Joe Rogan Experience #1779 - Michael Osterholm

Michael Osterholm 0:00 (drumbeats) Joe Rogan podcast, check it out. The Joe Rogan Experience.

Joe Rogan 0:06 Train by day, Joe Rogan podcast by night. All day. (instrumental music) Dr. Osterholm, welcome back.

Michael Osterholm 0:14 Thank you very much, Joe.

Joe Rogan 0:15 Very good to see you again.

Michael Osterholm 0:16 Good to see you.

Joe Rogan 0:16 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.

Michael Osterholm 0:30 (smacks lips) Well, you know, my job is not to scare anyone out of their wits. It's to scare them into their wits.

Joe Rogan 0:35 Ah.

Michael Osterholm 0:35 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-

Joe Rogan 0:45 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."

Michael Osterholm 1:00 (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.

Joe Rogan 1:07 (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?

Michael Osterholm 1:36 (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.

Joe Rogan 1:48 Humility.

Michael Osterholm 1:49 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.

Joe Rogan 2:21 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-

Michael Osterholm 2:40 Mm-hmm.

Joe Rogan 2:40 ... 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?

Michael Osterholm 2:51 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.

Joe Rogan 2:59 (laughs)

Michael Osterholm 2:59 I mean, it was just one of those situations where there was so much going on. Look at the politicization.

Joe Rogan 3:04 Yeah.

Michael Osterholm 3:04 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.

Joe Rogan 4:33 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?

Michael Osterholm 4:44 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

Michael Osterholm 5:44 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.

Joe Rogan 6:07 Mm-hmm.

Michael Osterholm 6:07 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.

Joe Rogan 6:15 Yeah, it's very strange, right?

Michael Osterholm 6:16 I mean, it's-

Joe Rogan 6:16 Yes, some, in some places, as many as 50% of the deer have antibodies.

Michael Osterholm 6:20 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?

Joe Rogan 6:39 Yeah, that's the question, right? Are they getting it from the capi- captive cervid industry?

Michael Osterholm 6:43 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.

Joe Rogan 7:07 Yeah.

Michael Osterholm 7:07 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.

Joe Rogan 8:02 Now, when you say the, the, so Omicron is far more contagious than Delta and far, far more contagious than the original variant.

Michael Osterholm 8:10 Yes.

Joe Rogan 8:11 Right? Now, when you say that, um, maybe, you know, wha- whatever numbers that you used-

Michael Osterholm 8:16 Yeah.

Joe Rogan 8:16 ... that it's, uh, less likely to cause hospitalization, but because it's infecting so many people, you actually get more hospitalizations.

Michael Osterholm 8:23 That's exactly right.

Joe Rogan 8:24 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?

Michael Osterholm 8:33 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-

Joe Rogan 9:21 For hospitalizations?

Michael Osterholm 9:22 Yes, even for hospitalizations.

Joe Rogan 9:24 Now, the kids that were hospitalized, did all of them have comorbidities?

Michael Osterholm 9:27 No. Mo-

Joe Rogan 9:28 None of them?

Michael Osterholm 9:28 Many, many of them did not.

Joe Rogan 9:29 So, ma- some of them were not even obese?

Michael Osterholm 9:31 Yep.

Joe Rogan 9:31 And they were hospitalized?

Michael Osterholm 9:32 Yes, absolutely.

Joe Rogan 9:33 Really?

Michael Osterholm 9:33 Yep. Omicron clearly really took a t- uh, uh, a hit on kids.

Joe Rogan 9:39 That's interesting, because, uh, I, in my kids' school, a few kids got Omicron.

Michael Osterholm 9:45 Uh-huh.

Joe Rogan 9:45 And it was, uh, essentially, like, me or my friends who got it. It was very mild.

Michael Osterholm 9:51 If you look at it right now, uh, just through this, up 'til this past month, with most of this activity having been primarily in the last six weeks, 1,334 kids between the ages of s- zero and 17 have died from COVID.

Joe Rogan 10:06 1,334 kids.

Michael Osterholm 10:08 Yep.

Joe Rogan 10:09 And out of these kids, how many had comorbidities? How many were obese?

Michael Osterholm 10:12 S- some, some did, but, but a comorbidity-

Joe Rogan 10:15 Just some?

Michael Osterholm 10:15 ... is not just obesity. Yes.

Joe Rogan 10:16 Right.

Michael Osterholm 10:16 In fact, let me come back and say somebody who has diabetes is considered having a comorbidity.

Joe Rogan 10:22 Sure.

Michael Osterholm 10:22 If you look at somebody who has, uh, uh, asthma, which, uh, you know, about 7% of all the asthma in the country is in kids.

Joe Rogan 10:29 All sorts of autoimmune diseases.

Michael Osterholm 10:30 Exactly.

Joe Rogan 10:31 Yeah.

Michael Osterholm 10:31 So, all of those add to it.

Joe Rogan 10:33 Right.

Michael Osterholm 10:33 And, and so that's been part of the real challenge we've had with this.

Joe Rogan 10:36 But for normal, healthy kids, is this something that's more dangerous than Delta?

Michael Osterholm 10:42 Absolutely, it was. It's abso-

Joe Rogan 10:43 Really?

Michael Osterholm 10:43 Yeah, absolutely, it was. Yeah. Yeah.

Joe Rogan 10:44 That, is tha- tha- is that shocking to you? Because it seems like for adults, it, the m- the effect that it has o- on the general population, it seems that th- the, the consensus is that it's more mild.

Michael Osterholm 10:56 Yeah. I think that's one of the challenges we have. If you've known the COVID-19 pandemic in 2020, and you knew it in 2021, doesn't mean how well you know it today, because things have changed.

Joe Rogan 11:10 Right.

Michael Osterholm 11:10 For example, if you look at the infectiousness in kids, the early data we had on how well this virus transmits in kids was before we ever had the Alpha variant, which showed up in roughly December of 2020 into, to, to January 2021, and we found limited transmission in kids, limited severe illness. Then Alpha came along, and we saw much more transmission. We had places in this country that had large outbreaks, school-based outbreaks. Then that kinda went away. Then Delta came and added even more transmission with kids than we'd seen before, and Omicron was the king. And so, I think if you knew...... COVID-19 back in 2020, you didn't necessarily know it today in terms of the infectiousness and what we ha- saw happen. So, I think that's one of the challenges we have, is just keeping up to date on what it did and how it did it with kids.

Joe Rogan 12:00 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?

Michael Osterholm 12:07 Well, the, yeah. That's, they, what they've labeled them by is the Greek alphabet. So, Alpha was-

Joe Rogan 12:12 Right.

Michael Osterholm 12:12 ... kind of the first one there, and then we've had subsequent s-

Joe Rogan 12:14 But not, not, not a, not the original virus, but the first variant of the virus?

Michael Osterholm 12:18 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.

Joe Rogan 12:50 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?

Michael Osterholm 13:02 Yeah.

Joe Rogan 13:02 Is there any of the original variant left?

