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Andy and Michael Osterholm have a candid conversation about where things stand two years into the pandemic. During this live event hosted by the University of Minnesota’s School of Public Health, they discuss how to reach science skeptics, the strain many states’ healthcare systems are experiencing right now, and what to say to parents who aren’t sure about vaccinating their young children. Plus, COVID will be with us long-term, so how do we adjust our mindset so we can learn to live in a world alongside the virus?

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Michael Osterholm on Twitter @mtosterholm.

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Check out these resources from today’s episode: 

• Learn more about CIDRAP, the Center for Infectious Disease Research and Policy: https://www.cidrap.umn.edu/
• Check out the data from the Kaiser Family Foundation on parents’ attitudes toward vaccinating their kids, which Mike mentioned in today’s episode: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-october-2021/
• Read the letter in support of OSHA’s vaccine requirement that Andy, Mike, and many more individuals and organizations signed: http://www.ezekielemanuel.com/writing/all-articles/2021/11/17/statement-supporting-osha-s-covid-vaccine-requirement
• Find a COVID-19 vaccine site near you: https://www.vaccines.gov/
• Order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response: https://us.macmillan.com/books/9781250770165

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.

For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Dr. Mike Osterholm

Andy Slavitt  00:18

Welcome to IN THE BUBBLE. This is Andy Slavitt. Your host, fresh off of my Thanksgiving. How was yours? Did you eat a lot? Did you get together with families? Did you take rapid antigen tests? That was a curveball question. Did you have stuffing with gravy? Did you get vaccinated? Did you get together with vaccinated people? Did you get together with unvaccinated people? All those kinds of things. I hope they worked out for you well, and hope that your travel was safe. Enjoyous. And I really hope you got to enjoy the holidays. We have a great episode today, which is a live interview that I did with Mike Osterholm, just a few days before Thanksgiving. And it is a really fun one. Mike asked me to interview him for the CIDRAP fundraiser. And it is a really good conversation, really great conversation. He wanted to go as deep as I wanted to go and get challenged as much as we needed to have a conversation where people would learn something, it was wildly attended. It was really fun. And they’ve allowed us to record it and bring it to you again, because I know how much people like listening to Mike. So without further ado, here’s Mike Osterholm.

Andy Slavitt 

Welcome, everybody, I got to know Mike Osterholm, starting literally about one month before the pandemic came to the US at least one month before we knew it did. And there was not a more timely introduction I could have had to someone who I think has become one of the country’s great resources, and who oversees one of the country’s great resources, relative to helping us go through this pandemic. So we’re going to have a great conversation, and we’re gonna go some really fun places. And Mike, I want to start out at a really really high level, we have about 20% to 25% of our country. That doesn’t seem to be on board with science, they seem to have an-anti expert, anti-scientific, anti-institutionalist, kind of perspective that is in this country today. And so the question for you and for all of us, given that it ends up being costly not just necessarily to them, but to our country. How do we get people on board? How does science and science communication reach the masses?

Dr. Mike Osterholm  02:56

Well, first of all, Andy, thank you so much for being part of this today. My respect for you as immense as you know, for those who are listening today, let me just say that I think all of you are well aware of the famous quote from the late Colin Powell that if you break it, you own it. In the circles that I run in the quote is, if it’s broken, you can’t fix it, call Andy. And so we have a very much appreciated his leadership and support through this time. Well, let me start out answering that question with just some sobering information that should put perspective to that very important issue. Yesterday, Minnesota had 80 cases per 100,000, population of COVID. How does that relate to anything? Well, it’s the highest in the country. We were the top state in the country. But more specifically, had we been a country ourselves, we would have had the 10th highest per capita incidence of COVID in the world. Think about that with all the low- and middle-income countries. And yet we have 74.7% of our population 18 years of age and older vaccinated.

