In the Bubble with Andy Slavitt: Our Shot

When Will the Delta Surge End? (with Michael Osterholm)

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Andy and renowned epidemiologist Michael Osterholm discuss how Delta is upending the pandemic landscape. They cover when the wave may end, what Michael thinks we should do about kids and schools, and how it’s caused him to rethink his own interactions with his unvaccinated grandchildren.


Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt. Check out In the Bubble’s Twitter account @inthebubblepod.


Follow Michael Osterholm on Twitter @mtosterholm.


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Dr. Mike Osterholm, Bill de Blasio, Andy Slavitt

Dr. Mike Osterholm  00:00

This is not our last rodeo; this particular pandemic is going to happen and continue to happen. But in fact that there’ll be others in the future. So we need to be better prepared. Imagine if we’d had these vaccines ready to go last year ago, last January. And so this is, I think, an outstanding effort on the part of the NIH to get us better prepared for the future.

Andy Slavitt 

Welcome to IN THE BUBBLE. I’m your host, Andy Slavitt. What is happening? Well, there’s plenty to sink our teeth into today, let’s just go through some of the things that are hitting our world, challenges. I think we still are dealing with this surprising challenge of Delta. What that means for all of us. We have questions about the vaccine, how long it lasts, how effective it is whether or not we should be wearing masks. We have questions about what’s motivating unvaccinated people to get vaccinated. We have questions about the globe. When are we going to be able to vaccinate people globally? And these are all policy issue actions that we need to be thinking about, should there be mandates, should there be other kinds of things that the tighten courage people to get vaccinated?

Andy Slavitt

Really, I think, a kind of amazingly similar set of issues a year later than what we’ve been dealing with. So just a little bit of a feel for what I’ve been doing over the last 10 days or so. And we’re going to be announcing tomorrow, I have come together with about 25 other people, some of whom served in the Biden administration. Just be me. Some have worked in the Trump administration, some in the Bush and Obama administrations, and all healthcare leaders, former governors and put together a letter that we are sending tomorrow morning to every employer in the country and posting in the newspaper, calling on employers to get serious about vaccinating their workforce, their population. And we’re gonna announce a number of major companies that are with us on this effort. Companies like Land O’Lakes, Tyson Foods, Disney, Google Centene. And we’re trying to make it a requirement almost, that a company takes a step and takes action here.

Andy Slavitt  02:44

You know, I think based upon if you’ve listened some of our past shows, there’s probably 8% of the public that I think can become vaccinated just simply from that move. I think it’s always useful for me at this point in time to just keep asking myself, what would I do differently? What can I do? So you’re telling me that there’s something different about this variant. You could tell me that, you know, we’re having challenges, but it’s some level measure, what are the things that we would do differently and the only thing that I think we do in every circumstance of everything I’ve heard is continue to push to vaccinate more and more people and more and more assertively. I was on a call just yesterday morning, that Mayor de Blasio in New York asked me to join, where he made quite an exciting announcement, a quite a major announcement.

Bill de Blasio 

The key to NYC pass will be a first in the nation approach. It will require vaccination for workers and customers in indoor dining, in indoor fitness facilities, indoor entertainment facilities, this is going to be a requirement. The only way to patronize these establishments indoors will be if you’re vaccinated, at least one dose. The same for folks in terms of work, they’ll need at least one dose.

Andy Slavitt  04:00

I saw in that announcement; I joined him and added my two cents.

Bill de Blasio 

I want you to hear from folks who have been working so hard on the response to COVID. And who care so deep, I want you to hear what they think of this new clear, strong approach. The key to NYC pass first of all, the former Acting Administrator for the Centers for Medicare and Medicaid Services. He was also a former senior adviser by Biden White House COVID response team. He is a powerful voice for expanding access to health care in this country. And I really want to thank him for joining us my pleasure to introduce Andy Slavitt.

Andy Slavitt 

Morning, Good afternoon. Thank you for having me Mayor and thank you for your leadership. The questions that people have now about society will be cleared up with this announcement. Can I go into this restaurant? Can I go into this gym safely? Can I go to this doctor? Should I go to this hospital, should I go to this movie, New York City will be the first city in the country that takes those questions off the table completely as this gets implemented. And I think that level of assurance should encourage people that this is not a choice pitting one against the other. But it’s a choice that benefits everybody.

Andy Slavitt

So I think things are ramping up. I think they’re amping up throughout the country. I think they’re going to amp up with employers with cities with states. There’s a couple folks that are headed the other direction. Some of the unions are being quite challenging. That’s been interesting, and a little bit surprising. The state of Florida, state of Florida and states like it, have had their own different strategy. Their strategy has been to outlaw requirement, to people show proof of vaccination while they’re outlining the requirement that people wear masks on while they’re allowing everything else. And I think what happened with people like Ron DeSantis is it’s not that hard to decipher how his mind works as he sees an opportunity when he thinks the pandemic is ending to say, hey, we chose freedom, not Fauci-ism, catchy, for sure, and populist and premature.

