. And Joe, we could do so much to reduce, if not eliminate, the serious illnesses, hospitalizations, and deaths, just with that alone.

   19. JRJoe Rogan1:08:25

       Just with testing?

   20. MOMichael Osterholm1:08:26

       Just testing and then the drug availability, the drugs you just talked about.

   21. JRJoe Rogan1:08:29

       Yes.

   22. MOMichael Osterholm1:08:29

       I mean, I think we're gonna see more and more drugs become available that I think are going to have real, positive impacts. So I see this as kind of the silver lining of this, uh, pandemic is that people are now beginning to do that. And we can do that around the world. If you know anything about HIV drug distribution, you know some of the most remarkable improvements in health have been in Africa, where we've been able to distribute these drugs for HIV day in and day out. So we surely can do this for a COVID-like situation. So that's what we need to focus on, and that's where we need as a globe- global community, understand how can we improve testing so that we make sure we get people on there, and then how can we make certain that they get their drugs?

   23. JRJoe Rogan1:09:09

       Now, you covered a whole bunch of things. So let's start from the beginning. F- first of all, you, you talked about testing.

   24. MOMichael Osterholm1:09:15

       (laughs)

   25. JRJoe Rogan1:09:15

       Now, one of the things that I thought was, uh, shocking, I was watching this, um, press conference where, uh, Ron DeSantis was, uh, addressing the claim that they had let a bunch of COVID tests expire, and that they were no longer useful. And I was like, "Wow, I didn't know COVID tests expired." So they have a shelf life? Is that-

   26. MOMichael Osterholm1:09:38

       They do, they do.

   27. JRJoe Rogan1:09:39

       Why is that?

   28. MOMichael Osterholm1:09:40

       Because basically, the reagents in there can degrade over time-

   29. JRJoe Rogan1:09:43

       Mm-hmm.

   30. MOMichael Osterholm1:09:43

       ... and you wanna make sure you have exactly the right ones. So they do have a shelf life.
10. 1:11:47 – 1:16:26

    Vitamin D, frontline exposure, and community trust (the barber/stylist model)

    1. JRJoe Rogan1:11:47

       Um, let's go back to vitamin D.

    2. MOMichael Osterholm1:11:49

       Sure.

    3. JRJoe Rogan1:11:49

       So when you're talking about how a disproportionate amount of Hispanics and Black folks and, and, and Native Americans, essentially people with more melanin in their skin, people with more melanin in their skin have traditionally had lower levels of vitamin D that live in urban areas, especially in like cold climates where they're covered up. How, how w- how much of a correlation do you think there is between low levels of vitamin D and, um, and more severe COVID-

    4. MOMichael Osterholm1:12:17

       Yeah.

    5. JRJoe Rogan1:12:17

       ... infections?

    6. MOMichael Osterholm1:12:18

       Well, I can say that there clearly have been studies done that demonstrate reduced vitamin D levels in cases coming in, into the hospital.

    7. JRJoe Rogan1:12:26

       It was like 84%-

    8. MOMichael Osterholm1:12:27

       Yeah.

    9. JRJoe Rogan1:12:27

       ... at one point in time of people-

    10. MOMichael Osterholm1:12:29

        Yeah.

    11. JRJoe Rogan1:12:29

        ... in the ICU had insufficient levels of vitamin D.

    12. MOMichael Osterholm1:12:32

        And, and I can't comment. The question we have...... with vitamin D, is it a marker for something else? Meaning people who have adequate vitamin D, is it because of their behavior, what they eat, is it because they have access to s- access to certain foods, et cetera? Um, what does that mean? And so, we still have to figure that out. But the point-

    13. JRJoe Rogan1:12:51

        Well, vitamin D isn't really like, effectively supplemented through food, is it?

    14. MOMichael Osterholm1:12:55

        Well, sunlight and some degree food, meaning I take a supplement.

    15. JRJoe Rogan1:12:59

        Sunlight, yeah.

    16. MOMichael Osterholm1:12:59

        See, I'm talking about taking a supplement.

    17. JRJoe Rogan1:13:00

        Supplement, yeah, okay.

    18. MOMichael Osterholm1:13:00

        You know, if you're, if you're basically living from paycheck to paycheck and you're having a hard time just feeding your kids, are you as likely to go buy vitamin D to supplement? That's what I'm saying.

    19. JRJoe Rogan1:13:10

        Got it.

    20. MOMichael Osterholm1:13:10

        And so, it's that kind of issue there. So, but I think the point that you're raising here is, again, this is another example of what the kind of studies we need to say could that help improve? You know, much like we did with niacin and milk and so forth, you know, where we basically were able to show that we can get health benefits in some cases by supplementing food.

    21. JRJoe Rogan1:13:28

        Don't they supplement vitamin D in milk as well?

    22. MOMichael Osterholm1:13:31

        Uh, to some degree, yeah. Well, bi- vi- milk is just a higher level. But, but I think the point being is exactly what you're raising is this is another example of can we have an indirect benefit to the public by learning this and actually helping people have adequate levels of vitamin D? I think that's critical. But I do wanna make one comment on this though, because I think this has been sometimes misunderstood about race and the issue of risk for COVID and for serious illness. If you look, the real correlation, which again is not cause and effect, but is who are the frontline workers?

    23. JRJoe Rogan1:14:04

        Mm.

    24. MOMichael Osterholm1:14:04

        Who are the people that are left largely unprotected? Who did the critical service for us, even in healthcare? During the course of this pandemic it was often, you know, our communities of color and people from that community. I could stay home and work on my computer in my office at home. I didn't have to be out and about. I didn't have to sit there and confr- you know, and have, uh, close contact with the public. And so, one of the challenges also is, of course, how do we protect these people from a work standpoint? And, uh, that's why getting vaccines to them is really, really important and supporting the issues. Um, and we've seen some really novel ideas. Probably the most, in fact, you would find this, uh, interesting, um, is the fact that one of the most novel programs I've seen has been a new movement among Black, uh, barbers and Black stylists who basically work to talk to their clients in their chairs. And who trusts people more than your barber? And they talk about all issues of health and it's a program that was started outta the University of Maryland and it's been fascinating of how it's actually having a really positive impact on health. But they do kind of like what you do, talk about all the health issues, not just-

    25. JRJoe Rogan1:15:12

        Wait, I'm, I'm confused. So, you're saying there's a program to educate barbers to talk to their clients?

    26. MOMichael Osterholm1:15:17

        There actually is and then they actually look at the outcome in their clients and they've been able to demonstrate major increases in people getting vaccinated-

    27. JRJoe Rogan1:15:26

        Mm-hmm.

    28. MOMichael Osterholm1:15:26

        ... people seeking out screening for cancer issues, et cetera, because the barbers use that time when you're sitting in the chair, or the stylists, to talk about health.

    29. JRJoe Rogan1:15:35

        So, how are they doing this? Through seminars? Like, how are they educating these people?

Episode duration: 2:28:43