Dr. Mike Osterholm  04:04

It’s not enough, good is good and not enough here. And I think your point Andy about even if we have a 10%, 20%, 25% part of the population that doesn’t believe in science, and won’t be a part of the solutions that we need to deal with this pandemic, we will see what’s continuing to happen in places like Minnesota. And so the issue is not whether this is going to be a debate where someone loses, someone wins, we all lose if we don’t improve the science literacy and the understanding of science in our world today. I you know, it’s a sad commentary. But in fact, you know, as many of you know who are on this today, I’ve been somewhat heavily criticized for bad news Mike, for suggesting last spring that some of the darkest days of the pandemic are still ahead of us. When case numbers are dropping and vaccine was flowing. But put it in perspective, six of the most critical people I’ve had in my tenure here during COVID, who were all in the media are now dead, all from dying from COVID. That’s not what we want to have happen. This is not a debate where the losers end up being seriously ill or dying. That’s what we don’t want to have happen.

Dr. Mike Osterholm 

So I think to answer the questions, specifically, let me just say, I don’t know the answer, but we can’t afford not to keep trying to figure it out. What are we going to do about the body politic? How are we going to get people at all ages, all economic levels, all races, colors, creed’s, education levels, what are we going to do to help them understand that this virus will not discriminate? It will keep doing what it’s going to do, if whether you comply or participate in or are part of the solution? And that’s the challenge I think we have today. If I had said to any of you on this WebEx today, that six weeks 10 weeks ago that Minnesota would one day have the highest rate of cases in the country would be one of the highest rates in the world, no one would have believed it. This is the consequence what the question you’re asking Andy. And all I can say as we are committed at CIDRAP, and the world has been committed to better addressing the anti-science bent that we’re now unfortunately experiencing.

Andy Slavitt  06:23

Well, I think this makes it a really important case for why organizations like CIDRAP are so vital to communicate with the public, you communicate, honestly. And there’s something you’d said, in what you just said, Mike, that I think, more important than any prognostication you’ve made, or anything else, which is the words we don’t know. And I would say that throughout the pandemic, if people really listened to you, I think your cautions have always been against some over stating of our current knowledge, more so than any prediction on what might happen next, you know, you’ve been the voice that has said, we ought to be careful about going too far in either direction. Because there’s such great uncertainty. And I remember something you said to me in March of 2020, which is that there’s only going to be a certain amount of telling the public that things are dire that people will tolerate, whether or not that’s true or not, whether or not even if the facts are right, but that we have to be conscious of how people hear and receive things.

Andy Slavitt

And so I think this humility, this humility to say that people are coming from different places, and that there are no absolute truths is something science has a hard time dealing with as a whole. And experts feel like they don’t get invited back on the TV shows, unless they can say definitively what the answer is. So why don’t you if you can talk about how you managed to introduce this humility, and then maybe speak about it in the context of not just the people who don’t believe in science anymore. But there’s a great number of people who may believe but they’re just tired of it. And so how do we communicate to people, when we are in the middle of surging cases, as you say, in Minnesota, and other places in the world, when people are in the state that they’re in right now, relative to the last year and a half.

Dr. Mike Osterholm  08:23

Well, thank you, I think the key message here is, is that first and foremost, always just tell the truth. If you don’t know just say you don’t know. You know, some of you have heard me say in recent months, you know, I wake up every morning and two things happen. First of all, the first song I hear humming in my head when I opened my eyes, is from that old Fifth Dimension tune from the 1960s. This is the Dawning of the Age of Aquarius. But in this case, the song is this is the Dawning of the Age of the Variants. The variants were fundamental game changers. And what happened to this pandemic, the fact that these mutated viruses, it could be much more infectious, cause more serious illness, even potentially escaped the immune protection of vaccines or natural immunity for after being infected, was really important that we laid out there. You know, what, in fact, now does this mean? And so telling the truth about for example, the vaccines, these are remarkable tools, remarkable tools, but they’re not perfect.

