Episode 151: Harm Reduction

Chris Dall: Hello and welcome to the Osterholm Update, a podcast on COVID-19 and other infectious diseases with Doctor Michael Osterholm. Doctor Osterholm is an internationally recognized medical detective and director of the center for Infectious Disease Research and Policy, or CIDRAP, at the University of Minnesota. In this podcast, Doctor Osterholm draws on nearly 50 years of experience investigating infectious disease outbreaks to provide straight talk on the latest infectious disease and public health threats. I'm Chris Dall, reporter for CIDRAP news, and I'm your host for these conversations. Welcome back, everyone, to another episode of The Osterholm Update Podcast. Over the last few episodes of the podcast, we've been discussing the changes recently made by the California Department of Public Health to the state's COVID isolation guidelines. Now, according to reporting by The Washington Post, the centers for Disease Control and Prevention is also looking at loosening its COVID isolation recommendations to align them with guidance on how to avoid transmitting flu and respiratory syncytial virus. Now, none of this is official, and any changes would need to get sign off from the white House. But still, the news has sparked strong reaction. Loosening COVID isolation guidelines, quote, sweeps the serious illness under the rug, unquote. A Harvard Medical School instructor and member of The People's CDC told The Post on this February 22nd episode of the podcast, we're going to discuss the potential changes to the CDC's COVID isolation guidelines after we examine the latest COVID-19 data from the United States and other parts of the world. We'll also provide an update on COVID-19 variants, discuss COVID-19 vaccine recommendations, look at the latest flu and RSV data, and answer an ID query about how people should understand and react to news about new and rare public health threats. And we'll bring you the latest installment of This Week in Public health history. But before we get started, we'll begin with Doctor Osterholm's opening comments and dedication.

 

Dr. Osterholm: Thanks, Chris, and welcome back to the podcast family to another edition of the Podcast Update. Uh, as I say, each and every time that we start these podcasts, it's so good to be back with you. Um, I cannot put into words how much we appreciate, uh, the listeners of this podcast and the kind of feedback that you share with us. I will say that today I want to start out by just saying that it was good news. My dear friend Don, who you've been following with me over the past few weeks. Uh, has is improving and should be released, uh, in the next few days. Go back home after a rather tortuous path with COVID. I never need to be reminded for one moment about the importance of COVID in my life personally. And just to add to that information, today, uh, we were supposed to have some friends over, uh, for an event here at our home, and they had to cancel this morning because they both tested positive for COVID this morning. So it just gives you an idea. I'm living in a COVID world. I know it every hour and never forget that. Having said that, at the last podcast that we had was probably one of the most interesting, if not challenging podcasts that we've done since the very beginning of this pandemic. Uh, the comments we received were, first of all, very positive.

 

Dr. Osterholm: When you talk about the dogs, everybody loves dogs. I mean, I'm telling you, if you're going to run for office, if you want to make it in this world, get a dog, okay? It's really, really helpful. So thank you for all those who could identify with that and the special relationship that we humans share with those very, very important creatures. Also, a number of you were very thoughtful and provided really wonderful comments about our discussion about the issue of screening recommendations for isolation, etc. and we're going to revisit that today because there was a group of you that were actually quite emotionally moved by it, and not necessarily in a good way. You were angry. You felt like somehow, uh, we here at CIDRAP and me specifically had abandoned science. And I'm going to talk at length about that today because I think that it's a really important time for us to understand. And maybe if I could put this into context, uh, one of my favorite authors of all times is Charles Dickens. And of course, uh, you know, from my perspective, Christmas can't exist without Charles Dickens, but also another one of his very famous books, A Tale of Two Cities, also, I think is very relevant today. As you know, he started that tale of Two Cities with the following quote. It was the best of times.

 

Dr. Osterholm: It was the worst of times. It was the age of wisdom. It was the age of foolishness. It was the epoch of belief. It was the epoch of incredulity. It was the season of light. It was the season of darkness. It was the spring of hope. It was the winter of despair last week. That's the feedback we got. And I think it's really important that first of all, we hear that kind of feedback. Uh, that is where we're at in this, uh, pandemic and we need to address it. So today I will take it head on both the good news and the challenging news. And in that light, I hope all of us on this podcast can have the good faith in each other that we're trying to do what we can do to help us all get through this pandemic. So buckle your seatbelt. I'm going to come back to that one again to just to know that, in fact, this is going to be an interesting podcast where I'm not even sure quite where it's going to go yet. And as you know, in my typical opening comments, I always have a dedication and I have one for this podcast. Oftentimes, these dedications call out a group of people who are impacted in some unique way by new pandemic guidance, disease research, or public health news. But for today, I'm flipping the script a bit and I want to dedicate this episode to the individuals who are actually responsible for the very challenging job of establishing those health policies that we then interpret as recommendations for how we should proceed with this pandemic.

 

Dr. Osterholm: When done right, public health policies translate research into practical solutions that improve and extend the lives on a population level. When I was at the state of Minnesota as state epidemiologist almost for 25 years, I dealt with this every day, never once forgetting that any policy that you put forward will have both positive and potentially negative impact. And with my experience at the state health Department, I came to appreciate that we owe a lot to the public policy folks who are responsible for an acting mandatory seat belt laws for drivers and passengers, leading to significant decreases in road traffic fatalities, public health initiatives, increased taxation on tobacco products, and passed smoke free laws, meaning fewer people smoke and develop related illnesses. Setting a minimum legal drinking age. Decreased injuries and deaths among young people. Mandating food fortification with an essential nutrient in. Proved overall public health outcomes and mass vaccination campaigns have led to a significant reduction in global prevalence of many very serious infectious diseases. These public policy wins have become the highlight reel of our field. But while it's easy to look back at these and other policy successes of the past with rose colored glasses, I think it's important to acknowledge that health policies are rarely, if ever, popular when introduced.

 

Dr. Osterholm: When seatbelt laws were introduced, for example, policy makers had to deal with personal freedom, objections, enforcement concerns, effectiveness, doubts, and a lack of public awareness and willingness to change behavior. Mandated tickets for those not using seatbelts surely was one of the ways in which this public policy was enforced, or, conversely, criticism that they didn't go far enough in protecting all passengers and that penalties for violations were far too lenient. We heard both sides of that argument. Right now, we're in the midst of changing recommendations and policies for COVID-19, and it feels like no one expert or otherwise can agree on what they should be at this point in the pandemic. After hearing from many of you listeners, it's clear that our podcast family has many differences in opinion on this issue. Later on in this episode, I will revisit this changing guidance and hopefully provide you with both the best science that we have and the best public health policy that we have. But for right now, I want to say this health policy is complex, it's nuanced, it's messy, and it's often controversial. But at its best, I think it's ambitious, optimistic and values driven. And I know the people who step up to take on the challenge of crafting health policies are smart and dedicated people who have a vision for a more healthy and equitable future, and motivation to act on it.