Michael Osterholm 13:04 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-

Joe Rogan 13:11 The variants don't come from, like, Delta creating a new variant? So, it's-

Michael Osterholm 13:16 It's, it's actually takes, take you back to the original variant.

Joe Rogan 13:19 Oh.

Michael Osterholm 13:19 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.

Joe Rogan 13:26 100%?

Michael Osterholm 13:27 100% 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.

Joe Rogan 13:56 And-

Michael Osterholm 13:56 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.

Joe Rogan 14:11 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-

Michael Osterholm 14:22 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.

Joe Rogan 14:43 Really?

Michael Osterholm 14:43 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.

Joe Rogan 15:12 Right.

Michael Osterholm 15:12 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.

Joe Rogan 16:13 Hmm.

Michael Osterholm 16:13 And we don't know what that means.

Joe Rogan 16:15 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?

Michael Osterholm 16:30 Well, there was, uh, game animals, mink and so forth, in-

Joe Rogan 16:33 Minks.

Michael Osterholm 16:34 ... Europe that we saw that. But it became clear because we started seeing zoo animals infected.

Joe Rogan 16:38 Right.

Michael Osterholm 16:39 Just, just this past week, we've heard about lowland gorillas.

Joe Rogan 16:41 Cats and stuff, yeah.

Michael Osterholm 16:42 Cats. We've seen dogs and cats in people's homes where there were cases, and they got the white-tailed deer. I, I think there's a whole number of animal species where ultimately they could be infected with this virus, and the trillion-dollar question we don't know. Will that, in any way, shape, or form contribute to a, a spillback moment into humans with a new virus that, again, will challenge our immune systems, challenge our protection, and what does that mean? And we just don't know.

Joe Rogan 17:07 Is that the term they use biolo- or, uh, animal reservoir?

Michael Osterholm 17:10 Yes, absolutely. That's it.

Joe Rogan 17:12 So, that's, um, any other animal that can catch it. Now, is that, is it-

Michael Osterholm 17:15 Well, catch it and keep it going inside them. So, if, sometimes an animal may get an infection from us and it's terminal. It ends. It d- doesn't keep going in the animal population. But as we just talked about, the white-tailed deer, clearly there, the virus is ongoing with transmission in the deer population itself.

Joe Rogan 17:31 Are there any examples of an animal being infected and then s- like, from a human, like, a human giving it to their cat, for instance, and then the cat giving it to another human?

Michael Osterholm 17:42 (inhales deeply) You know, it's-... unclear. A- and when I say unclear, there was surely some data looking at the game farms, where it was thought that some of the transmission was from human to animal, animal back to human.

Joe Rogan 17:52 When you say game farms, are you talking-

Michael Osterholm 17:53 Yeah.

Joe Rogan 17:53 ... about, like, captive COVID?

Michael Osterholm 17:55 Cap- cap- talk- in this, in this case-

Joe Rogan 17:57 Uh, captive, uh, survey, rather?

Michael Osterholm 17:57 In this game, what we're talking about are primarily fur-bearing animals for pelts.

Joe Rogan 18:01 Okay.

Michael Osterholm 18:02 You know, the mink, f- ferrets, that type of animal species.

Joe Rogan 18:05 So that's where they first started to see the transmission into-

Michael Osterholm 18:07 Well, the- it's suspected.

Joe Rogan 18:08 Okay.

Michael Osterholm 18:08 It's never been confirmed, but it's been suspected there. Um, there's been some discussion and s- uh, follow-up on people's homes, where somebody got infected, the animal was infected, the dog or the cat, then somebody else got infected in the home. Well, it could just have easily been person-to-person, the animal as incidental. So I don't think we have any good examples of a human to an animal and an animal back to a human. There was a recent outbreak in Hong Kong, it's now emerged into a large outbreak, where they thought that hamsters were potentially, being sold in pet stores, were involved with being infected and transmitting. But I think the data still are out on did the hamsters really transmit back to people? They were definitely infected, but I don't know if they transmitted back to people.

Joe Rogan 18:50 Now, this, uh, virus, a- are there parallels to other viruses that we could look to and, and see this kinda similar pattern emerging? Like, particularly with, like, transmitting it into these other animals, and then the potential of those, these animals transmitting it to the people? It seems like there's so many different species that have it.

Michael Osterholm 19:10 Yeah. You know, we really don't have one like this particularly, you know, that can cause such a widespread disease. I mean, when you think about Omicron, for example, you know, when this first emerged in November, I coined the term a viral blizzard, 'cause it, to me, it, that's what it looked like it was gonna be. It was just gonna flood the world. If you look at Alpha and Delta and all these others, it took weeks, in some cases months, before it spread around the world. This one spread around the world literally overnight, and, you know, we're now seeing major activity in the western Pacific region. You know, in, in Hong Kong, uh, likely in China, s- we're not hearing enough about it, Korea, et cetera. But most of the rest of the world's already been hit hard and over it. Well, that is like a blizzard, what it did. Um, we've not seen that with any other animal-related virus in humans. Even influenza hasn't done what Omicron's done, uh, in that way.

Joe Rogan 20:02 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?

Michael Osterholm 20:24 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.

Joe Rogan 20:46 No evidence that would support that it is a manmade virus?

Michael Osterholm 20:48 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.

Joe Rogan 22:13 But I don't think anybody thinks it's an intentional release. Do they?

Michael Osterholm 22:16 No. Well, some people have. No, some people think-

Joe Rogan 22:18 Well, of course, I shouldn't say anybody-

Michael Osterholm 22:20 Yeah. Yeah. Yeah. Yeah.

Joe Rogan 22:20 ... 'cause s- some people believe the world's flat.

Michael Osterholm 22:22 (laughs)

Joe Rogan 22:22 Right? There's-

Michael Osterholm 22:22 That's absolutely true, too.

Joe Rogan 22:23 ... people who believe some wacky stuff.

Michael Osterholm 22:24 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.

Joe Rogan 22:42 Is that part of the problem, a lack of transparency?

Michael Osterholm 22:44 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.

Joe Rogan 23:06 Hmm.

Michael Osterholm 23:06 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.

Joe Rogan 23:25 I see what you're saying.

Michael Osterholm 23:26 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.

Joe Rogan 23:37 Mm-hmm.

Michael Osterholm 23:37 Do you think the US would just willy-nilly open up the lab at the CDC to the Russians and the Chinese?

Joe Rogan 23:42 Right.

Michael Osterholm 23:43 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."

Joe Rogan 23:59 Right. But is the CDC doing gain-of-function research on coronaviruses?

Michael Osterholm 24:03 They're not.

Joe Rogan 24:04 They're not.

Michael Osterholm 24:04 No.

Joe Rogan 24:04 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.

Michael Osterholm 24:13 (sighs)

Joe Rogan 24:13 I think part of the problem with what's going on in Wuhan was that lab is a level four lab that was working on bat-born coronaviruses.

Michael Osterholm 24:22 Exactly. No, you're absolutely right about that. But at the same time, CDC might be working on a lot of the viruses that emerged in the Caribbean.

Joe Rogan 24:28 Mm.