Andy Slavitt  06:09

And of course, tying the hands of government telling your own hands, it looks like a bold move, until of course, you need government to do something. And that is the ugly this sort of faces now as they now have a record number of cases, a record number of hospitalizations. And they’ve really thought their own tools to deal with things. Thankfully, it’s a more and more of a minority voice, the senses of the world, and hopefully they get drowned out by good people saying, Hey, I’m not going to come to your business. Or I’m not going to go to your school, unless you make it as safe as possible. And you have the tools to do that. So when things get ugly, I like to call Mike Osterholm. Not because he’s ugly. He’s quite a handsome devil. But Mike Osterholm is a guy that I think will help answer probably of all the questions, some of the ones that are most important on our mind, and some of the ones that are toughest, namely, how long is this Delta thing gonna last? How long is this Delta thing gonna last after all?

Andy Slavitt

And I think we go into that question. In fact, we start kind of with that question. And then we go into some of these other head faces. I want to warn you that like Mike is, Mike is that negative guy, if you had someone on your shoulder who were red, and suddenly the shoulder that were white, he’d be the guy in your shoulder who would be kind of telling you that the down cases, the more doom and gloom cases sometimes he’s right. Sometimes he’s not. I just tell you this right now, but he was a big part of my book. He’s one of the smartest people on pandemics, but nobody’s always right. And so I want you to listen to what he has to say I don’t interrupt him or disagree with him or anything like that. But don’t you listen to what he says and understand that, you know, he tends to have the most the little slightly more pessimistic view. But he’s so articulate and so thoughtful, you know, his words are gold, because they’re just so well researched. And, you know, he can help, I think, tell us how we should be thinking about the current moment with Delta, how to get out of it. And then some other I think, pretty tough questions I put to him about kids and some other things. So let’s talk to Mike Osterholm.

Andy Slavitt  08:26

So we got some ground to cover here. I think if we were having this conversation three, four months ago, things look like they were gonna get gradually better, and they’re not. Tell us a little bit about what’s surprising us about Delta?

Dr. Mike Osterholm

You know, I’m not sure that that I’m as surprised about what Delta is doing. Because of just studying what has happened to date. Clearly, the level of infectiousness is a challenge. And after we saw what it did in India, I think that it, it is not a surprise that it’s doing what it is doing elsewhere. I think we really had not given enough thought to what we’ve been seeing through the duration of the pandemic. And while the variants have changed that somewhat. We’ve actually had this kind of surge issue going on, for some time. Cases suddenly increase in a given geographic region, and we don’t know why. And then they suddenly decrease and we don’t know why. And so when we had the situation last spring, the one surprise we had was not with Delta, it was actually with Alpha, where given what had been seen in Europe, in particular, and watching is very rapid rise in the United States. In terms of cases, of infection and given states we thought well, wow, this is going to take off and do what it did in England and other European countries, and only took off in Minnesota and Michigan, for which we had no explanation.

Dr. Mike Osterholm  10:04

You know, the peak in Canada in April was the largest peak they’d had. I mean, it was what we thought would happen here. It didn’t. And we couldn’t attribute that to vaccine. As such, the numbers weren’t just that high. And as you see now, even with increased vaccination since then look what it’s doing. So I think Alpha is what really threw me. But what I think is happening with Delta is the highly infectious virus it takes off. In the United States, we’re still not sure what it’s really going to do. We know the southern sunbelt states, again, are getting hit hard in Louisiana, Florida, Arkansas, you know, that’s getting hit hard. We’ve seen increases in all 51 states over the last two weeks. And in all the states reporting all take that all but four states are reporting 50% or more increases in 40 states, the increases add up to more than 100%. And in 12 states, it’s over 200% increase.

Dr. Mike Osterholm 

So we’re seeing more of a national increase, even though right now we have this group of states that are particularly getting hit in the southern south, remember, was just a year ago that the South lit up the first time and took off. And then remember those cases, just all of a sudden plummeted. We don’t know why. And I think that’s what is happening now. We’re watching the world unfold. Wherever this virus is at with sudden increases in sudden decreases happen in England right now. The one thing that’s really different is where you’re vaccinated like we are in the United States. To the extent we are seeing a major difference in deaths. Deaths have been dropped dramatically.

Andy Slavitt

But are you confident that that’s going to hold?