 

Dr. Osterholm: Thank you so much for your work and commitment to improving the health of our populations. I know it isn't easy. You will take criticism from the right and the left, from the up and the down in the in and the out. But please know I recognize how important this public policy work actually is. Now let me move on to something. Light. Real light. I am happy to report to you today here in Minneapolis-Saint Paul, the sun will rise at 703. The sun will set at 550. That's ten hours, 46 minutes and 58 seconds of sunlight. Now, what's really, really important to know? Today we will gain three minutes and two seconds of sunlight. Now, for those of you in our favorite location in Auckland, New Zealand, the Occidental Belgian Beer House on Vulcan Lane. Today your sunrise is at 658. Your sun sets at 810. You have 13 hours and 12 minutes of sunlight today, but you're losing about two minutes and seven seconds of sunlight each day. So we're on the way up. You're on the way down. We'll meet eventually here, and then we'll be in the position to share with you our sunlight. So, Chris, I think we're ready to go. As I said, everyone buckle your seat belts.

 

Chris Dall: So Mike, let's start with the latest COVID data. The most recent updates from the CDC show that the main indicators the agency monitors test positivity, emergency department visits, hospitalizations and deaths continue to decline. Mike, what are you seeing here in the US and in other parts of the world?

 

Dr. Osterholm: That's right Chris. We're seeing most of our indicators decline with some staying relatively steady. Now, remember, the only real indicators that we have today that have any real meaningful information is hospital admissions, deaths and the wastewater data. And even those, again, are open to interpretation depending on when it is deaths being a delayed indicator. And we're not yet quite sure how to interpret wastewater data in terms of the actual number of people infected in a community. We just know if it's going up or going down. But how that relates to case numbers, we're not sure, but let me dive into what numbers we have. But just reminding you that these indicators I'm about to talk about are less and less telling of the true COVID picture in the US and globally, but they're all we really have here in the US. Hospital admissions have remained pretty much steady over the past week, only up 0.8% compared to a week ago, with 21,400 new admissions last week. Interestingly, when looking at the state by state breakdown, there are several states that have seen more than a 20% increase in hospitalizations over the past week, especially in this 70 and older age group. These include Montana, Wyoming, North Dakota, Arkansas, Kansas, Texas, Louisiana, Delaware and Washington, D.C. emergency department visits are down 5.3% compared to a week ago, with 1.8% of Ed patients testing positive for COVID. The wastewater data is also showing decreasing viral concentrations across every region. Although the viral activity is still considered high by the national wastewater surveillance system, the South is still seeing the highest viral concentrations in their wastewater, but again, this is decreasing.

 

Dr. Osterholm: Deaths are down 7% from the previous week. But during the week of January 20th, which is the most recent week with complete death data, we still lost more than 2000 Americans. Let me just repeat that. We lost more than 2000 Americans. And last week, even based on the data from January, COVID was the seventh leading killer in the United States. Unfortunately, it is becoming more and more difficult to find the age breakdown of these deaths. So I can't tell you with 100% clarity who is dying of COVID lately. But it is pretty reasonable to assume that these deaths are occurring mostly in older Americans, as that is the age group to which being hospitalized is at the highest rates. This marks 24 straight weeks with weekly deaths above 1004 straight weeks, in which weekly deaths exceeded 2000. So while it is welcome news that deaths are also finally declining, I don't want to minimize the fact that each one of these is someone's father or mother or grandfather or son or daughter or friend. These are real people, not just numbers. We can never forget these. And as we talked today about the issues of policy development, never forget that in the back of my mind and in the front of my heart, is the fact that these are real people that we know, care about and love. Now, switching gears to the global situation, fortunately, we're seeing a number of countries report trends that basically mirror what we're seeing here in most parts of the US, with wastewater activity, hospitalizations, and even deaths in some places heading back down.

 

Dr. Osterholm: At least that seems to be the case for most of the European countries that have dealt with elevated activity over the course of the past several months. This includes Denmark, Italy and the UK. Other places like Australia and Singapore are reporting the same thing. Even Canada, where hospitalizations have been quite high for a long stretch of time. Basically from October into January, we're now finally starting to see some improvements in their numbers. So from that perspective, there has been some welcome relief these past several weeks. At the same time, I know of a handful of places where this has not been the case, at least as of right now. For example, in Japan, current hospitalizations sit at nearly 22,000, more than four times higher than the numbers they were reporting in late November when the latest uptick began. Likewise, there are several countries in Latin America also dealing with fairly recent increases, including Argentina, Chile, Colombia and Ecuador. This information further supports the point that we continue to make on this podcast is there is no evidence yet that COVID has become a seasonal disease caused by a seasonal virus. Overall, the ebb and flow nature of this virus and its waves continue. As for the most part, we're still largely just along for the ride, considering we have yet to fully understand why this virus does what it does and when it does it.

 

Chris Dall: On our last episode, we discussed the new highly mutated BA 2.87.1 variant identified in South Africa. Mike, have we learned anything new about this variant over the past two weeks? And is there any indication that it will soon be challenging Jan one as the globally dominant variant?

 

Dr. Osterholm: Well, Chris, again, this topic is one that is changing literally by the day. So let me give you what we know first. It is still in the early days for BA 2.87.1, and since our last episode, there have been no significant developments in terms of disease spread. There have been a handful of preprint studies coming out attempting to measure vaccine effectiveness against the mutational profile, but I still believe it's too early to really understand the actual trajectory of this emergent variant. Since the most recent South African sequence was detected in mid-December, over 100,000 additional sequences have been submitted to online databases from around the world, and not one was identified as BA 2.87.1. Of course, there are still large chunks of missing data, and these sequences cannot be considered representative of global health, but with the lack of detection, tells me that this variant has not begun a rapid rise like we saw with JN.1. The CDC announced just after releasing our last episode that they have begun tracking BA 2.87.1, but currently view it as a low risk for public health. I like to think addressing a variant early is a positive thing, despite little to no circulation levels, and it is far from the delayed reaction we saw with JN.1. It'll be interesting to see how their approach and guidance changes as the situation with this emergent variant progresses.