Michael Osterholm 24:29 And they would have labs that were working on that, because some of their best expertise is on, for example, mosquito-borne viruses-

Joe Rogan 24:35 Right.

Michael Osterholm 24:35 ... in there. So, I'm- I'm merely pointing out that it's not just the fact that the Chinese have basically stonewalled us. They have. And unfortunately, I think that that can be interpreted as, you know, there's definitely guilt there.

Joe Rogan 24:49 Right.

Michael Osterholm 24:49 I think some of it has to do with this issue of they just opened their lab up. I just wish they would, and let us- let- that an independent group from around the world go in, examine all the records. Was there any evidence of illness around that time? Was there any, uh, unusual activity? You know, the viruses they have, what they've self-reported, were not any that were close to this one, in terms of actually, yeah, that l- actual virus was in the lab that was suddenly found in Wuhan. So, I- I think it's a- continues to be a major distraction, a big one.

Joe Rogan 25:20 Wasn't there recently, uh, a version of the virus that was discovered, a very early version of COVID-19 in one of the labs?

Michael Osterholm 25:29 There's been s- a number of- of SARS-CoV-2-like viruses there, but again, this is out of my area of expertise. But the-

Joe Rogan 25:37 Okay.

Michael Osterholm 25:37 ... viral geneticists I know would say there surely is not the direct link yet, that that virus came from that virus in the lab. And so, I think that- but- but that's the kind of thing we need to have the transparency on. And-

Joe Rogan 25:49 And that's what's lacking.

Michael Osterholm 25:50 ... I wish we'd move on. I wish we'd move on then.

Joe Rogan 25:52 So, the part of the issue is that there's just not enough data from them to make an accurate, honest, clear determination.

Michael Osterholm 26:02 That's what I see. And I do see a virus that, right now, sure is very effective at moving between people to animals.

Joe Rogan 26:10 Right.

Michael Osterholm 26:10 So, it doesn't surprise me that it could move from animals to humans.

Joe Rogan 26:13 Now, the people that are suspicious that this did come from some game- gain-of-function research, they point to that as an indicator that this is a virus that was, at least, cultivated in a laboratory, right?

Michael Osterholm 26:27 Yeah, and I see no evidence of that. And let me just come back and add a context to this.

Joe Rogan 26:31 Okay.

Michael Osterholm 26:31 I sat for a number of years on what was the newly established, uh, s- basic group inside of the federal government to look at biosafety and biosecurity work, okay? The national science, uh, c- group that did that. And, you know, for all the years from 2005 to 2012 that I was on that, I was one of (laughs) the really outspoken people about my concern about doing influenza work in labs where they were trying to understand t- virus H5N1, a bird virus that occasionally infects humans, but could it one day become the next pandemic virus? And a group of researchers wanted to try to gen up that virus by passing it multiple times in ferrets and looking to see can we predict when it might become readily transmissible between mammals, i.e. could infect humans? And my concern was all along, wait a minute, what happens if this gets out? What's-

Joe Rogan 27:22 Right.

Michael Osterholm 27:22 ... what's the challenge? You could start the next flu pandemic. So, I have always, uh, considered myself kind of the champion in a way as, amongst others, of looking at biosecurity as a really critical issue. So, I- I h- come into this with the Wuhan experience feeling the same way. I think this is an important issue. I think it needs further discussion. But again, I don't see any evidence at this point that anyone has provided that shares that this is what happened. But I think we just need that transparency we don't have yet.

Joe Rogan 27:51 So, there's not enough evidence to draw a clear conclusion in your opinion?

Michael Osterholm 27:54 None. And I-

Joe Rogan 27:55 Now, there is some an- anecdotal evidence, right? There was, uh, some- I believe there was three researchers at the Wuhan lab who did get ill, uh, with a very similar disease to COVID-19 and one of their spouses wound up dying and there was some indication that that could have been the initial source.

Michael Osterholm 28:15 Yeah. You know, let me, first of all, just say in my world, anecdotal evidence is not really evidence. (laughs)

Joe Rogan 28:20 Right.

Michael Osterholm 28:20 You know? It's- it's- it's- it's not storytelling, but you know, I see some-

Joe Rogan 28:24 It's not enough.

Michael Osterholm 28:24 ... of these things. Yeah. And, you know, I've never seen any of those data corroborated by any responsible group. It's kind of one-off, you know?

Joe Rogan 28:32 Mm-hmm.

Michael Osterholm 28:32 It's kind of that old idea, you know, President Kennedy's secretary was named Lincoln.

Joe Rogan 28:36 (laughs)

Michael Osterholm 28:36 President Lincoln's secretary was named Kennedy, so there must be a tie between the two assassinations.

Joe Rogan 28:41 Got it, right.

Michael Osterholm 28:41 You know, it's that kind of thing.

Joe Rogan 28:42 Yeah.

Michael Osterholm 28:42 I've seen nothing that supports that activity at all.

Joe Rogan 28:45 Okay. So, as a scientist, you're just not willing to make that leap. You need-

Michael Osterholm 28:48 I'm not willing to make the leap, but I'm willing to make the leap if we get the evidence that it's there.

Joe Rogan 28:52 If the evidence is there.

Michael Osterholm 28:52 So, I'm not sitting here saying, "Write it off."

Joe Rogan 28:55 Right. I get it, I get it.

Michael Osterholm 28:56 Yeah.

Joe Rogan 28:56 Um, in the- the early days, there w- there was some evidence that was deleted. There was a lot of files that were deleted from the Wuhan lab. And th- a lot of people pointed to that as being an indicator that they were not- not just not being transparent, but withholding some data.

Michael Osterholm 29:14 Yeah. I- at this point, I can't comment on that to say I know exactly what happened. Uh, there surely was some evidence that there had been some files moved or deleted. Also, there's been evidence that some of those files have been replaced, et cetera.

Joe Rogan 29:29 Mm-hmm.

Michael Osterholm 29:29 So, I- I can't comment beyond that. But again, the people that I most respect in this business who have concerns like I have, have not pointed to that as being any evidence necessarily that that's what happened, was that there was data that they wanted to get rid of so people wouldn't see it.

Joe Rogan 29:45 Right. It's just-... again, not enough, right? Is that what you're saying?

Michael Osterholm 29:49 Yeah. Yeah, in fact, I wouldn't even say not enough. I would say I'm still waiting for even a limited smoking gun to come forward and say that. I just haven't seen anything like that. I'm open to it, I'm willing to it. I have said time and time again, I wish that there... Chinese would allow for an exhaustive, uh, outside review of what happened there, to corroborate all these pieces of information or basically, uh, show that they're not true, and I think that would put us all in a better place of trying to move forward.

Joe Rogan 30:20 Is there proof that they deleted evidence?

Michael Osterholm 30:23 I don't have any proof of that. I, I would... I don't know.

Joe Rogan 30:26 You don't know?

Michael Osterholm 30:26 I don't know.

Joe Rogan 30:27 Um, if there was proof that a lot of files were deleted, would y- would that give you pause?

Michael Osterholm 30:32 Well, I'd wanna know why.