Dr. Mike Osterholm

Yes, I am. I think it’s a function of given the percentage of people over age 65, who’ve been vaccinated, which were such an ordinate percentage of the deaths that we’ve seen in previous surges, I think it’s going to hold. Now that doesn’t mean ICU bed care is going to drop, it doesn’t mean that hospital beds are going to drop, because they’re now what’s happening as well, the overall severity does decrease by age. So the younger you are, the less chance you have of having a serious illness. It’s the population pyramid, you just have a lot more people who are 20 to 30 to 40. So now you suddenly end up having many more of them in ICU beds just because so many are infected.

Dr. Mike Osterholm  12:33

But parade, it’s not as high as a 65-year-old age group. And so I think what’s going to happen in the United States is one of two things, either, we will see the surge in the next five to six weeks, with the southern states really carrying the way or we will see the other states also eventually light up as Delta has now become the predominant virus everywhere. And then it will be a more prolonged situation but everywhere else is burns out quickly. And we don’t understand why.

Andy Slavitt 

So what you’re pointing to is this incredibly steep rise in India, that went quite high because of the low vaccination levels, followed by in the UK, the same looking what appears to be the same looking curve, right? Go straight up seems to be going straight down, not as high because the vaccination levels. Indonesia looks to be the same thing. I don’t know if we can quite say it’s predictable just yet. But even in Arkansas, I noticed that you’re starting to see the similar looking curve very just the beginning so hard, hard to know. And what I hear you saying is that could be true. But we could also see rises in other states that haven’t really begun yet. So the peak could be sooner in southern states and maybe a little bit further out and others.

Dr. Mike Osterholm

Absolutely. You said it very well. I think that’s the case. Either way. I think that by early September, mid-September, the latest the surgery up and out, just like we saw in January, up and down.

Andy Slavitt  14:11

So maybe not quite in time for the beginning of the school year. But hopefully, for if we lock down at least early on as the school year is getting started.

Dr. Mike Osterholm 

I think so I think that will be the case.

Andy Slavitt

That would be nice. And the other thing you said, which is really profound is this idea of breaking the tie between infections and deaths. And if we have a condition in this country where people get sick, they get infected. But we haven’t truly we have a vaccine for it. And then vaccine for it protects all those people, or almost all those people that want to be protected and that you end up with people who choose not to be protected as the only ones that are really dying. It’s really a different type of disease than the 2020 Coronavirus.

Dr. Mike Osterholm 

Absolutely. And I think that, if you look at the data from the UK is really compelling. And I think our data is beginning to match up completely with that. Remember that hospitalizations and […] lagging indicator. So we only know that for a month. But if you look at the data for the second wave that occurred in the UK, which was actually from last September, basically, into the December time period, if you look at the cases per 100,000 population, as you got from that 35 to 40, 45- to 50-year-old age group, the case numbers climbed 19, 21, 24, 29, 33 per 100,000 population for those five-year increments. If you look at the deaths, they have climbed in a very similar manner, deaths for 10 million population from age 35, up by five-year increment was 10.8 14.6 20, 28 35, almost 36 per 10,000. population.

Dr. Mike Osterholm  16:04

If you look at this new wave, the numbers are identical for cases per 100,000 population. And for the deaths per 10 million population as opposed to that 14 2020. Starting […] 35 by five-year increment, they’re 1.6 2.2 2.2 2.1. So it’s amazing. It’s like a population pyramid, where if you cut it in half, and you add on one side number of cases per population, and you put deaths next to it, the previous wave look like a tree, Christmas tree. But if you do this, the most recent wave is the half side of Christmas tree.

Andy Slavitt 

Right. So let me see if I can make sure that we’re clear enough what we’re saying here. But I wanted to ask you one clarifying question, does that account for enough of the aging of the cases, to be confident that those, that deaths aren’t going to blossom out from where they already think that that reflects the time it would take for those deaths to occur?

Dr. Mike Osterholm 

Well, using England just as the example remember, they are, you know, further along, you know, almost six weeks further than we are in this. So by now the lagging indicators were there. Case numbers are dropping in the UK in a way that supports what I made the point earlier is because they’re dropping just as quickly in the areas that are poorly vaccinated in the UK as they are in the areas that are highly vaccinated. So it’s not vaccine and the itself is driving it. But if you look, they actually first 65 years of age and older, they have 95% of the population fully vaccinated, we only have 80%. So we’re going to have more impact in the 65-year-old age group, but we have a lot of coverage there. And so I think that that’s where we’re going to see fewer deaths there.