 

Dr. Osterholm: If it does, the assessment comes at a time when the disease landscape is completely dominated by one variant, with now cast projections showing JN.1 accounting for 96.4% of all cases for the last two weeks. At some point, this dominance will be challenged by another variant. In the fall of 2021, we saw similar levels of dominance with Delta, and as the new year of 2022 rolled around, the world was hit with Ba1, Ba2 and so on. With the Omicron lineages, we cannot say if BA.2.871 will be the worthy challenger, but as of right now, the odds may not be in its favor. Now I cannot say the same for the latest JN.1 Derivative JN.1.23, which has just arrived on the scene in the last several weeks. This variant, which has picked up a series of concerning mutations in the spike, would increase Ace2 binding an area which hinders the parent variant. Earlier this month, about a dozen sequences were detected across Brazil, and as of now, it has been detected in at least three continents, with the latest sequences coming from Australia. That being said, we do not know what the immune landscape looks like in these areas.

 

Dr. Osterholm: If JN.1  infection rates and updated vaccination status were low, this would leave the door wide open for a newcomer to take over. It is too early to say if JN.1.23. This new variant would have an impact like that on the US. The situation with JN.1.23 is developing and will likely have more detailed updates for you in the next episode. Again, I remind all of you that in fact, we should look at these new variants as innocent until proven guilty. But we also have to understand from our history, there likely will be variants that will be challenging for us in the future. And remember, this is all bumping up against a 4 to 6 month post-vaccination and 2 to 3 month post infection status for many people around the world. And from that perspective, we can expect to see more waning immunity become an important part of will a new variant take over and what can it do? So at this point, hold on. We don't really know what's going to happen with these variants. We don't know how it will interact with potentially decreasing immunity from either vaccine or previous infection, but we just know that we're not done with COVID.

 

Chris Dall: So now let's get into the potential changes to the CDC's COVID isolation guidelines. Now, again, nothing is official. But as reported by The Washington Post, the changes, according to agency officials, would be similar to those made in California and in Oregon as well. So infected people would no longer need to stay home if they've been fever free for 24 hours without the aid of medication, and their symptoms are mild and improving. So, Mike, as we've seen with the changes in California and in Oregon, there are people, including some of our listeners, who will see this as a dereliction of duty by the CDC. And the refrain that I am seeing commonly is, whatever happened to following the science? This is coming from people who are older or who are immune compromised and who are worried about being infected. So what is your response?

 

Dr. Osterholm: I want to start out by reiterating something I've said for the last several episodes, and hopefully you as an audience, can hold me accountable for having said, through the last four years of the pandemic, I've never given up on science. I've never given up on telling the public the truth. This is a very nuanced issue, and I want to share today with you the sense of both the virologic science, which is all about the virus and when it's present, when it's not, and prevention science, because both of those are very, very relevant to understanding what we can do and how we can minimize the impact of COVID in our society. This is a very nuanced issue, and I want to be clear that these guidelines are not about giving up, but are instead about adapting our policies and recommendations so they can be as impactful as possible, preventing as many potential serious illnesses, hospitalizations, and deaths as possible. This is really a very, very important issue. But before I get into this issue, I want to take a step back and reflect on what our goal here is. At CIDRAP, we are the center for Infectious Disease Research and Policy. This means that as much as we are laser focused on the science of public health from the virologic standpoint, we're also concerned about using that science to inform effective policies that prevent illness and death. Another type of science in public health, good policy generally requires that we meet the public where they're at.

 

Dr. Osterholm: Basic science cannot compromise. We basically will know things, we can share what we know, and we will learn things and things that we thought we knew will change, or things that we said we don't know now have further definition. But just remember, effective policies often incorporate compromise to some degree. Why? Because public health, by its very nature, is largely a voluntary activity. I'll say more about that in a minute. Many of our listeners are probably familiar with the concept of harm reduction. A classic example of this is needle exchanges for individuals struggling with addiction. In the early days of the HIV pandemic, I was very involved with trying to bring forward harm reduction when perfection of ending drug use was not even a possibility. The science is pretty clear that the best way to avoid getting HIV or hepatitis from needles during intravenous drug use is to stop using intravenous drugs. Using that line of reasoning, we shouldn't have things like needle exchanges, because science would tell us that this isn't actually the best way to prevent disease transmission. The best way, again, would be for people to stop using intravenous drugs. But we know that in reality, most people that are struggling with addiction cannot just stop using these drugs altogether. Addiction is a disease and quitting is not easy. It's a lot easier to encourage someone to use needle exchanges to avoid getting an infectious disease through a contaminated syringe, than it might be to get them to stop using highly addictive drugs.

 

Dr. Osterholm: And so, despite the science as we know it from a infectious disease epidemiology perspective, we promote harm reduction strategies like needle exchanges because these policies are more effective since they are realistic for people to comply with. With this in mind, I'm not saying that these new isolation guidelines are a reflection of a new science that is telling us a five day isolation is unnecessary, but I find it somewhat disingenuous among supposed COVID experts today to talk about the fact that now suddenly we're not following the science. Let me just take you on a short journey through the history of COVID over the past several years. Remember, it used to be based on data from Virologic studies looking at how long people excreted virus after they were infected, that we came up with the idea of a ten day isolation period, noting that at that time many individuals would shed through the fifth day, but with some shedding virus well up into the 10th day. Now we have to be honest and say we don't know what the current shedding of this virus is. I have not seen a study done in the last two years that has actually looked at this issue to understand that with the new variants, what's happened? Remember, we've watched in terms of incubation periods of 5 to 6 day incubation period from the time of exposure to illness.

 

Dr. Osterholm: Onset was in fact common in the early days of the pandemic. Today, it's likely two days the variants have changed. Well, has that changed the shedding of the virus? How does that happen? In addition, we have had well recognized asymptomatic transmission with this virus from the very beginning of the pandemic. It's been estimated that as high as 40% of all the transmission in our communities have occurred from asymptomatic transmission. Testing ill people at that point will have no impact on that. So the people you need to protect from getting COVID and likely having serious illness, you got to protect them from the asymptomatic infected people too. Now, again, I would argue that we don't know. Today what the rate of asymptomatic infection is. Those studies haven't been done for the last several years. So when we talk about science, I'm not sure exactly what science people are talking about, but we have to acknowledge that we don't know and that one of the really important issues in this whole area of understanding virus transmission is what role does asymptomatic infection play? Very important. Now let's talk about the guidelines. For ten days, I've never deviated from the data that exists to say it's up to ten days of transmission. I don't know what the level of transmission is. For example, the day before one becomes clinically ill or in the first three days, five days, seven days, ten days.