Joe Rogan 30:33 Right.

Michael Osterholm 30:33 You know, we delete files all the time on research things after things are completed.

Joe Rogan 30:37 Mm-hmm.

Michael Osterholm 30:37 Now, on the other hand, laboratories typically are, uh... keep everything forever because they can... may have to go back to it-

Joe Rogan 30:44 Right.

Michael Osterholm 30:44 ... at a later date. So, you know, I, I can't comment on that other than to say, that should be pieces of evidence or pieces of investigation that would address that.

Joe Rogan 30:53 Now, uh, one of the things I think that you said early on in the pandemic was, you didn't think that it would, uh... that it had emerged from a lab. You thought it was a natural spillover, just simply because of the design of the virus itself, that we wouldn't design something like that.

Michael Osterholm 31:09 Yeah, and I still say that's, that's the case. I mean, this thing is so effective at infecting humans-

Joe Rogan 31:15 Mm-hmm.

Michael Osterholm 31:16 ... and it only got better over time. Think what it did in Mother Nature since the first Omicron or since the first, uh, variant occurred up to Omicron, and you can see, it just got better and better at infecting humans without any hand of a manmade event. And so this thing was an evolving virus right from the start that was basically capable of infecting humans and got better at infecting humans as time went on.

Joe Rogan 31:38 So the accusations or the people that think that it was made in a lab, how do they think that something like that would be created and why do you think that that's not the case?

Michael Osterholm 31:50 Well, again, this is out of my sphere of expertise.

Joe Rogan 31:52 Okay.

Michael Osterholm 31:52 I am not the person who can tell you from a genetic standpoint how to manipulate this virus, what to do it. As an epidemiologist, I can tell you, you know, I've seen these other spillover events. I've been very involved with investigating SARS-

Joe Rogan 32:04 Right.

Michael Osterholm 32:04 ... back in 2003 when it first emerged in China, spread around the world. I've been very involved with the work with MERS, the Middle Eastern respiratory syndrome, another coronavirus. And in each one of those, you can show clearly the spillover event from animals to humans.

Joe Rogan 32:20 Mm-hmm.

Michael Osterholm 32:20 In fact, with the camels being the main reservoir for MERS in the Arabian Peninsula, we keep having MERS cases because nobody's gonna put down all these camels, you know? We're not gonna get rid of 'em. And so we watch those spillovers occur from time to time into humans. So coronaviruses emerging out of an animal reservoir in and of themselves are not unusual. It's not somehow like A plus B plus C plus miracle ended up with the answer. So I, I haven't seen anything that would tell me that that was any different than that. But again, I'm wide open to whatever new data can come forward, and I hope we do exhaustively look at this.

Joe Rogan 32:57 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?

Michael Osterholm 33:19 Yeah.

Joe Rogan 33:20 Is that the case?

Michael Osterholm 33:20 I can't comment on what research they're doing. I don't know.

Joe Rogan 33:23 You don't know?

Michael Osterholm 33:24 I don't know that.

Joe Rogan 33:25 But you do know how gain of function is done, right?

Michael Osterholm 33:29 Well, gain of function, first of all, means that you're adding something to the virus, like I talked-

Joe Rogan 33:34 Correct.

Michael Osterholm 33:34 ... about with influenza. It was a gain of function. We were trying-

Joe Rogan 33:37 Mm-hmm.

Michael Osterholm 33:37 ... 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.

Joe Rogan 34:14 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-

Michael Osterholm 34:28 Mm-hmm.

Joe Rogan 34:29 ... and evolution to do the work for them? I mean, I don't necessarily think they're manipulating the virus. Aren't they-

Michael Osterholm 34:34 Yeah.

Joe Rogan 34:34 ... allowing the virus to go through its normal processes, but they're doing it purposely, right?

Michael Osterholm 34:40 Yeah.

Joe Rogan 34:40 Is that the case?

Michael Osterholm 34:41 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-

Joe Rogan 34:52 You don't know that they're doing-

Michael Osterholm 34:53 ... 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.

Joe Rogan 34:59 I thought that was the entire argument that, that even the NIH had laid out that they had done.

Michael Osterholm 35:06 Well, that had come up, and as you know, uh, EcoAlliance, the group that was doing the work does still-

Joe Rogan 35:12 EcoHealth Alliance?

Michael Osterholm 35:12 Yeah, EcoHealth Alliance, actually just-

Joe Rogan 35:14 Peter Daszak?

Michael Osterholm 35:14 ... d- yeah, d- uh, disagreed with that and said that's not what's being done. Again, uh...

Joe Rogan 35:17 They said they disagreed with it.

Michael Osterholm 35:19 Yeah, and I... so I can't comment. I don't know.

Joe Rogan 35:21 Right, because this was like the arguments between Rand Paul and Dr. Fauci and, you know, it was... they would get very contentious about the definition of gain of function.

Michael Osterholm 35:29 Right, right.

Joe Rogan 35:30 Do you think it's just splitting hairs, or do you think this is...

Michael Osterholm 35:33 Well, I think anytime you consider gain of function for any virus, uh, it's an important issue because-

Joe Rogan 35:38 Right.

Michael Osterholm 35:38 ... of the potential for it to do more harm, particularly if it's accidentally released, which can happen. Again, I don't have any firsthand or secondhand knowledge that that was what was being done in Wuhan.

Joe Rogan 35:49 ... but if they were doing gain-of-function, that's how they would do it. They would infect human respiratory tissue, and they would infect various animals, and they would study how this virus progresses and how it evolves and selects. Is that the case?

Michael Osterholm 36:02 Well, that's one way to do gain-of-function. But because I'm not a coronavirus, uh, virologist, I can't tell you if that's what they're doing with this or not, or if they have done that. I just don't know.

Joe Rogan 36:12 Right. And do you know if someone, or if a laboratory had done something like that, and they had gone through these steps to use evolution in terms of like infecting this human respiratory tissue, infecting ferrets who have the similar ACE2 receptors, that this would somehow or another make a virus more succ- more, uh, transmissible to people?

Michael Osterholm 36:35 Yeah. Yeah.

Joe Rogan 36:35 That's the idea behind it?

Michael Osterholm 36:36 Yeah. You know, yeah. And, and again, I just come back to the fact that, you know, you don't need to set up a research study today to do gain-of-function with this virus. Watch it in people.

Joe Rogan 36:46 Mm-hmm.

Michael Osterholm 36:46 Watch what it's doing on its own.

Joe Rogan 36:47 Right. But that's once it's been released, correct?

Michael Osterholm 36:50 That's once it's been released, but-

Joe Rogan 36:51 So if we're, if we were looking at the origins of it, I mean, this is what's concerning to people, right?

Michael Osterholm 36:55 Yeah.

Joe Rogan 36:55 They're wondering like, was this avoidable?

Michael Osterholm 36:59 Yeah. Yeah.

Joe Rogan 37:00 Like, is, is ... Like during the Obama administration, didn't Obama put the kibosh on gain-of-function research?

