February 19, 2021

Michael Osterholm

Epidemiologist Dr. Michael Osterholm says new COVID-19 strains will likely cause cases to surge in March. Osterholm, who was on Biden’s transition task force, says the U.S. needs to revise its vaccine and mask strategies now to save lives.

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Is a major new Covid surge on the way? This week on Firing Line. Case numbers are plummeting across the country, but epidemiologist Dr. Michael Osterholm believes this is the calm before the storm 

I see that hurricane five, category five or higher, 450 miles offshore. That hurricane’s coming. 

 The danger, he says, is new variants of the virus that spread more easily

SOT Osterholm Jan. 6: If one said am I worried about this, my answer would be no, hell no, I’m scared. 

Osterholm, who advised Biden during the transition, insists the country must act now.

The next 14 weeks I think will be the worst of the pandemic. 

While debate is focused on reopening schools, and with some states easing restrictions, what does Dr. Michael Osterholm say now?

‘Firing Line with Margaret Hoover’ is made possible in part by… Corporate funding is provided by…

HOOVER: OK, Dr. Michael Osterholm, thank you for returning to Firing Line. 

OSTERHOLM: Thank you for having me. 

HOOVER: President Biden, just this week, said that he hopes that things will be a lot more normal a year from now, and I’ve got to be honest, a lot of Americans were surprised to hear him say this could go on until 2022. New COVID cases are dropping dramatically across the country. I want to show you an image of the curve. You are warning that a hurricane is coming our way, that this is the calm before the storm. Some people say you’re an alarmist, you say you’re just a realist. Explain what’s about to happen.

OSTERHOLM: Right after Labor Day, when we were at 26,000 cases a day, and I said we’d likely be well above 200,000 cases by Thanksgiving, we hit that well before Thanksgiving. Case numbers came down again to 150,000 new reported cases a day in December, and I said we’re going to hit 300,000 cases in January. We did. Each time someone would point out to me when I made those predictions that they were scary and they were very unfortunate, and yet that happened. Now, I can tell you, I can’t say with certainty that we’re going to see this big surge, but everything tells me, based on the rapidly spreading B117 variant here in the United States, we are going to do a redo of what places like England and Ireland and Denmark and Israel, all these countries, have done in recent months with B117. And that is: we’re going to see a lot more transmission. We’re going to have many more people who are seriously ill and hospitalized, which will then challenge our health care systems. And I feel very much like I’m sitting on a beach with a group of people, not a cloud in the sky, telling them it’s time to evacuate. And they’re looking at me like I’m a madman. When in fact, I can see that hurricane, category five, just 400 miles south of there, is going to be coming onshore within days. That’s, I think, where we’re at right now with this situation with B117 and where the cases are going to go over the next five to 14 weeks.

HOOVER: B117, for the sake of the audience, is what most people know of as the UK variant. We spoke to you six weeks ago for an episode that aired on the Firing Line YouTube channel. At that point the US only had a smattering of cases of the UK variant detected. Now the UK variant, B117, as you say, is in the US, as you say, probably in all 50 states. More than a thousand cases have been detected and it’s doubling every 10 days. Last time you were here, I said, are you concerned and you said, quote, “Hell no, I’m scared.” Do you stand by that? 

OSTERHOLM: I sure do. I still am. If you look at the amount of vaccine we have coming into the system every day, you look at how the vaccine is being used, in fact 30 million out of the 54 million individuals 65 years of age and older in the United States will not have a drop of vaccine before April. With the potential for this variant to cause such severe illness and increased hospitalizations and deaths, particularly in that age group, yeah, that’s why I’m extremely concerned. 

HOOVER: There’s a South African variant of Brazil variant. There are seven homegrown American variants that have been identified in a study published last week. The variant that is most troubling to you is the UK variant, B117, because it’s most transmissible, is that right?