 

Dr. Osterholm: Uh, you know, you might be shedding virus for ten days, but is most of the transmission occurring in those first few days of actual infection? We know for a number of infectious diseases, that's exactly what happens. So it might be in those first several days. That's the key time to limit transmission. But remember we are at ten days for isolation procedures. And then along comes Omicron. I was one of those people that strongly urged the CDC to change their recommendation, acknowledging that it was not a change in science. But we had a major disaster on our hands. Many hospitals in this country had not nearly enough people to take care of the patients in the hospital. They were home with COVID. And so we said, okay, if you are well enough at day five and you're willing to wear an N95 fitted N95 for the next five days, go back to work, particularly if you're working with already infected individuals with COVID, who otherwise would be laying in a hospital bed with no one to take care of him. We had health care systems right here in Minnesota with over 1000 people a day out with COVID. We had a number of pharmacies that were closed because they had no pharmacists. We had a growing critical shortage of drugs because we didn't have enough delivery people to actually move the product from the warehouse to the pharmacies.

 

Dr. Osterholm: So CDC, to their credit, and I think it was well done, moved the recommendation to five days and then five days with using an N95. Well, that suddenly got bastardized, frankly. And everybody in the private sector, any number of public events said, okay, five days, that's it. And I didn't hear an outcry from anybody. And I was surprised because I kept saying, well, you know, five days without concern about that other five days. We don't know what that means. So the people today that are commenting about the science and how we're not following it, where were you in the last two years where we, in fact were talking about now we're at five days. Then on top of that situation, we ran into this problem of now with potentially a shorter incubation period for the infection. What does that mean in terms of transmission? So the science is unclear. I don't know how much transmission occurs one day before onset, the day of onset, the day after onset. Does it change with different severities of illness. So from that perspective please stop saying we're not following the science as such. We don't know what that science is. Yes, absolutely. Transmission is occurring, uh, from the asymptomatic individuals. How much I don't know. Yes. Transmission is occurring from acutely ill individuals. I agree, I believe that's the case, but we're not yet sure what that all means.

 

Dr. Osterholm: So with this in mind, I am not saying that the new isolation guidelines are a reflection of a new science that is telling us the five day isolation is unnecessary. I don't even know if a ten day is unnecessary. They are simply a harm reduction approach. The duration of infectious or COVID is clearly going to continue to vary, and we need more data to understand that. So from that perspective, let me just give you another example. I know that what I'm saying will not satisfy everyone, but I want to come back again to the reminder that this is a harm reduction approach. And we see this type of reasoning everywhere in public health. As I just mentioned, we see it in needle exchanges. We see it with sexually transmitted infection prevention messages. We don't mandate that people use condoms or only have one partner in their lifetime, to prevent transmission of STIs. That would be absolutely unacceptable to the public and many wouldn't comply. Instead, we recommend we do not mandate condom use and frequent STI testing as a harm reduction strategy. And it's not just in public health either. For example, most parents don't want their teenagers binge drinking or using drugs, yet many parents tell their kids that if they are ever in an unsafe situation and drugs and alcohol are involved, that they could call them for help with no questions asked.

 

Dr. Osterholm: Why not? Because they're okay with teenage drinking or drug use, but because they want to prevent their children from driving while intoxicated and other. Dangerous situations. Harm reduction is everywhere. I also want to highlight the fact that this is truly an equity issue. Some of us have the ability to stay home for ten days or more after showing symptoms or testing positive for COVID because we have the paid time off, ability to work from home, flexibility or a lack of caregiving responsibilities and frankly, financial flexibility to be able to do so. But a lot of people in this country don't have those things. In fact, 23% of Americans have zero paid sick leave. Among those who do, half of them have less than ten days of sick leave. Over half of Americans have caregiving responsibilities, whether they be for children, elderly adults or other adults that have high support needs due to medical conditions or disabilities. Many of these individuals simply cannot isolate for five days. They just can't. And so they don't get tested, and therefore they don't have access to Paxlovid, and they end up at higher risk of experiencing serious illness, dying, or having long COVID. The current isolation guidelines may work for those with the interest and privilege to be able to follow the five day isolation, but it leaves many people behind. Based on what I just said, I know that there are many individuals who hear this and think, if this is the issue about a lack of sick time and resource to isolate, then why don't we fix the problem instead? Let me be clear.

 

Dr. Osterholm: I think absolutely we should fix that problem, but that won't happen overnight. And in the meantime, we need to find an approach to isolation guidelines that will meet the public where they're at and in terms of both willingness and their ability to comply. Laying out the science, as I just laid out for you with all the uncertainties, is not going to convince someone who is in one of these positions that I just described in terms of no sick leave, of saying, okay, forget it, I'll stick with this uncertain science. We just have to realize that. So let me just summarize where I think we really need to be. I think we're missing the point on what we need to do for screening and isolation. I would much, much, much more take a situation where we can convince people, if they can, for stay out of the workforce or in schools for even 1 or 2 days if they're clinically ill. But improving, which is what the California recommendations say. Right now, they're not doing that at all. Now, I haven't changed the science. I'm doing prevention, research, messaging now saying that we have to keep these out. And let me remind you what's in the California guidelines. I saw a number of supposed COVID experts commenting on this, and it was clear they had never read these guidelines.

 

Dr. Osterholm: They didn't know what they were talking about. And we don't have a clue what CDC might propose. So how to be critical of CDC right now is I don't know why I don't have any inside line right now, what CDC is thinking about or what they might do. But the California recommendations say stay home if you have COVID symptoms and until you have not had a fever for 24 hours without using fever, reducing medications and COVID symptoms are improving. Second, they say mask when you are around other people indoors for ten days after you become sick or test positive. Right now we have a standard recommendation for that, but no one's following it and they haven't followed it for several years. Again, if you're going to be critical of this recommendation, where have you been the last two years saying that this should be done? I'm going to come back to this one again. Number three, they say avoid contact with at risk people for severe COVID-19 for ten days. I think that's really important, particularly for those who are in those age groups where they're more likely to develop serious illness. Number four, the California recommendations say if you have symptoms, particularly if you're at higher risk for severe COVID-19, speak to a health care provider immediately. You are likely eligible for antiviral medications or other treatments for COVID.

 

Dr. Osterholm: Where is anybody promoting that? You've heard me say it time and time again, but we should be doing that all the time. If you look at workplace setting recommendations in the California guidelines, they're the same as they have been. They haven't changed that. But let me tell you what is happening. I have so frustrated right now with health care in this country and what they're doing with COVID. Let me just share with you a email I received just yesterday from a very, very trusted dear medical colleague who I think the world of and I think is an incredibly wise, thoughtful individual in this area. He just wrote and said, my grandson has some disturbing symptoms with his first bout of COVID last week. All fine now and I advise my daughter to take him to the Ed because it was evening and the nature of considerations I had in mind, which might require an echocardiogram. And I was shocked that even though my daughter warned everyone that he had tested positive and they were both in N95 respirators, the doctor and the nurse walked in unmasked and remained so for all of his evaluation and treatment, and also merrily left the door to the hallway open the entire time. I know this is not just happening at this one hospital. I don't know why our infection control professionals are accrediting agencies are failing us right now.