Dr. Mike Osterholm

So the deaths will be up the ICU bed use is already up, we’re seeing that in the southern states. And some of them are actually outstripping the rate of growth for ICU beds for the same week of this previous surge that we saw last January. So if you’re in the fourth or fifth week of the surge already, they’ve basically surpassed the number of ICU beds, Louisiana is within a day or two of surpassing the most number of people ever hospitalized at any one given day for COVID 19. Even with a previous surgery, so those are going to happen, I just think deaths are going to be down, which is a great accomplishment with this vaccine.

Andy Slavitt  18:30

Absolutely. And with the visual you talked about this idea that, you know, we could have something that infects the same number of people, and many fewer people died. You know, we’ll provide a link to the graph to this great study. It’s probably hard. It’s probably hard for the listeners. We’ll post the link. I think it’s a great idea.

Andy Slavitt

Let’s talk about breakthrough cases. And then I want to talk about kids in school. Does anything you’re seeing the breakthrough cases, front concerning, surprise you?

Dr. Mike Osterholm

Well, obviously, the news of CDC is announcement yesterday and, you know, had been working with those same data with the White House for the weekend, showing the similar level of virus, or at least apparent similar level of virus in those who are vaccine breakthroughs or failures as those who are just unvaccinated is troubling, just because it adds another dimension to transmission. And of course, one of the motivating factors that we’ve laid out there for getting vaccinated, is you don’t have to worry about masks anymore. Now, I would think even if I had to continue masking the compelling data is the fact you have a lot less chance of dying, you have a lot less chance of being hospitalized and being seriously ill. But for some, the future of not having to wear a mask was an important issue. Now that’s changed again. So but on a whole, I don’t see the breakthrough cases, telling us much about the overall risk of disease, other than as we get further out, will it tell us anything about the waning immunity, but we’re already looking at that to begin with. So do you see more breakthrough? For example, the British data shows the number of breakthroughs increasing from two to four to six months and later, which just corresponds to waning immunity.

Andy Slavitt  20:54

Yeah, well, so bought Bourla, from Pfizer said that the 95%, drops off after two months to something like high 80s and drops off again, from there to four to six months, and then really begins drop off after six months. And I don’t know if that’s because of Delta, or if that was prior to Delta. But I asked him to go back and make the comparison of what he was seeing, to the clinical trial to people who are in the clinical trial. And he said it was pretty similar.

Dr. Mike Osterholm

Yeah, I think it probably is the case, I think the one thing that we’re not really clear on with Delta, is why we tend to see so many people in clusters being infected. And what I mean by that is we have examples of one person who transmits to 12 or 14 people who are previously vaccinated. That really speaks to me more of dose, and potentially that it’s not just that the vaccine is waning, but that there may be a point where you overwhelm the individual host with a higher dose. Now, that’s all speculative. And I could be totally wrong on that. But I can’t explain these clusters otherwise, I mean, if the vaccine is, you know, 90%-95% protective or if it’s even 80%, and is dropping with time, you should not see cases clustered like that, in big outbreaks. Interesting.

Andy Slavitt  22:23

Interesting. So someone’s becoming a super spreader. Somehow, when they get overwhelmed with the virus, which is, I don’t understand that myself.

Dr. Mike Osterholm 

I don’t know that. And in this case, you know, we actually had an outbreak reporting last week’s morbidity mortality report on P-1, or Gamma, in which a minor in a gold mine was infected. Asymptomatically infected, or at least very mildly ill, he had been vaccinated with mRNA vaccines as had the other miners. And a number of them came down with infection after exposure to this index patient. And, you know, again, why did you see such a large percentage of these miners get infected? I don’t understand that. So there’s something about this virus and this obviously is not Delta This is gamma or P-1, where the same thing happened, it was a huge cluster of cases that can be traced back to one source.

Andy Slavitt

Yeah, what I think, what Albert said is that in the third, you probably heard him say this, because he said publicly, that in the third boost, it creates 10x, the titers of the second dose. And I don’t know if this makes your point, though, to what you’re saying about dosage, or not. But there may be something that as we play with this in future years, we’re going to have to get right. I mean, I think the idea of people having to get boosts every six months, you given how little this public seems willing to put up with, feels pretty challenging. If that’s where we end up, do you to any reason, I think that’s where we’ll end up, or impossible to know.

Dr. Mike Osterholm  24:05

I don’t think we’ll end up there for one other reason. And that’s the moral equivalent of access. You know, unless we can provide the world with vaccines, I think we’re going to take a pretty big hit, even now looking at booster doses, where much of the rest of the world doesn’t have any at all. And that’s becoming a more I should say, apparent message or hearing. Now, if we can scale up production, and you know, I, again, have said to you, on numerous occasions, what you all did make the vaccine available as you did in the United States as quickly as you did is really been an amazing public health accomplishment. It has saved so many lives.