Michael Osterholm 37:06 (smacks lips) It was limited in the sense that it was for all gain-of-function research or how you actually were going to go about doing it and showing the safety steps you had in place to make sure that it couldn't be a release. A good example is, we do wanna know if flu viruses leave a mark that says, "We're about to become a human-to-human transmitted virus," so we can plan for that.

Joe Rogan 37:27 Hmm.

Michael Osterholm 37:27 So, we do wanna do some of this, but we wanna do it safely. And what I'm suggesting here is, I don't know un- uh, what happened in this lab or how it did it. I'd love to see that transparent information come out. I just can't comment.

Joe Rogan 37:41 Is it safe to say that, um, that this kind of research is important to understand how these viruses evolve, how they become more virulent, how they can infect people and jump species, that it, it has to be done safely, but it's, there's benefit?

Michael Osterholm 37:59 There surely can be benefit, and there's risk, and this is all about the risk-benefit equation. And I think that's what the whole purpose of what the NIH evaluation was, of when can we declare that there's a benefit here and this is the risk, and we can actually address the risk, and therefore the benefit is worth doing? And, uh, you know, you can't un-ring a bell. So I'm one of those people that am very concerned. I don't wanna find out later, "I wish we had taken more caution."

Joe Rogan 38:26 Right.

Michael Osterholm 38:26 Okay. My problem is I ... For this discussion, I just can't comment on what happened at Wuhan 'cause I don't know.

Joe Rogan 38:30 Right. Of course. Well, you're a scientist and you look at the evidence. You look at it, it has ... And there's just not enough of it, right? Is that safe to say?

Michael Osterholm 38:38 Yeah. And, and I'm open to any new information, as I said before, that comes forward.

Joe Rogan 38:43 Did you read any of those emails where there was discussions that was, were about the narrative of whether or not it had come from a lab leak and deterring that narrative?

Michael Osterholm 38:54 I did not.

Joe Rogan 38:54 Did you read any of that?

Michael Osterholm 38:55 I didn't. I, you know, I didn't really ... You know, if, if something substantive come out, what I ... You know, uh, you know, I already spend way too many hours a day working on (laughs) COVID.

Joe Rogan 39:04 Right.

Michael Osterholm 39:04 The last thing I have time for is basically getting into these, uh-

Joe Rogan 39:09 Politics.

Michael Osterholm 39:09 You know, uh, it's, you know, and as you know, I mean, it, it's oftentimes the kind of almost entertainment debate about, wait, he did this, he did that, who did this, what did that, and trying to trace it all back. And so for me, uh, you know, if there's substantive information, I wanna read it. I wanna know about it. If I can't understand it, I wanna ask people who do know, because there's a lot of the parts of this, as I said with humility, I don't understand. As an epidemiologist, I think I have a pretty good handle on what the virus is doing in terms of how it acts in people, but, uh, this particular area really does require a, a really level of scientific excellence in this area, for which we have people who have continued to pursue this. And so, we'll go for it, and I would like to see what they come up with.

Joe Rogan 39:55 So as an epidemiologist, you are just trying to follow the facts of the disease and avoid the weeds.

Michael Osterholm 40:00 Exactly.

Joe Rogan 40:01 Okay.

Michael Osterholm 40:02 And, and, and, and, and be really clear about this, is that I think that we have to have these discussions, but how we have them, they have to be based on data. What we can't do is more, you know, it's like the Kennedy-Lincoln analogy I just used, and now it proves a point, so therefore now the assumption is, well, they are linked. Let's ... I can tell you, the CIA of, you know, of the 1860s were still active back then and they were still active, uh, in the Pre- Kennedy era. You know, that does not help. And to me, that's where a lot of people find they spend time. I don't.

Joe Rogan 40:34 I don't know if that's a good analogy. Like see what you're saying, but we actually have the, the actual people that were trying to say that it seems like this is coming from a lab, and then, and these were credible people from legitimate universities. And then you had some other people that were trying to say, "We need to disparage these people, and we need to look at them as if they're fringe conspiracy theorists."

Michael Osterholm 40:56 Yeah, I think in the early days that happened in a way that-

Joe Rogan 40:59 Why would that happen?

Michael Osterholm 41:01 Um, you know, I can't comment. I wasn't part of that discussion. I did not get involved with that discussion, because I felt like it was a-

Joe Rogan 41:07 Right.

Michael Osterholm 41:08 ... you know, it was in the weeds in a way that, you know, I was trying to figure out what this virus was gonna do to kill people and how I could stop it from happening. So to me, again, I will let the experts who have that kind of expertise deal with it. And rather than he said, she said, I just-

Joe Rogan 41:23 Got it.

Michael Osterholm 41:23 ... I stay out of it.

Joe Rogan 41:24 Got it.

Michael Osterholm 41:24 That's why when I tell you what I know, you better count on it's true.

Joe Rogan 41:28 I believe.

Michael Osterholm 41:28 When I tell you that I don't know something, then you can take that to the bank too and say, "He just didn't know."

Joe Rogan 41:32 I appreciate that.

Michael Osterholm 41:33 (laughs)

Joe Rogan 41:34 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?

Michael Osterholm 41:54 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-

Joe Rogan 42:04 You mean by viral load?

Michael Osterholm 42:05 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.

Joe Rogan 42:23 Right.

Michael Osterholm 42:23 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.

Joe Rogan 43:01 Is it a... Is there a parallel to any other disease wh- that you've ever studied before or that scientists have studied?

Michael Osterholm 43:07 (sighs)

Joe Rogan 43:07 Like is there any disease that behaves this way?

Michael Osterholm 43:10 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.

Joe Rogan 44:25 Mm.

Michael Osterholm 44:25 And so it, it varies across all the viruses we have.

Joe Rogan 44:29 So is the high, the, the percentage, uh, unusual of people that are asymptomatic with this disease?

Michael Osterholm 44:36 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.

Joe Rogan 44:57 Right.

Michael Osterholm 44:57 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.

Joe Rogan 45:34 Mm-hmm.

Michael Osterholm 45:34 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.

Joe Rogan 45:50 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.

Michael Osterholm 46:02 Yep.

Joe Rogan 46:02 Other coronaviruses meaning common coronaviruses.

Michael Osterholm 46:05 Yep, yep.

Joe Rogan 46:05 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.

Michael Osterholm 46:17 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.

Joe Rogan 46:53 So people who caught the Alpha variant could catch it again?

Michael Osterholm 46:57 Yes. Well, everybody. Look at Delta. Uh, Delta's the same way. People... We know-

Joe Rogan 47:01 We've got Delta more than once?

Michael Osterholm 47:02 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.

Joe Rogan 47:10 Hm.

Michael Osterholm 47:10 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.

Joe Rogan 47:19 Mm.

Michael Osterholm 47:20 But so when I was talking about for the Alpha issue, we were talking about people who'd previously been infected with the ancestral variant. Now actually with Alpha, we're basically more likely to be protected by vaccine than previous infection. For Delta, if you had Delta, basically you were less likely to be protected from vaccine and more so from previous infection. And so what it's pointing out is this is a fluid situation and, and we're still trying to learn with Omicron. We had a lot of breakthrough infections with Omicron. You know, what was it that protected you or didn't protect you, uh, with Omicron and, and, uh, we're still really looking at that issue.