 

Dr. Osterholm: One of the areas that I've heard a number of negative comments about the CDC potential, uh, movement on these recommendations came from several, quote unquote, leaders from Boston. Well, I can tell you right now, I think Boston has been at the heart of real challenges with good infection control. And because of the policies and the Harvard related training hospitals, I've actually checked with several individuals who all came up with the very same conclusion. These are people in Boston saying right now, less than 15% of the time when a masking situation is required, our people using N95s and instead are using surgical masks. Think about that. This is at the heart of what should be the institution of higher learning that should be promoting this. Where are we on that? We should be doing that every day. The amount of transmission that's occurring in our health care facilities, particularly for those who are at higher risk for serious illness, hospitalizations and deaths coming in with a heart attack, but getting COVID in the House, we need to hit on that. That would be, to me, a much more effective way of reducing serious illness, hospitalizations and deaths. Where are we? What are we doing right now to get Paxlovid to these individuals who are at increased risk? So from my perspective, I look at this whole area and say, you know what? This is an important discussion, one we have to agree on.

 

Dr. Osterholm: We don't really understand fully what the science is today. This virus has changed and the data we have is two years old or older. Number two is that there are real life reasons why people can't and won't comply with this. And this is not bending to the will of the public at their convenience. This is about reality. And just as whether it's the needle use, it's the condom use, whatever we have. To meet people where they are. That's what public health is all about, and that's what prevention research is all about. You can have 100% effective intervention, but if nobody uses it, you have zero impact. You can have a 15% effective intervention. But if more than half the people are using it, you may really reduce and prevent some serious illness. So I think this is where we're at today and we're going to continue. So for those who wrote in who felt like I basically caved, I hope this provides you more explanation. And I do want to thank you for sending in these comments. There are important and, you know, I'm willing to go back at this again if in the next episode I can provide further clarification. My goal is to reduce COVID as much as possible and in particular to reduce serious illness, hospitalizations and deaths. I will not compromise on that. I will not, but at the same time, I will also follow the science for what we have.

 

Dr. Osterholm: And the science is both based on virus activity and it's also based on behavior and what we'll do. So I hope this gives us some sense of where we're at today. And I hope all of you who are feeling distressed by this potential for these new recommendations, take that energy and basically make certain that your hospital, your health care systems are using good infection control practices. Make sure that people get vaccinated. As we know today, only 42% of those 75 years of age and older have received the most recent booster dose, which we know can be very effective in reducing serious illness, hospitalizations and deaths. Why are we not doing more to get that number much higher? There's a lot of things we can do. And getting caught into this issue of the recommendations about isolation and as California laid them out, I think is a mistake because it's diverting us from really concentrating on some of the critical issues around vaccine, around infection control, around Paxlovid use. Those to me, are what are going to protect many of our at high risk individuals. And remember, again, even if everybody did all the screening right, as you would want this done with up to 40% of transmission from asymptomatic individuals, you still have to protect those who are at increased risk. With all the same recommendations that I'm talking about now, even with the potential screening going forward.

 

Chris Dall: Speaking of recommendations, the updated COVID-19 vaccine was approved by the FDA and CDC in mid-September and really became widely available in early October. So that means there are some people out there, probably many people in our audience, who will soon be six months out from their latest shot. Mike, is there any indication that the CDC and FDA will say that those who want to do so can get another shot at six months? And should they in your opinion?

 

Dr. Osterholm: Well, let me just say I had my last dose in October. I'm approaching that period where my waning immunity clearly is going to be a challenge. Let me just first of all, just provide kind of a basic update of where we're at. According to the CDC data, about 22% of American adults receive the fall 2023 updated vaccine. This is the one that is been demonstrated to show good protection against serious illness, hospitalizations and deaths against the current virus in our community. Vaccination status increased with age, but it was still only 43% of those 75 and older have received a shot to date. This is really a challenge because, again, remember that over 80 to 90% of the deaths that we're seeing right now are occurring in those over 65 and in particular those over 75 years of age. Our uptake rates have plateaued. But immunity from those updated vaccines is also waning, which means that it's time for new doses. It has been reported that the vaccine formula will be the same in the fall of 2023. Dosing targeting the XB 1.5 Omicron subvariant, which is maybe questionable given the ongoing emergence of these new variants. I'm happy to report that the ACIP is meeting on February 28th and 29th, and the following topics are listed on their draft agenda one. Economic analysis of an additional dose of COVID-19 vaccines two. Evidence to recommendations or workgroup considerations, and three next steps for the COVID-19 vaccine program. Similar advisory committees in Canada and the UK have already made their statements, and they recommend the updated vaccine for immunocompromised individuals over six months old, those 65 years of age and older, and those living in congregate care settings such as Long Tum care facilities.

 

Dr. Osterholm: At this point, I think we are headed to what I consider to be a policy disaster, and I'm happy to be quoted on that. The FDA has continued to maintain that COVID is a seasonal viral infection now, and the whole drive for that was so that they could coordinate it with influenza and RSV vaccines. And this is a mistake. You already heard me talk about on the podcast that the southern hemisphere has been hit hard in the last two months, the summer in the southern hemisphere, we have seen over and over again evidence, as I've shared on this podcast, that if you look at the nine peaks in cases that have occurred through the pandemic, it's beginning in 2020. These peaks were distributed almost equally through all four seasons, and they always followed the emergence of a new variant. And again, this ability to cause infection, there is no evidence this is a seasonal virus. So to me, the evidence does support, however, that at six months my waning immunity is real. I would welcome the opportunity to be permissive to get a dose every six months if in fact it were available. And the idea that it's not mandatory, we're not telling people they have to get it. But for those of us that increased risk and I'm in that category for serious illness, hospitalizations and deaths, I want the option. And medically there is no reason not to.