OSTERHOLM: Well, actually, let me clarify it. First of all, there are many, many variants. Variants are viruses that have a set of mutations. What we’re concerned about are specific variants we call variants of concern. And these are ones that have acquired one of three capabilities or a combination thereof. The first one is: they’re more transmissible. B117 is just that, 30 to 70 percent more transmissible. We also see that it can cause more serious disease and increase deaths. The third category of concern is variants that actually can escape the immune protection afforded us by vaccine or having had illness before and then developing an immune response. The reason I’m concerned about B117, is that one is here — that’s one that’s spreading widely. Fortunately, that one has not yet acquired the ability to defeat the immune response of either vaccine or humans, at least in the United States. There have been sporadic isolates identified in Europe in just the recent weeks that suggests that it may have now acquired that. But what’s circulating here is not yet that. So my immediate concern is the next six to 14 weeks. That’s what I’m really worried about, and I’m worried about what’s going to happen with this huge surge. I am worried about P1, the Brazilian variant that you mentioned that has evaded the immune protection of vaccines and natural disease. I’m also worried about the variant from South Africa, which, that too, has developed that capability. Fortunately, we don’t see them circulating nearly as well as the B117. So their ability to at least cause a major public health challenge here in North America is still limited. But I’m very concerned about these variants and I’m really concerned, also, about future variants because we are going to see this virus go largely unchecked in many, many, many countries that have not had one drop of vaccine. And it doesn’t appear they’ll get it soon. That’s where the new variants are going to keep emerging from, that could affect us in the future, is in all those infections that occur in those countries.

HOOVER: So are you saying that a B117 surge is inevitable?

OSTERHOLM: I believe it is. And I believe that everything we’ve seen so far in Europe and the Middle East would support that. So I see every indication right now in North America — that includes Canada — that the very same early days of B117 that we’re seeing in these other heavily impacted countries is playing out right here right now. And then you add one last ingredient, and that is the fact that, just as you pointed out, appropriately so, case numbers have dropped precipitously. We are extremely pleased with that. And we should be in terms of the reduced illnesses, hospitalizations and deaths. But that’s also given us license to believe we’re done. And we’re seeing the opening of all the kinds of restrictions or mitigations we put in place to slow down the transmission. And we could not have provided a more inviting environment right now for this virus to spread willy nilly over the course of the next weeks.

HOOVER: And just to, really hammer home that point — if a surge in the U.K. variant in the United States is inevitable, what does that mean, Dr. Osterholm, for our hospitals?

OSTERHOLM: You know, to understand what this could do — and I’m not going to say that it’s going to be one for one — but if you take the rate of hospitalization that occurred in England at the peak of their surge and you actually just look at that in the United States by population, we would have, every day, roughly 195,000 hospitalizations, if we see that rate of hospitalizations in England duplicated here. Now, we were at 130,000 hospitalizations a day in the January peak. And we all know how many of our health care systems literally were unable to provide, in some cases, minimal care. They were on triage status. We know how many hospitals had to bring in a number of refrigerated semis just to hold the bodies. So imagine if that were 195,000 hospitalizations a day, not 130,000. You know, I hope we never see that. But we have to prepare for this in the sense that that’s what this particular variant could do.

HOOVER: You’re calling for the country’s vaccination strategy to change. You want as many people to receive the first dose as possible, which also means postponing the second dose. Explain why. I mean, you believe this so fervently that you yourself have forgone your second dose. 

