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(Interview) Osterholm: A blueprint on moving to the ‘next normal’ in pandemic

Michael T. Osterholm, PhD, MPH
 

We’re heading into the third year of the COVID pandemic. So far, 6 million people have died worldwide from the respiratory illness. Last week, the U.S. was averaging 1,500 COVID deaths a day. However, infection and hospitalization rates are waning.

Michael Osterholm
University of Minnesota infectious disease specialist Michael Osterholm

Courtesy of the University of Minnesota

As we try to work our way back to normal — whatever that is — a bipartisan group of scientists and health and policy experts calling themselves the COVID roadmap group are releasing a blueprint Monday of how we could move into what they call “the next normal.”

A member of that group is Michael Osterholm, the head of the University of Minnesota Center for Infectious Disease Research and Policy. He spoke with MPR News host Cathy Wurzer.

The following is a transcript of the conversation, edited for clarity. Listen to the conversation using the audio player above.

The numbers are looking good. And so many want to move on. But the COVID roadmap group is warning against collective amnesia about what we just experienced. Now, to be clear, you’re not declaring victory over COVID at this point, right?

We’re not. In a sense, it’s almost a deja vu moment for us. It was a year ago right now that some people like me said that some of the darkest days of the pandemic could still be ahead of us because of the variants, and not knowing how they would emerge and what they would look like in terms of causing disease, how it would be transmitted around the world.

And while we’re in a much better place today with the vaccines that we do have — and we surely do have more people who have immunity from having previously been infected and/or the vaccines — a new variant could emerge tomorrow that could evade that immune protection, and could really put us back into a place where we were with omicron. But we think we still are in much better shape in terms of understanding how to deal with that than we were say six months ago.

The report released this morning is pretty clear in saying that the world won’t return to a pre-COVID normal. That normal is going to be different, and it could be better. Briefly explain that.

What we’re really talking about is envisioning the entirety of all of the respiratory illnesses that we have, the things that are transmitted by air — such as influenza, for children, in particular, and older adults, it’s an infection called RSV — and really all of those add to the annual deaths from respiratory illnesses each year. As we know, we can have very bad influenza years, even when it’s not a new virus causing an influenza pandemic.

So what we were trying to envision was, how do we deal with all of these? And frankly, the measure that we’ve used to date has largely been, is it overwhelming our healthcare system? Are we bending it or are we breaking it?

And we want to move beyond that. We need to understand how can we better control these. What can we do with new vaccines? What can we do with better testing and treating? What we’re trying to envision here is in a sense coming to live with this. If I could use an analogy: in the 1980s, HIV, and a diagnosis of that was a death sentence, literally. Today, it’s a manageable chronic disease for many, many people. We’re not going to get rid of COVID. It’s not going to happen. But what we can do is live in a much more safe way with it. And that’s what this report is really all about. How do we get to that place?

You talk in the report about in terms of post-COVID, life could be better with a better work life balance, more teleworking, less commuting, a reimagining of the education system, better indoor air quality. You stress that.

Yes. In fact, these are all the things that we could have done before COVID ever hit. But no one really saw the importance of that and the need. We just kind of went from year to year with influenza, this RSV virus I mentioned, other pathogens like that.

But, in fact, there is much we can do. For example, respiratory protection. You know, what we did is we got bogged down into masking or non-masking. The vast majority of people who were using a mask were highly ineffective in terms of preventing transmission to or from that individual. Today we need to put much more effort into devising much more effective respiratory protection and comfort that people are aware of and that it is not politically charged.

What we can do for ventilation in buildings? We have forgotten that air inside of buildings can actually be highly improved by improving the kind of filtration and the circulation of air there and at the same time being energy efficient. There’s just a number of things we can do.

We can do much better with testing, to have tests available. For example, one of the things we want to really achieve is what we call test and treat. So that if I’m an individual, and I think I have COVID, I can get tested within a very short period of time—hours, maybe even sooner than that I am infected. And then on the spot, you receive one of these prescriptions for one of these very effective drugs. Think how we could change the whole entire sense of COVID if we have that ability, much like I just talked about with HIV-AIDS.

And so this is really an opportunity for us to take us to a better place, not one where we live in fear all the time of the virus, but one that we really are living with.

Finally, I just have to add, there will be those members of our society that we have to really pay special attention to. Those who are immune-suppressed, those that don’t have the luxury, necessarily, their immune systems responding adequately to vaccines. How can we improve vaccines to make that better? What can we do to protect these people in terms of giving them drugs in advance of being exposed, where they just take it as we call prophylaxis?

There’s a lot here that we’ve envisioned. And I have to say, it’s been very reassuring that the administration has been very receptive to our work. We’ve been communicating with them regularly for the last two months. And they are fully abreast of this. And they have been incredibly supportive of what we’re doing here.

The section on long COVID was interesting. The report says if COVID becomes endemic, then there’s a risk that many more Americans will experience long COVID creating huge and lasting health impacts. What could the ramifications be of that?

Well, you know Cathy, we don’t know yet. Really, No. 1, just what is the frequency of long COVID? Meaning how often does it occur once you’ve been infected with SARS-CoV-2, the COVID virus. Some estimates suggest it’s 3 to 4 or 5 percent, some as high as 20 percent. But it’s real, it’s very important.

The other part of this is that we don’t really understand all the different mechanisms that go into place here to make long COVID happen. Is brain fog caused by something different than some of the cardiac or heart involvement? The fatigue? All these issues that may be present with someone with long COVID. But we know that we have a single event, I.E. infection with the virus, that triggers these. Now, are there certain drugs, certain kinds of therapies that we can provide that will actually help reduce the symptoms and even eliminate them?

And so you’re going to see a lot of emphasis placed on long COVID. The impact this could have on our economy, could have on everyday work life and most of all, everyday healthy lives for so many people in the world is really paramount with COVID. This is yet the unrecognized terrible tale of COVID. And we’re taking it head-on here with our report.

There’s already some grumbling in Congress over the $22.5 billion requested by the administration for our vaccines and oral medications, antibodies, that kind of thing. Your group’s plan has a hefty price tag associated with it. How do you actually see this going forward politically?

Well you know, first of all, I think the debate really has been around what are the funds that are still available from previous appropriations. So that no one is accusing the administration or anyone else was misspending. It’s just “Wait a minute, if we’ve got money sitting somewhere that, for example, should be used for improving ventilation in schools, do we need more money? Or should we efficiently use the money we have?” So I think that has been a primary focus.

The second thing is, you know, for a couple of us listening today, they’re old enough to remember the old Fram Oil Filter commercials when the line was “you can pay me now or you’ll pay me later.” And we recognize right now the investments that we’re making here with this report will pay big dividends in terms of eliminating, hopefully, future major surges like we saw with omicron. Trying to make sure that we are able to keep everyday life happening as much as it normally would if we see another one of these surges because we’re so much better prepared. So I think that this is must be seen just as we’re talking about investing in infrastructure, etc. This is investing in our public health and our medical care systems to actually try to eliminate what we’ve been through over the last two years.

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