 

Dr. Osterholm: And from a public health standpoint, there's every reason to do it. So I think right now, again, if you want to put pressure on things, spend less time worrying about what CDC is going to classify isolation and help organize efforts to get the FDA to understand the challenges we have right now with making this a seasonal vaccine. If I have to wait until next fall, there probably is a good chance I'm going to eventually get infected with COVID and be clinically ill. If I could get my new dose of vaccine in the next month, there's a good chance I'll get through to next fall. And even if I get infected, at most it'll be very mild if not asymptomatic, and I won't have serious illness. So I think this is really an important issue right now. I hope that the ACIP takes this up. I hope that they have this discussion. And I also just want to add a context about the issue of children and COVID. You know, I keep hearing over and over again, and there's been articles that have appeared in the media in the last couple of weeks saying there's no reason to vaccinate kids. I've shared these data with you before, but I want to share them one more time. If you look at what happened in 2021 during the height of COVID activity, 638 kids in this country died from COVID five from influenza. In 2022, 536 kids died from COVID 178 from influenza in 2023. This past year, the provisional data 153 kids died from COVID 94 from influenza.

 

Dr. Osterholm: Now, I have been a long terme major supporter of influenza vaccination of our kids because even though it doesn't mean that they'll all be protected, it will surely have some significant impact on not only getting influenza, but having serious illness and being hospitalized. In addition, if you look at the individuals who have died from COVID over the past two years, over half of them had no identified risk factor for developing severe COVID if they got infected, meaning you couldn't even target them for vaccination. Why are we still so strongly recommending flu vaccine, which I support, but we're not saying here's another infectious respiratory pathogen that's killing even many more people than flu is in kids. And we're not recommending that. Now, again, I'm not talking about mandating. I'm just saying to parents, look at these data, look at these data and tell me why you wouldn't want to get your child vaccinated. People say, well, most of it's occurring in the younger age population, less than one, even before they would be eligible to get vaccinated. Let me just point out to you, 80% of the deaths in kids were in kids older than one year of age when they would be eligible for the vaccine. So I think this is another example from a public policy standpoint where we need to look at these carefully. I'm not seeing anybody talking about all these deaths from COVID that continue on year after year, yet at the same time, again promoting flu vaccine. Do it. I think it's important, but why are we not doing that for COVID?

 

Chris Dall: As a quick follow up. Helen Branswell of STAT recently reported that there were multiple vacancies left fulfilled on ACIP, the Advisory Committee on Immunization Practices, which is the body that makes vaccine recommendations to the FDA and CDC. Mike, where does that situation stand right now?

 

Dr. Osterholm: Well, first of all, I want to give great credit to Helen Branswell stat. I think she is universally recognized today as one of the premier reporters in this whole space. And when Helen speaks, people listen. As you may recall in the previous podcast, I noted that Helen published an article on February 8th. “The title HHS leaves vacant more than half the slots on a key vaccine advisory panel.” Well, I can tell you that story made the rounds at HHS very quickly, and it made rounds even at the white House. And unfortunately, it took something like that to make this happen. But I'm very happy to report that in her February 15th article a week later, the title is “HHS fills key vaccine advisory panel slots.” It got done. So, you know, thank you to those at HHS and the white House. Thank you, Helen, for making this, uh, I think, a higher priority in the minds of some that might have otherwise not considered it. And I think that ACIP right now is in good shape. The new members that were appointed, I think are outstanding representatives of the infectious disease community. And so we can move on from that one success actually occurred.

 

Chris Dall: Now it's time for our ID query. This week the topic is rare public health threats, and we recently received an email from Michael who wrote. It seems like a lot of new diseases are popping up in the news over the past three weeks, namely Alaska pox, bubonic plague in Oregon, measles outbreaks, Listeria recalls, syphilis on the rise, etc.. Could the podcast please address these in context and perhaps give a perspective on why every quote unquote new disease we hear about sounds like the next COVID? I mean, is this out of the ordinary? I remember plague and hantavirus being a thing as a kid, but there wasn't much said about it because the public considered it as rare. So, Mike, from a news person's perspective, I'll say we cover these items because they are the definition of news. They are new. And agencies like CDC and public health departments put out press releases when they discovered these diseases because they want the public to know. But when people read or hear reports about a case of Alaska pox or bubonic plague, two items we've covered at CIDRAP news. How should they react? Do we really need to know about every rare new infectious disease that comes along?

 

Dr. Osterholm: Well, Chris, you've really hit on a very important issue, and it's one that, uh, I have, uh, had to learn how to live with myself for the past 50 years. And that is when a report of something occurs. What does that mean? Is it likely a one off situation that is going to occur again and again, but never in any meaningful public health way, meaning that we're not talking about lots of illnesses, uh, and, and potentially out of control transmission. Or is this like the situation that I had back in December of 2019, when I heard about the first cases of an illness in Wuhan? And the question was, is this the next pandemic or not? So I think what is really important here is that we as a public health community, need to do a good job of helping to detail is this something that's going to kill us? Is this something that's going to hurt us? Is this something that's going to worry us and how to distinguish those? So for some of us, early on, we held our powder on Wuhan until we had more information in those first 7 to 10 days. In terms of saying this is really a big deal, let me just give you another example of the situation with Ebola. When we had the very large outbreak of Ebola in Western Africa in 2014 to 2016. Uh, this was unheard of before outbreaks were in, you know, the double digit, rarely three digit numbers of cases. And they were often very isolated.

 

Dr. Osterholm: Now we have one coming along with thousands of cases in Western Africa which we'd never seen before. We also saw urbanized Ebola and in that sense, meaning it was in larger metropolitan areas, which made it even harder to control. Now that was a major story for Africa. It had never happened like this before, and it was really a challenge. But there were those of us who also said, but this is never going to be a major challenge to the high and middle income countries because of the way we have the ability from an infection control standpoint, to actually stop transmission to others. In fact, if you may recall, we had a case here in the United States of an individual who had come in from Africa, was visiting in Dallas, Texas, and there was limited transmission to several health care workers. But we stopped it quickly. It didn't go on from there. And so what we need to do in public health is help explain when we see these new diseases. And Chris, you as a news media expert, realized that news today is very different than it was 20 years ago, before the internet, before the ability of having social media, uh, you know, instantaneous understanding of what's going on around the world today. We get information that we wouldn't have gotten 20 years ago, uh, until weeks or months later than after it occurred. So I would say at this point, our job in public health is to help people better understand. In fact, does Alaska pox robotic plague represent a potential major new threat, or is this something that we can just continue to expect? And I think the example that I often use today is one that is somewhat intermediate is, in fact, that with monkeypox, where once that emerged in Africa to a largely uh non-immune population against, uh, any of the pox viruses, this represented a real concern.