Dr. Mike Osterholm 

And I think the data are bearing that out right now with regard to the Delta surge we’re seeing, but if we can’t get vaccine to that 6.4 billion people who live in low- and middle-income countries We’re going to be challenged by, of course, more variants, because this thing’s gonna keep circulating there. And second of all, we’re going to be accused, I think of, you know, basically contributing to the demise of some of these countries and a large number of people, because we hoarded vaccine. And so I don’t know where that’s going to fall out, but it’s surely not going to just go quietly.

Andy Slavitt 

Let’s go to the Balmoral question in a second. But just to the to the other question. presuming you had an abundance of supply? We’ll go back to that question. Do you think it’s playing out in such a way that you think it isn’t every six-month regimen a once-a-year regimen? Could you tell?

Dr. Mike Osterholm

You know, I don’t know. And again, I’m not at Coronavirus, immunologist or biologist. But let me just say that there’s enough information here as we see just the evolution from the wild type to alpha to delta with you know, P-1 throwing in and so forth, that I don’t think we’re done yet with surprises with these variants. And what we don’t really understand yet is what could be the virus replaces Delta. But you’d have a hard time envisioning it had less of the ability to be transmitted, meaning it is not as efficient a transmission because how it then outpaced Delta. And you don’t know for a fact what is constant exposure to an immune population. Just remember, a year ago today, the world was much, much less acquainted with this virus. So when it infected you he was more likely it was being, it was infecting you, as a non-immune individual.

Dr. Mike Osterholm  26:49

Today, if it infects you, and you’ve already previously have immunity, like we’re seeing with breakthrough cases, that’s one thing, but also, we have more and more people who have had disease recovered, and now they’re being exposed to the virus is this in an ecological environment where we’re going to see the evolution of the virus in ways we didn’t see a year ago in terms of immune escapes in terms of what might happen that way. And we don’t know, now, some would argue is never going to happen. That’s, that’s just not going to happen. Others would say, you know, be more humble, we’re not quite sure what this virus is going to do as it continues to expose humans. And now, it’s basically expose humans who may very well have some level of protection.

Dr. Mike Osterholm

What’s concerning also is if you do have waning immunity as is being suggested, that would mean that you may end up hitting people with these viruses when they just have enough to have it, but not enough to basically protect themselves. That puts him at even higher risk for creating almost the kind of monoclonal antibody challenge we had earlier this year, when we saw, you know, people who were receiving certain monoclonal antibodies that may have actually helped breed some of the challenges we had with these viruses and evading immune protection. So I don’t know what’s going to happen. I think that this is a wide-open question yet what the new viruses are going to look like. I mean, I wish you and I could sit here today and say, boy, we know that on July 27, and July 28, and 2022. This is what the variant will be. I don’t think we have a clue yet.

Andy Slavitt  28:30

Yeah. Boy, I’d say what listening to you now, it sure feels like an oral antiviral. It would be nice.

Dr. Mike Osterholm 

If we had a small molecule oral antiviral, a pill. It could go a long, long ways. A long ways.

Andy Slavitt

It is I think I’ve talked about on the show before we’ve got trials going on, that we should be learning more about over the course of the fall. And you know, it again, I’d say it says just like with vaccines, none of these things are perfect. In the oral antiviral is just like everything else, hey, you got to take it. Be you got to know you got to know to take it and see they don’t not everything works as well in everybody. But you know that if you could just add to the confidence that this is less and less lethal, you face the next set of challenges or variants with another important tool in your arsenal.

Dr. Mike Osterholm 

I agree. And I think that this again, though, is where we have to have those creative imagination about what the world might look like in the future with COVID. I think I fear that there were far too many people who number one want us to be an Influenza pandemic. And I say that meaning that it was going to play out just like an Influenza pandemic after 16-18 months, the surges would and it would go into a seasonal virus. You’ve heard many of our colleagues say, oh, this is going to be a seasonal virus before long. Okay? I think the second thing is about the optimism, you know, And you’ve done a good job, you talked about this in your book. But basically, the psychology of this pandemic is equally a challenge, in many ways is the actual physical impact that is having. And, you know, I have to tell you, I mean, I actually had some of my news media colleagues who would say to me, in March, April, May, well, you know, you’re just too scary.

Dr. Mike Osterholm  30:26

People don’t want to hear from you anymore. You know, that kind of thing. And it was all I was saying is, what’s happening now is going to happen, something’s going to happen like that. We have to look at what’s been happening and how this virus is moved around the world. I mean, you got Iran it’s fifth surge right now. It’s fifth. You have Johannesburg. And it’s just as third major surge. And so I think that one of things we have to do is adjust to what is the new normal, everybody, I think, thought the new normal would be well, it’s over with is done. You know, I knew and I have, you know, share the views that we don’t want to declare mission accomplished, when it’s not. But that doesn’t mean we can’t celebrate; we’ve made great advances. But were not done with this virus by a longshot.

