Coronavirus epidemiologist Q&A:

https://www.usatoday.com/story/opinion/2020/05/12/coronavirus-epidemiologist-were-just-second-inning-qa-opinion/3114615001/

Coronavirus epidemiologist Q&A: ‘We’re just in the second inning of a nine-inning game’

On COVID-19, ‘my job is not to scare people out of their wits, it’s to scare them into their wits,’ Dr. Michael Osterholm of CIDRAP tells USA TODAY.
USA TODAY
Updated 8:58 a.m. PDT May 13, 2020

Coronavirus epidemiologist Q&A: ‘We’re just in the second inning of a nine-inning game’

As the number of U.S. deaths attributed to COVID-19 approached 82,000, the USA TODAY Editorial Board spoke with Dr. Michael Osterholm, one of the nation’s leading epidemiologists. Osterholm, 67, is director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota and co-author of “Deadliest Enemy: Our War Against Killer Germs.” Questions and answers have been edited for length, clarity and flow:

Q. How bad is this outbreak?

A. Sixty days ago, COVID-19 was not even in the top 100 causes of death in this country. Within six weeks it was the No. 1 cause of death. That hasn’t happened since (the) 1918 (flu pandemic).

Q. The United States has 4% of the world’s population but has 28% of the recorded deaths from the coronavirus. Why is that?

A. Any number like that is artificial at best. If you had to add it up globally, we still play a very prominent role in the number of deaths that have occurred. But at the same time, I would say that we’re not any different than many areas of the world where there are lots of cases that are going uncounted, both deaths and regular cases.

Q. Where are some of the biggest hot spots in America?

A. Nursing homes, long-term care, prisons, homeless shelters, meatpacking plants — these are all areas where, once that virus gets into those locations, it’s like a gas can. Suddenly 50% or 60% of the people are infected in those locations. I think we’re going to burn through those populations quickly over the course of the next three to four months at most.

Q. Does that mean the worst will be over then?

A. I think you’re going to start seeing it move into the rest of the U.S. population. When you look at adults 18 years of age and older, up to 40% of us have some co-morbidity that would put us at increased risk of having a severe infection or dying. We are still going to have lots of deaths. … While the rate of deaths will be much lower in younger individuals, the obesity epidemic in our country is going to take a hell of a toll. I’m convinced of that.

Q. If the epidemic dies down during the summer, can we rest easier?

A. Right now the thing that scares me more than anything is that suddenly, in the next two months, cases in the U.S. suddenly drop off dramatically. That would tell me, this may be acting like a flu virus. And if that were the case, you might very well expect to see a late summer/early fall peak that could be much, much more severe than anything we’ve seen already and much more universal in terms of where it hits and how it hits. We’re in uncharted territory. We don’t know.

Q. Why wouldn’t a sudden drop-off in cases be a good thing?

A. It would give people a (premature) sense of euphoria. I know it sounds counterintuitive, and some people would say it’s unethical for me to say this, but to me it would look a lot better if we kept in this slow burn or the kind of peaks and valleys, little ones, that we’ve seen and not go quiet. I think that’s not a good sign. If we have a big fall peak, it’ll redefine us as we are as a modern society.

Q. Why are you so concerned about another peak?

A. As much pain, suffering, death and economic disruption as we’ve had, it’s been with 5% to 20% of the people infected, and most of those areas of the country have been in the 5% to 10% range. That’s a long ways to get to 60% to 70% to even begin to see herd immunity. Think what we have to go through. This damn virus is going to keep going until it affects everybody that it possibly can.

Q. Why are some areas, even within the same country such as Italy, hit so much harder than others?

A. We don’t know, and it can’t be explained by any sociologic, population density, transportation issue. We don’t know. That’s the random nature of these viruses, and that’s what makes it so tough.

Q. In a recent report, CIDRAP said it’s important for leaders to “proclaim uncertainty.” So what else don’t we know?

A. One question is (whether we will have a safe vaccine before we get to) that 60% to 70% level or higher, or will we have to achieve it through illness and hopefully durable immunity? A second question is, what does immunity mean? If we don’t have durable immunity, we can expect these (waves) to happen over and over and over, and that’s a scary proposition.

Q. How would you rate the government’s response?

A. I have a major, major concern about leadership right now. We’re not where we need to be, either from an execution standpoint or understanding the problem. We’re just in the second inning of a nine-inning game. (Leadership means) admitting when you’re wrong. Don’t sugarcoat things. Just tell the truth. I think we have some real challenges ahead, because this may get a lot worse, not better. And I don’t think people really get a sense of that yet.

Q. How can officials communicate better with the public?

A. Just tell the truth. What do we know, and what don’t we know. I’ve already acknowledged a number of things that I don’t know. And I think I know this virus pretty well. Don’t minimize issues. My job is not to scare people out of their wits, it’s to scare them into their wits. Basically, you’ve got to be clear and compelling. To tell people that this is gonna be over with right now, I think, is absolutely an abdication of leadership.