Dr. Mike Osterholm 

And so not acknowledging this waning immunity initially. And as Andy, you know, back in August, I was very much concerned about waning immunity at a time when no one wanted to hear that. And yet today, we have to deal with it. It’s important, doesn’t mean the vaccines still can’t work and work well. But booster doses are now a reality. So I mean, I could go through the laundry list of where we at CIDRAP who’ve just tried to tell the truth, what do we know and not know? So that’s number one. Number two is you got to tell it in a way people can understand. You know, this is surely reflection of my upbringing, you know, I was born and raised in a small farm town where I learned early on, if you couldn’t sell it to the 10 o’clock coffee club at the S&D cafe on Main Street, basically, it was going to be a hard sell. And so I think we’ve tried very hard at our center, not to talk down or talk up because neither of those are really right. It’s just tell the truth in a way that people can understand.

Dr. Mike Osterholm  10:25

And so I think that, that has been really important. The final piece is, you know, we’re not in this for a popularity contest. We’re not in this to have people like us, we’re not in this to get on the media as such, we’re in it to basically make a difference. You know, I don’t need a lot of motivation every morning after I get that humming out of my head. And then I scraped the five inches of mud off my crystal ball, to understand that today, I’m doing this and why I’m on this screen right now. This is about my kids and grandkids. And this is for all of us, you know, what are we doing to make the world a better place? You can’t know that professional joy, overwhelming personal satisfaction, when my kids grandkids who could have been vaccinated last week are all vaccinated. That’s I think part of trying to share the message of what’s happening with the public is what does that mean? And I think that’s what we try very hard to do at CIDRAP.

Andy Slavitt

Well, here’s to Midwesterners. And that very common-sense perspective that you have, and that you bring is surely one of the reasons why you may be doing something right. And when experts refute you, yet, the real, yet Real Americans only listen to you more, it might tell you, you might be doing something right, because you’re really trying to connect with people and how they’re making decisions. So let’s go there. Let’s now talk about the Americans that are listening. And those that don’t want to listen, and the things that they need to know right now. On the one hand, I’m going to talk about this, like the balance sheet. On the one hand, we really haven’t figured out how to contain the spread of Delta, it continues to do what it will when it will. And we have not yet figured out how to vaccinate the globe. So there may be concerns more variance, and I’d like you to be able to comment on that, on how that effort works.

Andy Slavitt  12:20

On the other hand, we today, compared to a year ago, have a number of tools, I’ll use the word tools, because it’s a word you use as well, for people to use in their lives, vaccines, obviously, booster shots, portable air purifiers, monoclonal antibodies, soon to be pills that that you can take that are therapeutics if you get COVID, rapid antigen tests. And so my question is, if you can comment on, you know, these threats and how you think about them, but also as you bring it to people in their lives with these tools, what does that mean for how people are able to live their lives even in the context of this pandemic?

Dr. Mike Osterholm 

Well, let me divide this into two really different groups of individuals, one who want to use the tools, they just need the instructions, the support, to know how best to use them. You know, there are people today that are concerned about I willingly jumped on board to get vaccinated, and I’m hearing about all these breakthroughs was that the right thing to do? Answer is absolutely, yes. Today, even though we are seeing waning immunity, that can be restored quickly by a booster, you have a sixfold increase of getting infected, if you’re not vaccinated, you have a 12-fold increase in dying if you’re not vaccinated. So we have to reassure the willing that they’re doing the right thing. The second thing we have to do is we have to empower the willing. And what I mean by that is that even with these very, very amazing tools, these vaccines, we still have people who will likely suffer breakthroughs. Because of their age, we know that the challenged of those 75 years of age and older still have problems in terms of their immune response. We know people who have underlying comorbidities as we call them, increase BMI’s other immunosuppressive conditions.

Dr. Mike Osterholm  14:20

We know that people who have been solid organ donor recipients and stem cell recipients that they to have a less response. So the next thing is once you get vaccinated, what else can you do to protect yourself and allow you to empower yourself and this is coming home front and center right now, during the holiday season. And my podcast released this morning, which we release every Thursday morning. One of the major discussions is don’t be afraid to protect yourself. Empower yourself. So if you have family that want to come to your Thanksgiving day dinner, that are not vaccinated to refuse to get vaccinated, you know, you shouldn’t feel guilty about saying, that’s not going to work. And you got to take that bull by the horns and empower yourself. If you are in a community like the Twin Cities right now, or unfortunately states all the way from the Four Corners area right up through the Great Plains, all across Northern America right now, well into the Northeast Vermont, New Hampshire, we’re seeing major increases in transmission. This isn’t a time that you want to put yourself at risk of being in the community. This is a time when you have to look at how can I protect myself.