Andy Slavitt

That’s well said and look, in fact, in my book, there were some smart people who were informing what was going to come early on. And one of them was Mike, who’s in a fun part of the story, and certainly advised me, as I blurred all this time, I tried to learn what’s going on. And you continue to.

Andy Slavitt  32:04

Kids in the schools for a second if we could?

Dr. Mike Osterholm 


Andy Slavitt

So how do you feel about in person schooling, protections parents should take the key questions people have, what policies do you think there ought to be towards masking etc?

Dr. Mike Osterholm

This is a really tough one. And I say it’s tough, because I don’t have a good answer. But let me just lay out some conditions. First of all, we have to understand that much of the information has been collected and used for policymaking around schools, was largely collected last year before alpha ever arrived in this country. Back then we didn’t see nearly the same dynamic transmission we’re seeing now with this virus. And so the conclusions that were reached were correct last summer, last fall even. But they don’t hold today. When Alpha arrived, we saw that right here in Minnesota, how the changes begin to occur in school-based transmission, youth sports and how important they became in transmission. And now Delta’s only emphasize that.

Dr. Mike Osterholm

So while it has increased the transmission, from kid to kids, and with kids, I can’t say that we’ve seen an increase in severity of the illness, it’s just more kids are getting infected. And I worry about that. Because while the number of kids who have serious illnesses surely is very different than we see in adults, I mean, we’re still seeing the same number of kids die each year through the past year from COVID-19 that are about twice the level it expected a bad flu year. So it happens. One area, though, that I’m going to predict right now is going to become a real challenge is we’re seeing enough information now to support that anywhere from 15 to 20% of kids who have milder illness still go on and develop long COVID. And I don’t think we had understanding the pediatric population, the significance of that. Now take it to the transmission issue, where I think the challenge we have is that when kids get infected, now they transmit and they bring it home.

Dr. Mike Osterholm  34:20

And you know, as a grandparent of kids 11 to 4 years of age, I’m challenged by that, because I want to be my grandkids. Well think about all the family settings right now where kids can transmit. So I don’t think that we can just automatically assume that, you know, the kids are in an issue. They are real. So what are you doing in school? Well, because of the transmission issues, it’s hard to protect kids. You know, the CDC suggesting well, maybe they can even be just three feet apart, I think is just absolutely irresponsible. At the same time, how do you put kids in school if you put certain facecloth carbons on and we know facecloth coverings have limited ability to protect you. N95 respirators, a totally different discussion, their protection can be really very high. But it’s hard to do that with kids. And so I’m sitting here saying to myself, you know, I do understand the importance of education, I think it’s important to get kids in school.

Dr. Mike Osterholm 

But I think we have to also be honest, and just say, these are the data that say, one, there’s going to be transmission, like the summer camps we’re seeing right now in the summer, you know, people thought that was never going to be a problem. Now we’re seeing a rash of summer camp outbreaks. So we’ve got to acknowledge we’re going to have transmission and kids, I wish we had the vaccine for them now, we don’t, at least for those 11 and younger, and I don’t have an answer I wish I did. Parents just need to be aware of this information. It’s going to be very, very divisive. I can tell you right now, as you well know, the mask issue and kids is something that, you know, is a highly politically charged discussion on both sides. And all at the same time, I understand. You know, people want to get their kids back in school, and there are those that won’t send their kids to school, as long as they proceed, there’s some risk of COVID. And I don’t know how we bring it all together.

Andy Slavitt  36:16

I’m gonna make it personal, but feel free not to answer if it’s too personal. So someone who’s vaccinated, who has grandkids. Are you comfortable with them attending school in person with or without a mask? And then are you comfortable seeing them with or without a mask? This is a question that I know it’s the most challenging, but everybody’s facing it. So they really want to know what you think.

Dr. Mike Osterholm 

I’m confused, I’m drawn, you know, I, before the Delta data came out, I was seeing my grandkids, and I’ve still seen them outdoors, but I’m seeing them. And, you know, I understand their need and desire to go to school. Fortunately, we’ve not had any illnesses in our family yet. But I always worry that one day, I’m going to get a call and one of my grandkids is sick with Delta, and it’s not a good situation. And so I don’t know what to you got to live your life. I mean, we you know, if we use just absolute numbers, you’d never get in a car, you know, 38,000 people die a year in automobile accidents. That mean we don’t drive? No, but how do we internalize that with this new risk, this kind of foreign, almost Martian like risk is really hard to internalize. And that’s what I’m dealing with right now, myself.