Joe Rogan 48:01 And that is with people that have been previously infected, as well as people who have been vaccinated with Omicron, correct?

Michael Osterholm 48:07 Right, right. So, if you, if you look at just hospitalization alone, if you were unvaccinated, you had about a 79.6 per 100,000 people were hospitalized. If you were fully vaccinated, it was only 4.4%, okay?

Joe Rogan 48:21 So, 79 people out of 100,000 were-

Michael Osterholm 48:24 Were-

Joe Rogan 48:24 ... were hospitalized-

Michael Osterholm 48:25 If you were unvaccinated-

Joe Rogan 48:26 ... or unvaccinated?

Michael Osterholm 48:26 ... and it was 4.4 if you were, in fact, previously vaccinated.

Joe Rogan 48:31 Four people? 4.4 people-

Michael Osterholm 48:33 Four, about-

Joe Rogan 48:33 ... versus 79 people?

Michael Osterholm 48:34 ... uh, 100,000 people. Yep, yep. Right.

Joe Rogan 48:35 So, uh, the, a lot of people thought it was a lot higher than that. Like, uh, there was an impression that, uh, when you got infected by SARS-CoV-2, that there was, whi- whichever variant-

Michael Osterholm 48:45 Yeah.

Joe Rogan 48:45 ... that you had a high likelihood of being hospitalized.

Michael Osterholm 48:48 Yeah, and this is for Omicron.

Joe Rogan 48:50 Right.

Michael Osterholm 48:50 Remember, we just talked about the fact that for many people who were infected, you know, you didn't even get seriously ill.

Joe Rogan 48:56 Right.

Michael Osterholm 48:56 But for those that did, yeah, they were seriously ill and the number of deaths were elevated.

Joe Rogan 49:01 D- do you think that there was a wasted opportunity to discuss metabolic health, metabolic health in terms of, uh, weight loss, in terms of, uh, y- taking care of yourself and eating correctly and vitamin-

Michael Osterholm 49:14 Yeah.

Joe Rogan 49:15 ... supplementation and e- eh- exercise? All these things were kind of ignored during the pandemic.

Michael Osterholm 49:20 (smacks lips) Well, you know, I, I don't know if I agree with that because, I mean, I surely have heard it over and over again that this was important. Uh, but it's important for everyday life. I mean, basically, whether you have Omicron or Delta or SARS-CoV-2 at all, these are important things that you should be-

Joe Rogan 49:38 Right.

Michael Osterholm 49:38 ... considering, okay?

Joe Rogan 49:39 Do you think that that was reinforced by the government?

Michael Osterholm 49:42 Oh, I think particularly around body mass index a lot.

Joe Rogan 49:44 Really?

Michael Osterholm 49:45 You know ... Oh, yes, I think so.

Joe Rogan 49:46 But-

Michael Osterholm 49:46 By ... I mean, I, I gave many talks where I was talking about-

Joe Rogan 49:49 You might have given many talks, but, I mean-

Michael Osterholm 49:51 Right.

Joe Rogan 49:51 ... this is not something that was, like, echoed by the White House, where they were talking about it openly in public, "Hey, folks, you gotta lose weight."

Michael Osterholm 49:57 Well, I think that if you look at the, just even the recent weeks in terms of the discussions about comorbidities and what they are, you have to separate out those ones which you can control, such as, as you said, you know, the exercise, that type of thing, those which are unfortunately just a part of your health profile-

Joe Rogan 50:17 Right.

Michael Osterholm 50:17 ... diabetes, asthma-

Joe Rogan 50:19 Autoimmune diseases.

Michael Osterholm 50:20 ... autoimmune diseases, et cetera. So, you know, I, I fully support the fact that we should be emphasizing this issue around body mass index, uh, meaning I.E. should lose weight, et cetera.

Joe Rogan 50:31 Yeah.

Michael Osterholm 50:31 And, and I, I agree with that.

Joe Rogan 50:33 It's really obesity, isn't it? But body mass index is a weird one because, like, I'm technically obese-

Michael Osterholm 50:39 Yeah.

Joe Rogan 50:39 ... by the body mass index.

Michael Osterholm 50:41 Yeah. Y- uh, and in that sense, you're right. You're right.

Joe Rogan 50:43 Yeah.

Michael Osterholm 50:43 It's really about weight, and ...

Joe Rogan 50:45 Um, the, the weird thing about, uh, COVID-19 also is the, uh, the way it attacks fat cells, correct?

Michael Osterholm 50:53 (smacks lips) It can, and that can be part of the amplification of this immune response issue that we work on. Yes, absolutely.

Joe Rogan 50:59 That, is that really unusual? Or, or, I mean, how much of a factor is obesity in terms of just g- a general, uh, immune system robustic?

Michael Osterholm 51:08 Well, I c- I can't say ... Again, I, I'm not the expert in metabolic-

Joe Rogan 51:12 Right.

Michael Osterholm 51:12 ... disease issues. But we know for a number of conditions that if you have increased weight, i.e. body mass index-like measures, that you are at a higher risk of having the additional problems because there is, from an immunologic standpoint, some activity with fat cells that can surely enhance, uh, an over vigorous immune response. And remember, with SARS-CoV-2, it's a combination of directly what the virus does to impact you, but also what does your immune system do?

Joe Rogan 51:41 Mm-hmm.

Michael Osterholm 51:42 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-

Joe Rogan 51:56 So, could you explain what long COVID is, technically?

Michael Osterholm 52:00 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-

Joe Rogan 52:24 Mm-hmm.

Michael Osterholm 52:24 ... a real condition, and people were really suffering.

Joe Rogan 52:27 And when you-

Michael Osterholm 52:27 Yeah.

Joe Rogan 52:27 ... say chronic fatigue syndrome, is that something you have a test for?

Michael Osterholm 52:31 No, that's the whole point.

Joe Rogan 52:32 Right.

Michael Osterholm 52:32 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-

Joe Rogan 52:47 Is there a d- like, uh, a specific infectious disease that-

Michael Osterholm 52:50 Well, you know-

Joe Rogan 52:50 ... is the origin?

Michael Osterholm 52:50 ... 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.

Joe Rogan 53:27 There's an interesting parallel with fighting. I can talk to you about this-

Michael Osterholm 53:30 Okay.

Joe Rogan 53:30 ... with, uh, MMA fighters.

Michael Osterholm 53:32 Yeah.

Joe Rogan 53:32 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.

Michael Osterholm 53:58 Mm-hmm.

Joe Rogan 53:59 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-

Michael Osterholm 54:36 Yeah. Yeah.

Joe Rogan 54:36 ... 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-

Michael Osterholm 54:51 Yeah.

Joe Rogan 54:51 Maybe some of them are not quite at the level that they used to be.

Michael Osterholm 54:55 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.

Joe Rogan 55:06 Yes.