Dr. Mike Osterholm

So I think among the willing, we just need to give them the tools, the things that you’re talking about how to use the best kind of respiratory protection if I go to the grocery store, and I want to have that added benefit of protection. And then we have those that basically don’t believe, they’re against vaccines, even though they’re so well studied. They’re, you know, the gold standard of scientific research is what we call a double-blind placebo-controlled trial. And these vaccines have all been through that. And while they’re rejected, we know quite clearly, that treatment with drugs like ivermectin, an anti-parasitic drug that in levels that many people take it today for COVID is highly toxic. And again, the benefits are zip zero. And yet, we see healthcare providers today being sued by family members of some loved one who’s in critical care unit. And the staff refused to treat them with ivermectin and the family is suing to have been treated with it. You know, those I don’t know if we’re ever going to reach with the tools that we have. And all we can do is just keep trying.

Dr. Mike Osterholm  16:37

And one of the reasons why we want to keep trying is obviously, you know, as I pointed out earlier, I don’t want anyone to be harmed by this virus, whether they’re a friend or foe. But also, as long as we have this widespread transmission in our communities, two things happen. One is, in fact, we are at increased risk. Because there’s just more infections out there, there’s more likelihood that an infected child will bring the virus to school or the infected child to bring it back home, or into the daycare. And so we want to limit as much transmission as we can. The second thing is, today, I don’t think people fully understand particularly in a state like Minnesota right now, where our healthcare system is incredibly challenged. We’re at the point right now, where we’re not just bending in their locations we’re breaking. And you don’t want to be someone today to have a heart attack or a stroke, or be in an automobile accident and find that there are no beds for you anywhere near. And I think that that messaging also is please, if for no other reason, understand, even if you don’t agree with COVID, if you are one of those individuals who is taking up a bed right now, because you’re unvaccinated, you are also compromised in the health of the entire community.

Dr. Mike Osterholm 

So I think we have to split these out, we will continue to work in providing the most current comprehensive information we can to those who are the willing who want to use the tools, they just want to know how to use them best. And for those that won’t use the tools who reject them, you know, I’m not going to give up, you know, failure is not an option here. And unfortunately, I hope the virus doesn’t basically infect them first cause some serious illness or even death before we hopefully can change their thoughts. Now someone say, you know, that’s naive, you’re not going to change it. The body politic is such today, that that’s not going to happen. Well, you know, I that may be the case. But we’ve watched over the course of our history, little events become big events, and eventually monumental events that change the course of history. Will we change everyone’s mind? No. But maybe today, when that grandfather who’s lying in that ICU bed just before he’s been intubated, looks up and says I wish I had been vaccinated to all my family to get vaccinated. More and more of those moments are happening, and maybe that’s where we can begin to keep changing the unwilling to the willing category.

Andy Slavitt 

So Mike, let me take the skeptical side of the equation for a few minutes here, which will be lots of fun for you. Why not say to people who are dead set against getting vaccinated? Why keep talking about vaccinations? Why not talk to them about the other tools? Why not talk to them more about? Yes, monoclonal antibodies are not as good. They’re more expensive. They’re taken after the fact. But certainly things like ventilation, portable ventilation. In these other things, why not emphasize, hey, you’ve got five or six tools? If you’re not going to do one? Why not at least do some of the others?

Dr. Mike Osterholm  20:10

Yeah, well, and thank you for adding that context, because I think you’re actually right. A very, very right. You know, wherever we can reduce risk, however, we can reduce harm. You know, it’s like, we don’t want to have to make a tradeoff between seatbelts or airbags, or the collision computer system on the car that helps you stop an impending rear end accident. We don’t want to, you know, say you have to pick between, you know, one type of safety measure in your car and another. And we surely don’t have to do that here. We should use them all. And if one like vaccines are polarizing, if there are other things we can do to limit transmission. Yes. And, you know, we have said for a long time, that you know, and I come from a 45-year career of working in influenza, you know, if we can increase building ventilation and energy efficient way, look at all the good that that means in terms of respiratory pathogens.