 

Dr. Osterholm: But in this case, it wasn't that we're all at risk for it. It was those because it was largely a sexually transmitted disease. Of those who were at risk, were those partners of individuals who were infected. And while, you know, impacts is not a gay disease, anyone can get infected. Clearly, 95% of the cases we've seen have occurred in cisgender men. And the vast majority of those were in men who reported recent sexual contact with multiple male partners within a short period of time. So even in this situation where it is a challenge and a much larger scale, it still is very defined largely to a single risk area, and that we can address that. So our job is to basically help you understand and the media understand what is it that we need to be concerned about that will kill us? What do we need to be concerned about that could hurt us? And what do we need to be concerned about that will really just worry us, but not represent a major public health threat. So expect more of these. Now, let me just say that we are seeing more of these infections and the world is in fact changing.

 

Dr. Osterholm: It's a very different world today. You know, I had the opportunity to be in Kinshasa, in Africa, in Zaire, um, in early days of HIV. When the city was basically 2 million in population and at that time struggling to maintain that infrastructure for 2 million. Today, Kinshasa has over 20 million people. It's a very different place in just those few decades, how much that's changed and the struggles are even more so now. Well, if you look at all the other issues climate change, deforestation, uh, hunting, uh, wild animals and having contact, we have pushed the boundary of many of our exposures with animals, and particularly to a whole new level. On top of that, add in things like the anti-science movement, particularly the anti-vaccine movement we're going to talk about in a moment. But I worry desperately about measles right now. I think the world is primed for a major, major outbreak of measles. And just this past week, the W.H.O. issued an alert saying that over half the countries in the world right now are primed for major measles activity. So these are the kinds of things we need to make sure that we're keeping you updated on, and that we give you the information so that you can understand where does this fit in the higher risk category? Does it really, really threaten me? Does it possibly threaten me? Or is this just something I'm going to read about? Sounds scary, but I don't have to worry about it.

 

Chris Dall: So two public health threats that are not rare and that we should be paying attention to are flu and RSV. Mike, what are you seeing in the latest flu and RSV data?

 

Dr. Osterholm: Well, Chris is still appears at the worst of this year's respiratory virus season is behind us, with flu and RSV cases at much lower levels than they were at the season's peak. We're beginning to see a transition, however, from a rapid decline in cases to a more slow and steady plateau. The percentage of outpatient visits for respiratory illness has remained steady over the last week, as have influenza hospitalizations. Influenza mortality is down slightly, just at 0.7% lower than last week. Interestingly, despite an overall decline in influenza activity, influenza B transmission appears to be increasing the number of reported influenza A cases for the week ending in February 10th. The most recent data available were 2.2 times lower than it was six weeks prior, but the number of reported influenza B cases for the week was actually 1.3 times higher than six weeks prior. This is not unusual. We often see the bee activity following a activity, and tends to signal almost that we're getting closer to the end of the seasonal flu activity, so we'll see. But at this point, uh uh, I think we can say that we are surely in better shape with flu, uh, than we were just a couple of months ago.

 

Chris Dall: And now for this week in public health history. Mike, how are we celebrating today?

 

Dr. Osterholm: Again. I say this every time we have this section of the podcast. I love this part of the podcast, uh, history and understanding the impact that individuals or activities have had on public health over the decades is really important. Well, as we're closing out the month of February, which in the US is celebrated as Black History Month, now 29 days in this month, the leap year, this year, uh, let alone one podcast closing segment is not enough time to honor all the Black and African American pioneers and public health, but I wanted to highlight just a few today that may or may not be on your radar screen. These have been giants in our public health world. The first individual is William Du Bois. Du Bois pursued several degrees before ultimately becoming the first African American to earn a PhD from Harvard University. His postdoctoral work centered around African American populations living in urban settings, and was among the first to systematically study the socially driven health disparities between black and white Americans at the time, linking his findings to the continued detrimental effects of slavery. Du Bois went on to co-found the NAACP and pursued countless literary and scholarly projects promoting racial equality until his death at the age of 96. Next is William Augustus Hinton. Hinton was born to formerly enslaved parents, and went on to earn both his undergraduate and medical degrees from Harvard.

 

Dr. Osterholm: When no Boston area hospitals would host Hinton to specialize his practice and surgery because of his race, he turned his focus to communicable disease research. He went on to become Harvard's first black professor, served as director of the Massachusetts State Communicable Disease Laboratory, and frequently consulted with the US Public Health Service. During his decorated career, Hinton developed a diagnostic test for syphilis, also known as the Hinton Test, which improved disease detection. In addition to his work on disease prevention. Another giant, Charles Drew, a surgeon and medical researcher who early in his training began studying the effects of shock and how the condition could be remedied with blood transfusions, while becoming the first African American individual to graduate from Columbia University with a doctorate of Science, drew developed the concept of banked blood to overcome ongoing challenges with blood supply and preservation. He developed a revolutionary method to preserve blood plasma for transfusions, which ultimately saved countless lives. During World War Two, Doctor Drew was the director of the first American Red Cross Blood Bank, and throughout his career protested against racial segregation in the donation of blood. Next, Marilyn Hughes Gaston is another pioneer of public health research. Despite initially being dissuaded from pursuing a medical degree, Gaston went on to specialize in pediatrics, where she gained a particular interest in sickle cell disease affecting her young patients.

 

Dr. Osterholm: In 1986, Gaston published a groundbreaking study which found that penicillin could be used to prevent sepsis and children with sickle cell, and led to the establishment of nationwide screening programs. Shortly after, Doctor Gaston was appointed as the director of the Bureau of Primary Health Care in the US Health Resources and Services Administration, becoming the first African American woman to direct a public health service bureau. Finally, I don't think we can have this segment without touching on some of the deep harm and ethical problems of public health, and the health care systems have contributed to the infamous and tragic Tuskegee study of untreated syphilis is certainly one example that many are familiar with. Another that fewer people may be aware of is Henrietta Lacks, whose contribution to the medical field was involuntary and raises considerable questions about research ethics. In 1951, Miss Lacks was diagnosed with an aggressive malignant cervical tumor at Johns Hopkins University, one of the only hospitals to provide medical care to underserved black communities at the time. When the attending physician passed along the cells to the pathology research lab, something unexpected occurred. The cells from Miss Lacks tumor appeared to be immortal, resisting the normal cell cycle and continuing their relentless replication. The resulting cell line, known as Hela cells, was sold to biotechnology companies and used in countless experiments, but all without the patient's knowledge or consent.