Q. Where do we go from here?

A. I’ve been saying from the get-go: We can’t lock down for 18 months or more to whatever it might take. And then even then, we don’t know what it will do. At the same time, we can’t let these cases go willy-nilly. I mean, they will bring down our health care system. The number of deaths will be remarkable. So how do we thread the rope through the needle? We need leadership there right now. This is not going to be easy.

Q. Isn’t there a trade-off between the economy and health?

A. This shouldn’t be dollars or lives. This should be, how do we integrate both and bring them together? How do we make tough choices? That’s not happening. That’s leadership again. All those things are not happening. It’s not a partisan issue. It shouldn’t be.

Q. Will the economy bounce back quickly?

A. Six months from now, the economic picture in this country is going to look a lot worse than it looks now. There’ll be more unemployment. There’s gonna be a higher likelihood of this disease having much more impact on our communities. How are we preparing to get the American workers through that now? How are we preparing national and international supply chain issues now?

Q. Aren’t other countries showing the way forward?

A. Please don’t tell me that I just have to do what they do in Korea. Or I have to do what they do in Singapore. Or I have to do what they do in New Zealand. Every one of those (nations) is vulnerable to this virus tomorrow. Look what’s happened in the last 72 hours in Seoul. And yet last week, I had people telling me if we just did it like Korea did we’d be OK. I’ve been an adviser to the people in Singapore working on this issue. Don’t tell me Singapore has it down. We just all have to confront the fact that there’s not a magic bullet, short of a vaccine, that’s gonna make this go away. We’re going to be living with it, and we’re not having that discussion at all.

Q. How can leaders in this country improve the conversation about moving forward?

A. Using my baseball analogy, where I said we’re only on the second inning of a nine-inning game, we’ve got to figure out: How do you declare balls and strikes? Four weeks ago, we had everybody agreeing that we’re going to reopen (once we) have 14 days of reduced occurrence of illness. Then, when it got another couple of weeks along and that wasn’t happening, we just threw all that out the window without ever saying we did.

Q. How does that affect public perceptions?

A. We’re setting the precedents for making decisions by press conference or by tweet. And this is where the American public is getting confused and more angry, because all they want is the truth. Just tell us what it is and why we’re gonna do it. The first step is basically saying there are no easy answers here. There aren’t any. … People are going to die. Don’t deny that. People are going to die no matter what we do.

Q. What else does the public need to understand?

A. We’ve been asking about the data in New York about how many people have been hospitalized who say they were sheltering in place. But when you do follow-up interviews and say, what does that mean? A lot of people say, “Well, you know, I have not left my apartment, but my kids come over three times a week.” That’s not sheltering in place.

Q. What do you think about the protesters who want a faster reopening?

A. If people at these rallies want to infect themselves, that’s their choice. It’s like smoking. If you smoke, the health care system will take care of you. But if you come in with your lung cancer, you don’t put three other health care workers at risk of getting lung cancer. (If you come in with COVID-19), you put a lot of health care workers at risk. The numbers are clear and compelling. Health care workers are taking a heavy hit in this pandemic.

Q. Are we sufficiently protecting other essential employees who can’t work from home?

A. I would never have believed this possible, in this day and age in public health, where you could have people at high risk of transmission at meat processing plants, where a president just determines by the Defense Production Act that this is an essential area of work. And that basically, if you don’t go to work, the governors have decided you don’t get unemployment, and yet we don’t provide them protection. These people aren’t getting N95 (masks). That’s just wrong. That’s morally, ethically wrong.

Q. What should our national conversation look like?

A. If I were going to start this discussion, I’d say, OK, these are the ground rules. One is we can’t let the economy as we know it just suddenly fade away, because that’s about society, that’s about livelihoods, that’s about much more than dollars and cents. Second of all, we can’t overwhelm our health care system. So how do we hit that middle ground? And that’s where we need to have the emphasis. We need to have the business people. We need to have the media. We’ve been out there trying to get this discussion going, and it just falls on deaf ears because it’s too hard.

Q. How much control do we really have?

A. I’ve been saying all along, we’re not driving this tiger, we’re riding it. And that’s a really important point. We are not going to determine the course of this pandemic beyond potentially flattening some of the peaks or in some ways limiting high-risk people from potentially getting infected and having bad outcomes.

Q. Is widespread testing part of the answer?

A. Test numbers surely are important, but how well can you basically maintain testing? Let’s just start at the front end. We are seeing equipment that has not ever been meant for the purposes it’s being used for right now: 24/7 testing, 365 days a year. We’re starting to see a breakdown, because these machines were never meant to run like this.