Dr. Mike Osterholm 

I mean, people forget that 40,000 to 60,000 people a year die in this country from influenza. So doing the things you’re talking about Andy terms of improving air quality, improving the kind of respiratory protection, you know, one of the challenges we have in this country right now is all the efficient and effective respiratory protection, the kind of masks you wear, are largely occupational based, meaning that they were always made for the workplace. We’ve never really embarked upon highly effective respiratory protection for the citizen. What is the right fit? How does it work in kids? And so I think you’re right, there are a lot of other things we can do. And we should do them all at the same time. The reason I really have focused on the vaccines or in the antivirals, is right now, you know, as they say, it’s a hard time to think about draining the swamp when you’re up here, south side alligators were up that were way beyond the south side right now and alligators.

Dr. Mike Osterholm  22:00

So we need as well, the most immediate things we can do. But your point is a really good one. And if we learn nothing else, from this pandemic, is we should be embarking and all of these, these should be fundamental game changers. You know, people don’t realize that for every two days, we’ve lived in the last century, we’ve gained a day of life expectancy. Think about that going back 80,000 generation to the caves, we have suddenly changed that whole picture now COVID challenge that. But why did that occur? That occurred because somebody figured out, you know, drinking all that contaminated water, that wasn’t good for you, suddenly having a water system in place. Oh, my look what that did, and a safe water system. And so I think the whole point about air is only going to become more important that way. And I agree with you 100%.

Andy Slavitt 

So what about people who say that we overestimate the risk to people of COVID-19. And an epidemiologist did this analysis for me, it’s roughly right, basically said the chances if you drive 50 miles or more of being in a fatality on the highway, this Thanksgiving season, if you’re driving to a loved one is 1 per 100,000. So if 100,000 people get on the highway, one of them is going to get in a fatal accident and not be here. And if you look at Minnesota’s level, even today, of COVID, your chances of going into Thanksgiving somewhere contracting COVID and dying, if you’re unvaccinated is about 1 and 100,000. If you’re vaccinated, it’s about a sixth of that. And so you could you made this point earlier about if you’re inviting someone to your dinner and you’re vaccinated, but they’re not saying you know that you’re not going to allow that to happen. But if you look at some of this cold hard data on actual risk, what it would suggest is your ride over to the Thanksgiving dinner is going to be riskier if you’re vaccinated. And so if you have unvaccinated people there, it doesn’t matter. Now that doesn’t take into account everything. There’s lots of other externalities, including continuing the spread, including long COVID, etc. But what do you say to people who, who say I think this risk is being overblown? I think we should be making decisions to live our lives more alcoholic assertively, and then we are because we’re over calculating this risk?

Dr. Mike Osterholm  24:27

Well, you know, one of the challenges we have is that COVID tends to be very episodic, meaning that if you look right now probably one of the safest places in the country to be is in the Deep South, you know, in rural Louisiana right now probably has one of the lowest rates of transmission anywhere in the country. Because after that surge occurred this past summer, numbers dropped down dramatically to a pre surge level. On the other hand, if you’re here in Minnesota right now, particularly certain county areas that risk is very different. So I think that even using the numbers you use. And we could surely have a great discussion about that, let me just use a set of numbers which I think, may even provide a more stark reminder of the importance of COVID. If you assume that the delta surge started roughly in late June, which is when it did in this country, and you look at where we’re at today, since late June, and you realize we are a country that was flushing vaccine, where clearly everyone could have had a dose of vaccine. Since late June 140,000, people have died from COVID 140,000. And they would never die. If they had been willing to be vaccinated, the vast, vast majority were never vaccinated.