 

Dr. Osterholm: When Henrietta Lacks passed away from her illness several months later, no one at Johns Hopkins notified her family of the innovation that their loved one cells had made possible. In fact, for over 20 years, members of the lacks family had no idea that Hela cells were or what they were capable of. Hela cells are responsible for critical work in polio and COVID-19 vaccines, in vitro fertilization, cancer genome mapping, and many other specialties in August 2023, the lacks. Family received a private settlement with Thermo Fisher Scientific, compensating them for decades of research made possible by their relatives cells. I can't imagine that any amount of money would provide restorative justice, but this case provides a greater platform to understand Henrietta's legacy as a real and loved person. This list included just a small handful of stories. There are countless other Black and African American public health leaders of the past and present that we could feature, some of whom are. Dear colleagues. I feel incredibly grateful for the platform to be able to share these incredible public health contributions and acknowledge we would not be where we are today without these pioneering individuals. I will end with a quote from Congresswoman Yvette Clarke. We must never forget that black history is American history. The achievement of African Americans has contributed to our nation's greatness. What a wonderful section.

 

Chris Dall: Now, just a note to our listeners. As hard as it is to believe, we are coming up on our four year anniversary and we have some special segments, uh, that we're going to have for that anniversary coming up in March. If you have any questions about the podcast, about how we put it together, about how it started, please send them to us at OsterholmUpdate@umn.edu and stay tuned. Mike, what are your take home messages for today?

 

Dr. Osterholm: First of all, let me celebrate the podcast crew that helps make this podcast possible every two weeks. And the fact that we're going to be interviewing each of them on a podcast, uh, learning more about them and what their contributions and what they've learned from this whole process is really exciting for me. So, Chris, uh, this is, I think, going to be a really wonderful, uh, section of the podcast going forward in terms of the messages today. Uh, let me just reiterate over and over again, COVID is still the seventh leading cause of death in the US today. Yes. Grant you, most of the deaths are in those 65 years of age and older, but nonetheless, it is still a tragedy that we shouldn't let happen. And we can do so much more about it. But we have to stay focused then on what it is that we need to do something about, which is my number two point. Stop saying we're not following the science and making recommendations. We haven't really been following the science, you might say, for several years. If you believe that the ability to excrete virus and infect others, whether you're symptomatic or asymptomatic, is important. We have two types of science that we're following today. One is virus infection, which is the virology, the biology of the virus. And we have a second type of science, which is prevention research, which is a very important and valid area. This is all about behavior and the biology and the behavior have to be combined together as two sciences that then give us an answer as to what might be the most effective route we can take to minimize and limit transmission, and to ignore one or the other here means that you're going to miss really understanding what it is we can and should do today with our public health recommendations.

 

Dr. Osterholm: The final piece, and I intentionally have brought this forward, as I mentioned earlier in the podcast, measles, measles, measles, I think it is becoming the poster child for a public health and medical care system around the world that is fragile, fragmented and sometimes highly ineffective as it relates to vaccine preventable diseases. I think we're going to see major activity with measles around the world. As I noted earlier in this podcast, just this week, W.H.O. has issued a warning that over half the countries in the world are at high risk right now based on very low vaccination levels. Mark my word. This virus is highly infectious, highly infectious. It will find you if in fact you are not protected from either vaccination or previous infection, and we hope that you don't get protected from previous infection. The possibilities of severe illness, hospitalizations and deaths with measles and kids is just too great for us to accept. So, uh, COVID is still with us. We got to understand what we mean by talking about the science. And we have to realize in this case, measles represents a true, and I think, critical threat to the public's health.

 

Chris Dall: And what closing song have you picked for us today?

 

Dr. Osterholm: Well, again, we're back to an oldie but a goodie. Uh, and this one we used once before on June 9th of 2022. Hard to believe Episode 106. Way back then. You know when when I still had a full head of hair and, you know, all those kinds of things were going on? Um, this particular song was chosen today. Uh, really, I think for, uh, the time this, this is one that, given all that's going on in the world and beyond COVID, this is to me, an anthem that we need to really understand. This is a song by Frank Turner, uh, English singer songwriter, and it was released as part of an album on May of 2018 by, uh, his recording company. The title of the album and the song that we've chosen today, is based on a line from Clive James's poem that first was published on the June 3rd, 2013 issue of The New Yorker, which in fact the title reads I should have been more kind. It is my fate to find this out, but find it out too late. And I think he really does an incredible job of helping us understand today why being kind is so important. So here it is, Frank Turner. Be more kind. History's been leaning on me lately. I can feel the future breaking down my neck.

 

Dr. Osterholm: And all the things I thought were true when I was young. And you were too turned out to be broken. I don't know what comes next. In a world that has decided that it's going to lose its mind. Be more kind. My friends. Try to be more kind. They've started raising walls around the world now, like hackles raised upon a cornered cat on the borders in our heads. Between the things we can and can't be said. We stopped talking to each other. And there's something wrong with that. So before you go out searching, don't decide what you will find. Be more kind, my friends. Try to be more kind. You should know you're not alone. And that trouble comes and trouble goes. How this ends. No one knows. So hold on tight. When the wind blows. The wind blew both of us to sand and sea. And where the dry land stands is hard to see. As the current drags us by the shore. We can no longer say for sure who's drowning or if they can be saved. But when you're out there floundering like a lighthouse, I will shine. Be more kind. My friends try to be more kind. Like a beacon reaching out to you and yours. From me and mine. Be more kind, my friends.

 

Dr. Osterholm: Try to be more kind. In a world that has decided that is going to lose its mind. Be more kind, my friends. Try to be more kind. Frank Turner, thank you again for spending your time with us today. We never take for granted that you have lots of other sources to get your information. I realize for some of you this is a difficult conversation today. It was difficult for me. Um, most importantly, I do feel that this podcast family can have its moments and, uh, and still appreciate each other and understand that we're all in this trying to get through it together. So thank you for being with us. Thanks, Chris, and to the podcast team for their efforts. And, uh, we'll continue to do our best to keep you current on the science, uh, whether what kind of science that is and also on the policy making. But most importantly, we'll continue to push those things that will protect our grandpas and grandmas, our moms and our dads, our brothers and our sisters and even our kids. That's what I'm going to keep promoting. And that, to me, is the most important thing I can do in my job right now. And as Frank said, be kind, please be kind, be safe. And thank you again for being with us.

 

Chris Dall: Thanks for listening to the latest episode of the Osterholm Update. If you enjoyed the podcast, please subscribe, rate and review wherever you get your podcasts, and be sure to keep up with the latest infectious disease news by visiting our website CIDRAP.umn.edu. This podcast is supported in part by you, our listeners. If you would like to donate, please go to CIDRAP.umn.edu/support. The Osterholm Update is produced by Sydney Redepenning, Elise Holmes, Cory Anderson, Angela Ulrich, Meredith Arpey, Clare Stoddart, and Leah Moat