Andy Slavitt

Yeah, we got to constantly recalculate. And it’s hard, because you said something that I think is earlier, super tricky, which is, we’re living 2021 using 2020 assumptions. And things have changed. And we’re not quite sure the ways they’ve changed. And so we have a lot of risks in life. There’s a lot of challenges in life. I moved to Southern California. Okay, the traffic here. It’s a challenge. It’s a challenge. But I don’t let it affect my life too much. I try to avoid rush hour. I try to, you know, have something to do when I’m in the car. I leave myself enough time. But it’s one of those unpleasant things in life. And we have a list of things in all our lives that are challenges. Some of them are challenges, because they’re minor threat, some of them are challenges, because there is some are challenges because they’re unpleasant.

Andy Slavitt  38:29

But, you know, we all do our very best to not let those things that become roadblocks, but just to become little speed bumps. And like to think that that’s exactly where we could place COVID if you get vaccinated, that jurists are low enough, that, you know, it’s not going to prevent you from seeing your grandchildren, because the chances of the rapid chain of events of them getting COVID, not knowing it, transmitting it to you, and someone who’s vaccinated. You know, there’s still a lot of things that would have to go wrong, and for that to become a serious case. But I don’t know, maybe that’s a rationalization.

Dr. Mike Osterholm

No, I think it is, I think, you know, again, we are going to be confronted with situations I happen to personally know situations where adult children have unintentionally, obviously infected their aging parents, because they thought that they were protected and they weren’t. And the guilt that goes with that can be extreme. And, you know, I know, personal events, weddings, where somebody came to the wedding was infected, didn’t realize it, but transmitted to a number of people at the wedding party. Were actually in that case, one of the grandfather’s died and so we are going to have these they’re going to be you know, relatively rare, I hope with that kind of death issue. But that also can be a challenge for families. If they think someone brought the virus, and it caused harm. Now, you can’t live your life for that. But you also have to be aware of it. That’s the kind of thing that’s going to happen.

Andy Slavitt  40:09

Right. Do you think we ought to have requirements from employers and government agencies and venues in schools and colleges, that people who are eligible be vaccinated, and if they’re not vaccinated, they take, show a negative test?

Dr. Mike Osterholm 

I am very strongly supported getting people vaccinated how we can within the legal constraints of doing that. I’ve been recently accused of being anti-vaccination by some because I’ve also nuanced that position. There are some admit, in fact, many settings, particularly in public venues, where the existing laws around mandatory vaccination mean that you have to offer people religious, medical and philosophical exemptions, that if you basically put a mandate in place today, you’ll definitely take all the people are not vaccinated and just drive them into a I’m not getting vaccinated. And then the question is, if they sign such a form, how do you, how do you ever get them back? And for the vaccine hostile that group that will never get vaccinated who don’t believe COVID is real, we’re not going to get them anyway, they’re going to sign the exemption for those who are vaccine affirmative, meaning they already want it, they got it, they drove 130 miles last February in a snowstorm to get it. Okay?

Dr. Mike Osterholm

And then that middle group, the vaccine hesitant pregnant women, young black men, I get on the list of groups that we see who have legitimate real questions. They’re not anti-vaccine. They’re not, it’s not some political ideology, for them they’re just concerned. And so I want to make sure we get those people. And if you have exemptions that will happen. If you don’t have exemptions, if you just own carte blanche the ability to say do it, then, you know, I think I’m there. I do feel it’s a moral imperative to have health care workers acts, and I think, for them to be in the business, they should be vaccinated.

Andy Slavitt  42:04

Got it. So what I’m talking about is do it with the only exemption being that you show a negative test, you get to go into work twice a week. Yeah. Because what I think the outcome we’re not looking for is your accident, the outcome we’re looking for is you’re not contagious.

Dr. Mike Osterholm 

Yeah, I you know, testing is good, but it’s not perfect. I mean, people flip through all the time. And, you know, I work with the NFL, and their efforts to minimize the impact of COVID. And they did a remarkable job last season, I thought they were incredible. And you saw recently, their new efforts, they’re basically upping the game, in terms of, if players and staff are not vaccinated, and they have to forfeit a game or they can’t play a game, they may had to forfeit and pay the opposing team a substantial amount of money to cover their costs. Well, that’s a real incentive to get vaccinated, particularly when the players won’t get paid for that game. And so I think there’s multiple ways to use the lever to make it happen. I’ve always been one that believes that honey works a lot better than vinegar. But in the end, it may be that you have to use vinegar too because of the fact that we can’t spend three years trying to convince people.