OSTERHOLM: I have. And let me be really clear: I’m actually calling for a review of the data on an emergency basis, that exists, for the effectiveness of a single dose. And all we’re saying is, is that everyone who has had one dose now should get their second dose. Nobody’s trying to take your second dose away. But if we could then go to a one-dose strategy and particularly concentrate in those 65 years of age and older, we could almost vaccinate all 53 million individuals in this country, 65 years of age and older, which would have a dramatic impact on the number of deaths, the serious illnesses and the hospitalizations. And then what we would do is, as the surge ends and vaccine continues to increase, we’d go back and get those second doses. So no one is ever going to be denied a second dose. But the first and most important thing is review the data. You know, and I’ve had, you know, numerous people say, ‘well Osterholm wants to do a study.’ No, I don’t want to do a study. There are data available now that could give us much more clarity about: is this a reasonable option? You know, I hear people who complain and say, ‘well, you know, it’s going to make variants worse because of incomplete protection.’ Let’s be really clear. All the variants that we’ve had to date have come from natural infected people, not from vaccine-related protection. And so I think that the time for doing this is running short. If we don’t consider this soon we won’t have the opportunity to even consider that because the surge will be here. And remember, once you start vaccinating people like this, it’s still going to take two to three weeks for them to mount the kind of protection that we would want everyone to have. And let me just conclude, I think on a personal level for everyone here. Imagine it’s your parents or grandparents sitting on the other side of the desk. They’re over 65 years of age, they have underlying health conditions, and I have two doses of vaccine. I can look at either one of them and say I can give you the two doses or give you the two doses, but I can’t give both of you two doses. Which would you do? Would you give one to each or would you give two to one and the other person, leave them totally vulnerable? That’s the kind of choices we’re going to have to start making from a public health standpoint. We’ve had health care systems that have already had to make very painful decisions in January about triaging patients — who got care and who didn’t — because they were overrun. Now I think it’s a public health triage moment. What are we going to do with this surge coming to protect as many people as possible? 

HOOVER: It sounds like, Dr. Osterholm, that you think the data actually will reveal that this is the right strategy?

OSTERHOLM: My message is: time is running out. Time is critical here, but at least do an exhaustive review to determine do we have enough data to say people would likely be protected? I’m willing to go with the data, and what I find difficult are people who just say, ‘well, you know, we have to stick with the science,’ which is not true. If you were sticking with the science, you would consider all data that might be possible, including looking at what’s happened in Israel and countries like that, that have used the Pfizer vaccine in a way that is exactly what we’re talking about here. And I …and I do believe it’s critical. I wouldn’t keep talking about it. I wouldn’t keep addressing the issue. I wouldn’t keep getting hammered in public with it, if I didn’t believe it. I wouldn’t have given up my second dose. You know what? I was so looking forward to that second dose because I was ready to wrestle with my five grandkids. I have missed an entire year of that. I believed with my second dose I could go do that. I gave it up because I hope somebody else’s father, grandfather, grandmother or mother got my dose and it saved their life and kept them out of a hospital. That’s what I think right now we need to do. We are in a critical public health period where there is no easy answers, and it’s going to be tough calls. But this is one of them we have to make now. 

HOOVER: Is the Biden administration weighing this consideration with sufficient urgency, in your view? 

OSTERHOLM: At this point, I’m not certain. I have a lot of confidence in the senior leadership in the vaccine side of the House in the Biden administration. I think there are some excellent people there who… who really are bringing order and critical thinking to this area. I think that there are those who also have just gotten into the, ‘we have to stick with the science,’ mindset. We don’t want knee jerk reactions just because that’s what everybody else has said. This is a time for critical thinking by people who are willing to potentially, you know, put it out there. But it’s also a time when we may very well be able to save literally thousands and thousands of people from hospitalizations, serious illnesses and deaths.

HOOVER: One of the things you’ve said is that the data is available to study this one-dose issue. You’ve said that the CDC and the FDA took it.. if they took it on, quote, “that review could be done within days.” Why aren’t they doing this? 

OSTERHOLM: I don’t know. And I don’t know that they’re not. We’d just like more clarity. 

HOOVER: You recently wrote a Washington Post editorial …or, you wrote an opinion editorial in The Washington Post with other transition task force members that says quote, “We must develop multivalent vaccines. That is, vaccines that can immunize against more than one strain of the same disease.” Where does this stand?

OSTERHOLM:  At this point, we have to take a step back and rethink, I think, coronavirus vaccines. I think we need, today, to have what we call a team B, or a group that is kind of in the back room thinking about, well, these variants continue and we’re going to have to be faced with those challenges, are there new vaccine types we ought to be considering that are not the current ones? Second and third generation vaccines? Vaccines that might target, for example, t-cells, another part of the immune system. Right now, we’re looking at neutralizing the antibody. And so I think that the real message from our group was: now’s the time to begin that. Looking long term — three, five, six years down the road — what might a vaccine that we need at that point look like?