Dr. Mike Osterholm 

And so I think that when at a population level, you look at what COVID has done. It’s the first time in the history of our country, we’ve actually seen states that have less population at the end of the year, and they started at the begin of the year. And it wasn’t because of migration out is because of doubts increased. So I think that from a standpoint of this, those are very abstract numbers. But what it all comes down to, is how we all independently, basically respond to that. So you know, I would say, to the grandpa and grandma who are coming to Thanksgiving day dinner, who may have an underlying health condition that would put them at high risk of having a serious illness and death, then they should feel empowered to say I don’t want to put myself into that position, and not feel somehow guilted into that they need to do that. And so I still maintain that position, I will maintain that position. And I would just summarize it in the sense of saying there’s no right or wrong answers. In a sense, there’s no easy answers. And this was really put to me some months ago, when a very famous civil war historian, after we had a long discussion about what was happening to our country around COVID. He looked at me and he said, you know, Mike, for the first time in my career, I finally understand what mothers and fathers must have felt when half their sons went to fight for the North and half went and sought to fight for the South.

Dr. Mike Osterholm

That was a very telling, telling moment. And you know, there are a lot of people who are listening today who have been in the middle of these very same difficult moments. So you’re right, we’ve got to use the numbers, we’ve got to put them out there, I can tell you right now, I don’t need a number to understand that we’ve got a healthcare system that is bending and breaking. We’ve got healthcare workers who are quitting their job daily, because finally, after two years, the stress is so dramatic. So painful that they’re leaving, which is only accentuating the problem of trying to find adequate staff for these intensive care units. That hadn’t happened before. In 45 years in the business that I’ve been in, I’ve never seen that before, even with HIV. And so I think that this by itself, gives us a sense of what we’re up against.

Andy Slavitt  28:12

Well, I think what you’re saying, and it’s very well stated, is that if you can take a simple precaution, why wouldn’t you? And if it just decreases your odds, no matter what the numbers are, you know, why wouldn’t you take that additional precaution. And I think the place where I’m pushing a little bit is for people who have been vaccinated and who’ve done what they believe to be the right things and are taking precautions. If we’re sitting here, let’s just say it’s two years from now. 2023. And the situation is largely what it looks like today. Same levels of risk, etc. People feel years of their lives going by, the risk of being estranged from family, you know, starts to add up the costs shouldn’t say the risk, the cost, etc. And so I think a lot of people what a lot of people are struggling with this is very practical, these goes back to the people in the diner is what portion of the things that are important to me should I give up? Maybe I like going to a Twins game or Timberwolves game. No, that’s a stretch. Nobody likes going to Timberwolves games.

Andy Slavitt 

But maybe I like going to a concert, an indoor concert that I just get so much pleasure out of seeing my family at Thanksgiving. And I’m taking precautions I’ve been vaccinated. My eyes are much, much better. But I want to know how to think about these daily risks. And I want to know how to offset them with the joys You know, you talk you talk very movingly. And I appreciate when you do this about your grandkids and hugging your grandkids and why and what that means to you. And I think everyone in America can relate to that. And they want to do, the majority people want to do the right thing. The vast majority people want to live but they really want to understand at what point do they lean back in to some of these normal things, even when there are some risks?

Dr. Mike Osterholm

You know, and this is a very critical question we have to answer and our group has tried to, and I try to cover this my weekly podcast. You know, it’s not just that we’ve had to try to come to grips with how we die with this virus. But as I said months and months ago, it’s also how do we live with it? What do we do? What are the risks that we assume? And I think that we’re still really on the road to greatly reducing these risks in a way that makes the personal choices much simpler. You know, right now, I mean, I have to say, with all honesty, thank God, I’m not an organ recipient. Because the best data we have shows right now that the vaccines are only about 50%, protective against developing serious illness, and even dying, if you get COVID. If you’re organ recipient. Now, you know what, that’s not abstract. If you’re one of those people. That’s real. That’s scary. And I think that what we’re trying to do is figure out for the whole entire population, where the risk is, is very low for young children to have serious illness and die.