Michael Osterholm 55:06 So they're-

Joe Rogan 55:07 That's why I brought it up. Yeah.

Michael Osterholm 55:07 Yeah, no. I think the issue around the immune response in the host, and things like inflammation, you know, the fact that the, you can actually find that, that your body's ongoing activity ... And we've seen this with people who, again, it's chronic fatigue, but chronic Lyme disease people have talked about this kinda same concept. And we really, I think, are at the opening of what I think will be a huge, huge effort to really look more at long-term impact of immune response on something once it gets triggered. Remember, our immune system is like skating on a razor blade. You wanna make sure anything that shouldn't be there shouldn't be there, but you wanna protect everything you can that's yours, and you don't want anything to happen to it bad. And where that really gets interesting is, for example, in pregnancy, where, you know, that fetus is not totally all that mother. But at the same time, the body is working to protect that more than it's done anything ever to make sure nothing bad happens to it. And when that dysregulation occurs, where the immune system tips a little bit more on one side or the other, you can see ongoing problems. And I think that's what this virus is doing, is, is creating this environment where this ongoing immune response is occurring. And I think you're go- And, and it's not just one thing, it's, it's a series of different issues. But I think the most important message is, is if anybody listening to this, uh, uh, effort here, is that there is people, there are people right now working on this, and that this is not something you have to live with, hopefully forever. Looking at drugs, treatments, what can we do to deal with long COVID? But right now, it's a daunting challenge, and I think the example you just gave very well could possibly be a part of a long COVID picture.

Joe Rogan 56:52 Now, long COVID, as described, um, as the way, the way we're talkin' about it, is essentially people that feel like they're not the same now as they were before the virus. They never have recovered fully. Is that a, a fair way to-

Michael Osterholm 57:06 Yeah. I think it's, it's really important-

Joe Rogan 57:07 Or they were damaged?

Michael Osterholm 57:08 Yeah, it's really important to distinguish. If you've spent the last three and a half to five weeks in an intensive care unit, I don't care whether it was for an automobile accident or it was for COVID, you have a long-term recovery in, at hand. And it's gonna take a while before you begin to feel like yourself again, you know, what will happen. So, it's y- you have to distinguish that, which is not necessarily that you can't get long COVID that way, but you also would just have that no matter what. Where it's really becomes very clear is people who've had milder COVID, who then in the second or third week, thinking they're getting better, all of a sudden start feeling tired. They feel like they forget things. They're feeling this brain fog. And that's where it's really most noticeable, because these were people whose bodies were not, quote unquote, "insulted" in such a way with COVID to have been bedridden for days and weeks and, you know, trying to recover from that. And I think that's the one example where you can say it's clear that there is a aftermath of this COVID for which some people experience and some don't. I mean, I know many people who have fully recovered from COVID, and, you know, they are doing perfectly fine.

Joe Rogan 58:23 Now, the, so you're saying some people with mild COVID still show some sort of a decrease in, in th- their physical response? Like, their ...

Michael Osterholm 58:32 Yeah. I've actually know of people who had milder COVID, and they'll tell you that their long COVID was much more severe than when they had the acute infection.

Joe Rogan 58:42 But what do they mean by that? Like, when you-

Michael Osterholm 58:43 Meaning, meaning when I w- had COVID itself-

Joe Rogan 58:46 Mm-hmm.

Michael Osterholm 58:46 ... I was test positive, I was tired-

Joe Rogan 58:48 Right.

Michael Osterholm 58:48 ... you know, but I was kinda around the house, and, you know, not feeling that bad. Now, here I am, eight to ten weeks out, and I have some days feel like I can't get out of bed.

Joe Rogan 58:58 So, something happened. And do we know, is it measurable? Is this like, can you get a, a EKG?

Michael Osterholm 59:06 Yeah.

Joe Rogan 59:06 Is there, there something you can show? Uh, do they have a higher resting heart rate?

Michael Osterholm 59:11 All of those things.

Joe Rogan 59:12 All those things.

Michael Osterholm 59:12 All those, all those come to play, and that's what these new centers that have been set up are actually studying. Is there a mechanism that can explain this, or is it a series of mechanisms? Why do some people have more cardiac and lung involvement, other people have more brain fog? You know, where clearly neurologically something is happening.

Joe Rogan 59:31 Hm.

Michael Osterholm 59:31 You know, why do some people feel such severe fatigue and others don't? So, one of the things is there's not a hallmark of long COVID that just says, "If you have this symptom, this symptom, and this symptom, you have long COVID." It's a combination of different conditions that are happening to people.

Joe Rogan 59:47 And are there any methods that they're utilizing that seem to be effective in treating people that have this?

Michael Osterholm 59:54 At this point, we're just in the infancy of that. And that's, as I said just a moment ago, this is going to be a critical part of our ongoing efforts with COVID, is just the study of and trying to understand what's happening. First of all, as you pointed out, we have to know why you're having these findings. What's going on?

Joe Rogan 1:00:11 Right.

Michael Osterholm 1:00:11 And then once we do that, what can you do about it? What k- what kinda treatments could be effective? And giving people hope, because I've seen people who at, 12 months after their COVID infection, who are feeling like they've kinda lost their life. They, they, they don't have the energy to go to work. They don't have the energy to be with family. Um, and this, this is really a challenge.

Joe Rogan 1:00:34 And, um, have you read anything about hyperbaric therapy-

Michael Osterholm 1:00:38 (inhales deeply) I-

Joe Rogan 1:00:39 ... in relation to recovery from this?

Michael Osterholm 1:00:41 I haven't.

Joe Rogan 1:00:41 You haven't?

Michael Osterholm 1:00:42 No.

Joe Rogan 1:00:43 Have you read anything about ... Is there anything else that stands out, like stem cells or anything that they seem to think would be effective?

Michael Osterholm 1:00:49 I think right now, uh, it's in that stage of just trying to define what it is.

Joe Rogan 1:00:54 Mm-hmm.

Michael Osterholm 1:00:54 You know, before they can even know necessarily the interventions that they can look at. You know, what are the markers? How is your immune system operating? Do you have evidence of certain immune markers that are elevated? Uh, you know, why might you have, uh, some evidence of some heart involvement or your lung involvement? So, part of it is, right now, just taking very seriously that long COVID really exists, and that we're trying to figure out, first and foremost, what might be the mechanisms that are causing it. And then I think you're gonna see, uh, a, a large number of efforts trying to address treatment itself.

Joe Rogan 1:01:27 So, it's still ongoing.

Michael Osterholm 1:01:29 Still ongoing, absolutely. And, uh, you know, one of the things that's going to be a challenge is to find out how many of the people who had Omicron, even in their mildest stages, that go on to develop long COVID. We don't know that yet.

Joe Rogan 1:01:39 It's such a strange term, long COVID.

Michael Osterholm 1:01:42 I know, yeah. (laughs)

Joe Rogan 1:01:42 You know, because it's like you don't really have COVID. Your, your COVID is done, but you have the deterioration of your, uh, your physical abilities.

Michael Osterholm 1:01:50 Yes.