HOOVER: President Biden gave a town hall this week and he talked a lot about the school reopening strategy. The CDC put out a road map last week that you said you think is the right set of guidelines — the guidelines are sufficient. Do you think that more K-8 schools ought to be open right now? 

OSTERHOLM: Well, let me be really clear. When I talk about the CDC guidelines, I continue to refer to that from the K to eighth grade. You know, there is something very different about the epidemiology — or how the virus is transmitted, who gets infected, who is doing the transmitting and how seriously the people get ill — in the younger kids. I don’t have the same conclusion about the older kids. You know, we have had numerous outbreaks in junior high and high schools, particularly related to organized sports. So I think that that’s a different set of issues. And so I do think that we can provide that in-person learning experience in a relatively safe manner. However, I add the caveat: if you look at the experience of Europe and Israel, in all of those examples where B117 took off, they ended up having to close their schools, even though that was a high priority, to keep them open. And they had to do that to basically bring the B117 under control. So I am also very, very aware of the fact that, you know, if we do see any turnup of this virus causing more more disease, which I think is surely going to happen, then, you know, we got to basically be able to stop on a dime and give back nine cents change. We got to pivot quickly. Remember, the virus is in charge here right now. We’re not. And so what we do or not do about schools is going to be largely dependent on what this virus does. 

HOOVER: Let me show you something Dr. Fauci said this week about schools. Take a look. 

FAUCI: I think if you were going to say that every single teacher needs to be vaccinated before you get back to school, I believe, quite frankly, Tony, that that’s a non-workable situation. 

HOOVER: Is it your view, Dr. Osterholm, that vaccinating teachers should be a prerequisite for opening schools back up? 

OSTERHOLM: Well, I will just make one extremely unpopular statement that will– You know, we might as well try to upset everyone. You know, if you follow my priorities right now, we’d be vaccinating sixty five year olds and older. That’s what we’d be doing. Not because I don’t think teachers are important. Not because I don’t think essential workers are important. I recognize the equality issues of younger age populations, and a disproportionate number of cases in our BIPOC communities. I get all that. My immediate concern is keeping our health care systems from being overrun with a B117 surge. And so I have to look teachers straight in the eye and say, ‘I’d love to have you get vaccine, but right now I want to get all the vaccine I can to the older population.’ So I want every teacher to be vaccinated. If nothing else, just for the psychological risk. You know, I’m in the game here with this, but I’m also a human. And I got to tell you, this virus has taken a toll on me. You know, I worry even with my one dose, I’ll sit there and say I really do feel protected. But you know what? I can’t wait until we all can get two doses. So I think right now, you know, you can open schools, particularly for younger kids without teachers all getting vaccinated. I hope they get it soon. But please get as many of our 65 year olds and older vaccinated. 

HOOVER: So you do think 65 and up, before teachers, even if that means it takes longer for schools to reopen? 

OSTERHOLM: I would say that. And again, the question is, is that a requirement that you have to get all teachers vaccinated before you reopen? So to me, as unpopular this is as this is, I continue to say, for the sake of this B11 surge that’s coming, I want to see as many 65 year olds and older vaccinated. Everybody’s mom, dad, grandma, grandpa in those age groups should be vaccinated with at least one dose. 

HOOVER: You said, quote, “What scares me right now is that we’re talking like somehow we have just basically won the COVID lottery” end quote. Iowa and Montana have lifted their mask mandates. The CDC director has warned that this is a mistake and you agree, now is not the time to lift mask mandates, Dr. Osterholm?