Dr. Mike Osterholm  31:06

But at the same time, during this recent surge in the United States, over 10,000, kids aged 5 to 11 have been hospitalized, 1/3, in intensive care. During the surge with Delta, it has been the number fifth cause of death in kids 5 to 11 years of age. So I can talk all I want about, you know, its role risk, it’s all these things. And so I think you’re right, one of the things we have to do is come to grips with how do we live with this virus. What are the risks we accept. You know, I often joke about the fact imagine the guy laying in his living room floor, having an acute myocardial infarction and the EMTs are there, they got him stabilized, they’re going to transform emerge for me, so I can’t go with you. It’s too dangerous driving that ambulance, I may get in an accident on the way to the hospital. And you sit there and say, Come on, buddy, you know, put your wrist into perspective. And I think that’s what we’re gonna have to do a lot more with COVID over time, but I think there’s a lot more we can still do to lower the risk.

Dr. Mike Osterholm  32:07

I think the vaccines, learning how to use them better. The antiviral drugs, I think so many things that we can do to really limit risk yet, and then make it an easier equation. As you and I have talked before, Andy, I mean, as I said, we you know, we have 40 to 60,000 people that die annually in an average flu year in this country. We don’t shut down the country. We don’t quit, you know, go into school, we don’t basically shut down businesses. And you know, at some point we are going to have to come to grips with how do we deal with this. But I think right now, this COVID Tsunami when it hits and it’s like a tsunami, it doesn’t hit yesterday doesn’t hit tomorrow, but it hits today and it hits hard. How do we deal with that? And how does that enter into our everyday thinking?

Andy Slavitt 

Let’s talk about kids a little bit. Because I think a lot of parents and a lot of people are confused about now that they can get kids vaccinated. Should kids five to 11 continue to wear masks? Should schools continue to ask kids to wear masks or require kids to wear masks? You How to think about that risk. And then also, there are a number of people who are very pro vaccine and very bro COVID vaccine who just aren’t sure yet whether they want to give the vaccine to their five- to 11-year-old because they look at that risk reward trade off or the risk benefit trade off and they’re just uncertain. I you know, I think we have the great benefit of having 28,000 pediatricians who are capable of having these conversations with parents about this with their kids. Because these are very individual decisions at some level. What do you think about what are you recommending? What are you saying in terms of where that leaves parents and what they should be doing what they shouldn’t be doing?

Dr. Mike Osterholm  34:20

Well, again, I think we have to tell the story of COVID and kids in a much more effective way. Meaning that you know, I just thrown out some abstract numbers. But those numbers are just numbers. They’re not people. You know, one of the things I try very hard in my podcast and we at CIDRAP try never to forget is behind every one of those numbers as a person so grandpa or grandma or mom or dad or brother and sister and unfortunately even a child. And I think that people want to understand more internalized. You know, what does this mean for me? I can tell you that and there are people who are on this program right now who have suffered through children who have been severely ill with COVID over the course of the past month to two months, and the question becomes, I think, you know, how do you translate that into information that then you can act on or think about. And I think that middle group that you’ve talked about, and there are three groups of parents as it relates to vaccinating five-to-11-year old’s, the Kaiser Family Foundation data that was clearly showing that about a third of parents couldn’t wait to get the vaccine for their kids, they were the ones calling 12 clinics a day until they could get an appointment. Thank you, by the way for that.

Dr. Mike Osterholm 

There were those in the middle that said, you know, I’m not against these vaccines, but I want more information. I want to understand what they do, what they’re not doing, what their safety issues are, we owe that group a lot more information as we get it. The problem is, is that if this was a regular vaccine research and development and licensure process, like we see with so many other of our vaccines, we’d have had five, seven years of research under our belt before an application would ever been made to improve the vaccine. Well, you know, I don’t have the data right now before me on 5-to-11-year old’s, for what the two-year outcome is, after having been vaccinated, we have to accept that that’s what we’re working on. You know, we’re flying this plane to 30,000 feet and also building at the same time, we know what the safety data are, what we’re trying to figure out is how best to use it. But so we owe that middle group that. But then the third group that is are the group of parents who say under no condition, I vaccinate my kids. You know, that goes back to your earlier question. I don’t have an answer for that. But that’s not an acceptable answer, we need to better understand how do we deal with both the scientific beliefs in this country, as well as I guess what you would call the body politic? And so I don’t have a good answer for that. But that doesn’t mean we can’t and shouldn’t keep trying to find that answer.