Joe Rogan 1:01:51 Yeah. Very strange, right?

Michael Osterholm 1:01:54 Yeah.

Joe Rogan 1:01:54 Is there, is there no disease that's like that?

Michael Osterholm 1:01:55 Well, you know, we saw it again, as I said, with chronic fatigue syndrome.

Joe Rogan 1:01:57 Right.

Michael Osterholm 1:01:57 You know, that's a term that many people have, uh, had to suffer with for years and years and years. And, you know, we didn't have the major research initiatives around that, that I think COVID now is drawing the resources towards. And hopefully, you know, people who have that condition also can be, uh, helped by learning what, what did COVID do, why did COVID cause this?

Joe Rogan 1:02:21 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?

Michael Osterholm 1:02:42 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-

Joe Rogan 1:04:39 Why is that?

Michael Osterholm 1:04:40 Because we just didn't have the testing capacity.

Joe Rogan 1:04:42 But doesn't that seem ... That seems like something that would be much more easily-

Michael Osterholm 1:04:46 Well, that's what I'm going to.

Joe Rogan 1:04:47 Okay.

Michael Osterholm 1:04:48 Okay? That's exactly ... You, you-

Joe Rogan 1:04:49 Okay.

Michael Osterholm 1:04:49 ... 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.

Joe Rogan 1:05:37 Isn't this, uh ... Hasn't there been correlations drawn between vitamin D deficiency?

Michael Osterholm 1:05:42 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.

Joe Rogan 1:06:24 By COVID.

Michael Osterholm 1:06:24 By COVID.

Joe Rogan 1:06:25 Yeah.

Michael Osterholm 1:06:25 I mean, what it's done to f-... care in general.

Joe Rogan 1:06:27 Mm-hmm.

Michael Osterholm 1:06:28 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.

Joe Rogan 1:08:25 Just with testing?

Michael Osterholm 1:08:26 Just testing and then the drug availability, the drugs you just talked about.

Joe Rogan 1:08:29 Yes.

Michael Osterholm 1:08:29 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?

Joe Rogan 1:09:09 Now, you covered a whole bunch of things. So let's start from the beginning. F- first of all, you, you talked about testing.

Michael Osterholm 1:09:15 (laughs)

Joe Rogan 1:09:15 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-

Michael Osterholm 1:09:38 They do, they do.

Joe Rogan 1:09:39 Why is that?

Michael Osterholm 1:09:40 Because basically, the reagents in there can degrade over time-

Joe Rogan 1:09:43 Mm-hmm.

Michael Osterholm 1:09:43 ... and you wanna make sure you have exactly the right ones. So they do have a shelf life.

Joe Rogan 1:09:47 So they must be manufactured in accordance to the need, and you're gonna have a surplus, and then you have to abandon those, but you-

Michael Osterholm 1:09:55 Well-

Joe Rogan 1:09:55 ... have to keep up the supply.

Michael Osterholm 1:09:56 Well, also, it's not just surplus, but we do a thing called vendored management control. So you know, you're basically rotated in your shelf. So you-

Joe Rogan 1:10:04 Okay.

Michael Osterholm 1:10:04 ... have a place that says, "Okay, I will help vendor manage your product." So I'll make sure that of all the locations out there, somebody's not sitting on some stuff and others are using more. I'll make sure that the most lo- the one closest to outdating gets out there.

Joe Rogan 1:10:20 Right.

Michael Osterholm 1:10:20 And the ones that are farthest back, basically I'll hold so that we don't lose. And with vendor manage, you can do a lot to actually reduce that problem.

Joe Rogan 1:10:28 So that was the accusation from the Florida administration that they hadn't distributed those things. They could have done that and got them out there before they expired, and they, it seemed like they were hoarding them.

Michael Osterholm 1:10:39 Yeah, and I, I, and clearly, this, again, is part of that whole testing issue is some of it's gonna be surge capacity, because there's only so much you can actually put in surplus stock with the fact that some of it basically will, in fact, uh, expire. And so then it's a matter of, okay, so what's your surge capacity? How do you then say, "I can bring on board..." And, and you can't make it at the last minute. It's kind of like a fire department that goes out and tries to buy their fire truck when the 911 s- alarm comes in. And so you gotta have people ready to go. You have to have manufacturing capacity to be able to. So when you have the surge, you can do that. Now, here's the challenge. If you believe that Omicron's a- is the last of the variants, you believe that COVID is done, why would you invest in that? And that's where I come back and say, "Well, I hope it's the last one." But hope's not a strategy.

Joe Rogan 1:11:24 Right.

Michael Osterholm 1:11:25 You gotta be prepared. What if another variant shows up? The challenge is, again, we're gonna have the same needs. We're gonna have the same issues ahead, so we're gonna have to plan for that.

Joe Rogan 1:11:36 What kind of shelf life do those tests have?

Michael Osterholm 1:11:39 It varies. I can't tell you test by test, but it, it, it, uh, it's, it's months.

Joe Rogan 1:11:44 Months.

Michael Osterholm 1:11:44 But it's not-

Joe Rogan 1:11:45 It's not years.

Michael Osterholm 1:11:46 ... you know, years. It's not years, yeah.

Joe Rogan 1:11:47 Um, let's go back to vitamin D.

Michael Osterholm 1:11:49 Sure.

Joe Rogan 1:11:49 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-

Michael Osterholm 1:12:17 Yeah.

Joe Rogan 1:12:17 ... infections?

Michael Osterholm 1:12:18 Well, I can say that there clearly have been studies done that demonstrate reduced vitamin D levels in cases coming in, into the hospital.

Joe Rogan 1:12:26 It was like 84%-

Michael Osterholm 1:12:27 Yeah.

Joe Rogan 1:12:27 ... at one point in time of people-

Michael Osterholm 1:12:29 Yeah.

Joe Rogan 1:12:29 ... in the ICU had insufficient levels of vitamin D.

Michael Osterholm 1:12:32 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-

Joe Rogan 1:12:51 Well, vitamin D isn't really like, effectively supplemented through food, is it?

Michael Osterholm 1:12:55 Well, sunlight and some degree food, meaning I take a supplement.

Joe Rogan 1:12:59 Sunlight, yeah.

Michael Osterholm 1:12:59 See, I'm talking about taking a supplement.

Joe Rogan 1:13:00 Supplement, yeah, okay.

Michael Osterholm 1:13:00 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.

Joe Rogan 1:13:10 Got it.

Michael Osterholm 1:13:10 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.

Joe Rogan 1:13:28 Don't they supplement vitamin D in milk as well?

Michael Osterholm 1:13:31 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?

Joe Rogan 1:14:04 Mm.

Michael Osterholm 1:14:04 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-

Joe Rogan 1:15:12 Wait, I'm, I'm confused. So, you're saying there's a program to educate barbers to talk to their clients?

Michael Osterholm 1:15:17 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-

Joe Rogan 1:15:26 Mm-hmm.

Michael Osterholm 1:15:26 ... 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.

Joe Rogan 1:15:35 So, how are they doing this? Through seminars? Like, how are they