OSTERHOLM: Absolutely. I think we’re gonna be going back very quickly and redoing the issue around restaurants and bars. And so, you know, I hope we never go there. I understand the pain, I understand the mental health issues, I understand the economic issues, I understand what it’s doing to our society. But at the same time, I also understand what it means to overrun your health care system. People may not want to hear that. That’s what we’ve got to be prepared for and to do anything less than that, would I believe would be public health malpractice. 

HOOVER: You and three other members of the Biden covid transition team, along with eight other health and safety experts, have written the Biden administration, urging them to more widely recommend and mandate the use of N95 masks for high risk workers. If somebody has an N95 mask, Dr. Osterholm, should they use it? 

OSTERHOLM: I would absolutely use it right now, particularly if you’re a high risk worker, meaning you’re an essential worker, you don’t have a choice, you have to stand for eight hours in a crowded customer area. You don’t have the luxury of working from home. Then I think we have to protect these individuals much more. I think the real message here, though, Margaret, is, is that we need the federal government to really update their recommendations on respiratory protection and in a sense, bring them into the 21st century. I think right now it’s very clear and compelling, and there are many such experts out there who have strongly, strongly supported the fact that aerosols — these very tiny droplets that basically float in the air — are very important in the transmission. You know, it’s not just basically the big droplets that occur nearby. And so what we need really right now is for OSHA to do its job, CDC has to do its job. And for CDC to do its job, it has to look at all these data and I believe come up with recommendations to say that this type of aerosol or airborne transmission is really very important.

HOOVER: You’ve been an adviser to New York Governor Andrew Cuomo since May, and Governor Cuomo is under investigation for his handling of nursing home health data. He’s also faced criticism for, back in March, directing nursing homes to readmit residents who had been hospitalized with Covid-19. What do you think of Governor Cuomo’s handling of the pandemic in general and the nursing home issue in particular? 

OSTERHOLM: Well, first of all, I haven’t had not had anything to do with his nursing home activity at all. I came on basically in early June only just to review data on a weekly basis, did it meet the standards that they had set. I’ve never met with their group. I’ve had one five-minute conversation my entire life with Governor Cuomo, just a few weeks ago when he called me just to congratulate me on a TV program appearance. So I can’t really comment on anything about the nursing home issue. I can say that during the summer months, as you know, the state of New York and the program that they put in place was by far one of the most effective programs in the country in terms of new cases. You know, surely this fall that has changed, and we saw a substantial increase in cases in New York. And right now they still have a real problem. So, you know, I’m just not in a position to know what they did or didn’t do on the nursing home side. 

HOOVER: Back when we spoke a few weeks, several weeks ago, you were beginning to wonder if this might turn into the big one. Your nickname is Bad News Mike. Is it possible that this is the big one? Do you still hold that view? 

OSTERHOLM: Well, let’s put it this way, this has thrown us recent curveballs that make us wonder just what is the long term relationship between these coronaviruses and humans. And in that regard, I’m not sure if it’s the big one, meaning a large pandemic where this is going to be a challenge, unlike anything we’ve seen since HIV-AIDS. If you look at the influenza pandemics — there have been 11 of them in the last 250 years — where it happens, it gets over, and then we move on. This one, I think, is a chronic issue that, like HIV, is never going to go away. So when you ask me, is this the big one, this is really a big one for certain, but it’s almost a totally different kind of big one. In that I don’t have the hope like I might with influenza, that it would one day attenuate or become less serious and no longer be the pandemic risk. This one, I think, is going to be with us for a long, long time. You know, people have always asked me kind of on the balls-and-strikes approach that I try to take, what inning are we in? You’ve asked me that. And, you know, I’ve said we’re in the bottom of the third or top of the fourth. You know, the last few weeks I begin to wonder If we’re in a whole new ballgame. The variants have left us with lots of questions and not a lot of answers. And these are really challenging questions. So, you know, we’ll see. I think that the future is challenging, but I hope that we arise to that occasion and develop the kind of vaccines and therapeutics that will help get us around that. 

HOOVER: I hope so too. Dr. Osterholm, thank you for returning to Firing Line.

OSTERHOLM: Thank you. 

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