Andy Slavitt  36:55

Great. How do you feel about mandates, Mike?

Dr. Mike Osterholm 

Well, I actually support the mandate in the sense that it is all about not just the individual, it’s about the community. And what I mean by that, as I’ve already pointed out that if you don’t get infected, you’re not infectious to others, we know that we have data that shows that even if you’re a breakthrough, you’ll shut the virus for a shorter period of time. And at least some of the studies show less transmission. You know, if somebody wants to drink and drive, and they want to be intoxicated behind the wheel, because it’s their choice to do what they want, we say no, you don’t have the choice. That’s a choice. Basically, you’ve done whatever you do to your body, but you’re a risk to the community. I think in the public health action world, mandates are actually critical to doing two things. One is actually truly reducing risk. And making it so that we have less transmission in the community, particularly for those who can’t protect themselves because despite being vaccinated, they still have an increased risk of having a breakthrough and could be serious because of their underlying health conditions.

Dr. Mike Osterholm  38:03

So I think from that standpoint, this is about community good. The second piece of it is, is that as we see in the surges, in particular, when people get infected, they take a bed, if they become seriously ill, and they’re more likely to be seriously ill if they’re unvaccinated. Well, now that begins to affect a lot of other things. You know, horror stories were well aware of, of people who after being in the emergency room department for 18 hours finally died from their heart attack, because nobody can find him a bed. You know, we have also a community good. That’s all about providing the most for those that needed the most. And in this case, if you could help reduce the amount of COVID in our healthcare systems, that will surely help also, in terms of others who need health care. One of the ways to accomplish that is the mandate. I understand the challenges with that I don’t want for a moment not to appreciate and acknowledge about the personal choice aspect of that. But I think when you’re looking at the greater community good, I very much support the mandates.

Andy Slavitt 

And appoint to a letter that you and I both signed that came out today. If people want to see what a number of experts are recommending. From there, Mike, I believe we are just about done with a call. I want to just thank everybody for attending. And you know, I would just say one final thing when Mike, I know this for a fact. And Mike’s modest, but when he gets called by a governor or mayor or someone and says we need help, and he mobilizes half a dozen people overnight quickly responds get results. He doesn’t charge you for that. There’s no bill at the end of that. He does that. Because he does that for us. He does that for all the people who are living in this country and in the state. And so thank you and thank you again for attending.

Dr. Mike Osterholm  40:00

Thank you, all of you. Thank you. And, Andy, I just want to thank you, I want to thank you on behalf of, I think a very grateful number of public health people in the nation. for all you’ve done, I watched what you did to make these vaccines a reality. I’ve watched how you; you can cut through red tape faster than anybody I’ve ever known. And like I said at the beginning, you know, if it’s broken, and you can’t fix it, call Andy. And that’s, that’s what you’ve done. So thank you very much for your comments. And thank you to everyone who’s been online here today, listening to this conversation.

Andy Slavitt 

Three upcoming episodes. First, we have the episode on the Regeneron monoclonal antibodies with Lynch Schleifer who runs Regeneron. It is a very interesting conversation, I think, something that we should all be informed about. The next episode is on things that have changed in the healthcare system, particularly focusing on virtual care and getting access to virtual care. And finally, an episode on what the heck’s going on with inflation. What is happening? What is really driving this? What is all this supply chain stuff doing to us? I can’t buy Christmas gifts. It’s hard to buy meat, what’s going on here? Inflation. Jason Furman, who is a wonderful economist and was head of the National Economic Council in the Obama administration. I got a chance to work with, he’s going to be on the show. Very smart lad. Let me tell you that very smart lad. Okay. Be well, thank you and I will talk to you Wednesday.

CREDITS

Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev and Veronica Rodriguez. Jessica Cordova Kramer and Stephanie Wittels Wachs are the executive producers of the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, please tell your friends and please stay safe, share some joy and we will definitely get through this together.