Q. How about tracing the contacts of infected people?

A. I’ve been in the business for 45 years. I started the very first program in the world for HIV contact tracing in Minnesota back in 1985. I know a bit about contact tracing. I’ve done it all my life. A lot of the people who are making comments right now about contact tracing have never done it. They have no idea what they’re talking about. It’s not a panacea

Q. Why not?

A. Early on, if you had a small number (of infections), you can get in and you can control it to the extent that you can’t get rid of it, but you can surely minimize it. Once it hits a level like it is in most countries right now, contact tracing plays almost no role, I believe. Once you see a big escalation in cases, you’ll be having contacts by the many thousands and thousands and thousands, and it’s just not going to work. I think it’s going to come back to the individual and following up and trying to limit it that way.

Q. Will people trust the information that tracers provide?

A. The world is full of scammers. If I called anybody and said, “Hi I’m from the Health Department, and I’m here to help you. I’m here to tell you that you have been exposed to COVID-19. I can’t tell you any more than that, but you need to shelter in place for the next 12 days.” That means if you have a service job, you can’t go. How many people are going to actually believe that? How many people are going to act on that?

Q. Do you think that we’ll have a vaccine before we get to the 60% to 70% herd immunity?

A. We have 100-plus vaccines (in development) right now. The question is, will any of them work? What happens if you have a vaccine that’s only 20% effective? Are you going to use that? Are you going to put it out there? And when I say effective, what if it’s for six months that it’s protective and then the data shows that it wears off after six months and you need a booster? I think that we have real challenges yet there. Knowing what I know about coronavirus immunology, it’s not a slam dunk. I hope, more than I can put into words, that we have one. But hope’s not a strategy.

Q. Aren’t some of the potential vaccines showing a lot of promise?

A. In the early animal model data, at least three different vaccines are showing short-term protection, and I think that’s very encouraging. We just don’t know if we’re going to get it there in humans. The second part is safety. I think safety is going to be a huge issue here. … Somebody dies and they blame it on the vaccine. I think you could see the whole thing implode, even though, on a risk basis, the vaccine would still be a much better proposition.

Q. If we get a safe and effective vaccine, then what?

A. We have no plan in place at all if we have a vaccine and we have the supplies to make it and we have the manufacturing capacity. What happens to it after that? What if the Chinese get the vaccine first? What if we get it first? Will we share it with anybody? Boy, I’m going to tell you right now, the answer I’m getting out of this administration is “hell, no.” Well, then why would the Chinese want to share a vaccine with us? Why would the Europeans want to share vaccine?

Q. How long will it take to sort all this out?

A. To get to 8 billion people (in the world) vaccinated would take years to accomplish with even the best manufacturing capacity, with all the supplies for immunization, mobilization, syringes, etc. And I worry that we’re going to have a very, very significant fight among governments, among parties within governments, within the population, for vaccines that I think we’re not prepared for at all. We don’t have enough of a way of sharing.

Q. Who should get vaccinated first?

A. I think, in this country, the first people that should get the vaccine are health care workers. They’re the ones that are on the front lines. Those are the people that need the bulletproof vests more than anybody right now. And yet you can imagine the reaction that will be loud, vocal and angry if it looks like we’re taking care of our own. I think we’ve not had any of those discussions yet.

Q. Where should the leadership on these issues come from?

A. If there was ever a time that we need to have a unified response plan, and I know this sounds trite, I liken it to D-Day. I want my Eisenhower right now with every allied country around the table and when Ike calls it, it goes. That’s what we need right now. We need a D-Day plan. We don’t have it. I worry we’re going to have all these different countries marching to their own drummer. To me, that’s the biggest challenge that nobody is talking about. The R&D is huge. Safety is huge. But in the end the biggest tragedy would be to have a vaccine and not be able to get it used in the way it should be used.

Q. At what point did you realize this was going to be a really big, bad pathogen?

A. We knew in December that something was happening in Wuhan, before it was in the media. On Dec. 31, I commented to our staff, “Well, we’ve got another MERS (Middle East respiratory syndrome) or SARS (severe acute respiratory syndrome) on our hands. This is going to be a tough one, but we can handle this.” And I was wrong.

Q. What changed?

A. By the first week of January, we saw the pattern emerging in China that this wasn’t MERS or SARS. On Jan. 20, probably the most important thing I’ve ever done in my career, if I’ve ever done anything at all, was I put out a statement to a group that we advise that this was going to be a pandemic. I don’t think anybody had yet declared that publicly. And I said, this is why it’s going to happen. It’s going to take weeks before it unfolds around the world, but it’s going to happen.

Q. What else did you do?

A. I met late that afternoon with senior leadership at 3M and said, this is going to be a pandemic. And they made a business decision. The following morning, they ramped up production of N95s. They had, at least, six weeks head start before the government ever contacted them about doing anything. And, you know, hopefully during that time, enough extra N95s got made that saved some people’s lives.

Q&As: Coronavirus experts on what to do and U.S. response to the pandemic
HOTLINE: Share your coronavirus story. We may publish your comments.