Andy Slavitt 

To really be fresh out of honey.

Dr. Mike Osterholm

Yeah, there you go.

Andy Slavitt

Well, as long as questions remain, you’re gonna remain a very busy man. And we got as many questions today, different ones, as we did a year ago. But there’s no question that  we haven’t shortened the list. But as I want to just with all of the challenges you talked about, I want to just come back to one thing that you said that probably the most important thing we could have wished for a year ago, which is if fewer people would be dying, you know that that is a gain. Hopefully, it’s a gain that we sustain, and build on and increase. Probably the most challenging part of all of it is probably less the science and more the social science and more of the human dynamic that we got to figure out. And you know, none of us have good answers. But all of us are accountable for trying to work on that.

Dr. Mike Osterholm  44:09

Well, I think you’re absolutely right. I think the one thing that people hopefully are beginning to understand we’re in this for the long haul. This isn’t one done and out. And I think that this past several months gave people the false sense of security that was happening with the pandemic was happening somewhere else, the pandemic was over in the United States, and it’s not. At the same time, we have done a great deal to minimize its impact. And I think from that perspective, that that’s great. Now we’ve got to try to do that same thing for the world. And that’s going to help us it’s going to help us a lot if we can shut down transmission of this virus everywhere in the world. We do ourselves a huge favor for our own vaccines.

Andy Slavitt

That’s right. 11 billion doses by the end of 2022. I think we got to beat on most of them. Not all of them, like we’re paying for most of them, we just got to get them out there. And you’re so right. That is I think, of all things we talked about today, we neglected to say, that’s probably the top priority, because if we’re sitting here in the US, we got small problems. If we were sitting in Indonesia right now, we’d be talking about a world of much more challenging problems. That’s right.

Dr. Mike Osterholm 

And you know, and I just want to thank you, by the way for the messaging you do. As you know, some of this message is tough. And it puts you in a place where you don’t always have all the friends you’d like to have. And you’ve not been shy from doing that. And I just, I want you to know that there are a number of us out there in the public health world that have appreciated your willingness to put yourself out there, to basically tell the truth about this pandemic, and what we can do about it.

Dr. Mike Osterholm

And most of all of what you did, you know, I have an inside view, I know what you did, during the course of the time you were at the White House to help move the whole vaccine availability along. And, you know, I don’t say this simply in whether your friends that can go at it at any time. So that I also understand the significance of this. But I can’t begin to even imagine how many lives you saved by just the work you did, to make sure that we had the vaccines we had. And I don’t think that story has been adequately told enough for those people who have been in the administration who did so much from, you know, January through February, May, to get us those vaccines.

Andy Slavitt  46:35

I appreciate that, you know, it was a massive amount of team effort, and so much more to do that it’s hard to focus on that. But I do appreciate you saying it, and I am, I am grateful for the President’s willingness to lead make tough decisions, not leave anyone behind, not sweep this under the rug. You know, I

Dr. Mike Osterholm 

You know, I have said with great respect, hopefully, it’s never taken as a negative comment. But I’ve often referred to him as the backstage or in chief. You know, I mean, you know, we we’ve not had a President like that, who has done such an amazing job of being out there and being on message in right, you know, factually right. And that’s really helped. Yeah, that’s an amazing gift to this country. And you I don’t care what your political ideology is, I don’t care what you think of him. He has been absolutely on message. And with the support that he’s provided to those programs, but nothing short of remarkable.

Andy Slavitt 

You know, it’s a seems like a small thing, but having a President who is hurting when any Americans hurting whether they voted for him or not. Hard times are hard, but if you feel like someone’s looking out for you and got your back, you feel some sense. You’re gonna get through it, I think. Yeah. And hopefully, that and execution, and yeah, thanks so much, man.

Dr. Mike Osterholm  48:05

Thank you. Thank you. Keep it up, man. Thank you. We need you.

Andy Slavitt  48:23

Okay, thanks to Mike Osterholm. Let me tell you about some of our upcoming show topics. First, we’re going to have a great episode on schools. Those episodes will be a toolkit, and we’re going to have the great Rich Corsi and the great pediatrician, scientist, vaccinologist, Peter Hotez, that will be great. We’re also going to have a session with some of the state governors to talk about how we are effectively managing to deal with vaccinations in states. That’ll be a pretty exciting episode. And then finally, we’ve got a great episode on how we vaccinate the globe. Coming up all three of those topics I think, will really help our understanding of what to do next. Anyway, enjoy the rest of this week. I look forward to chatting with you again on Monday.


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. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And 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, most importantly, please tell your friends to come listen and please stay safe, share some joy and we will get through this together.


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