#436 — A Crisis of Trust
In this episode of Making Sense, epidemiologist Michael Osterholm shares insights from his five-decade career studying infectious diseases and his involvement in the COVID-19 response. Drawing from his experience advising U.S. presidents since the Reagan administration, Osterholm explains how early pandemic warnings were communicated and discusses key findings about COVID-19's airborne transmission that shaped public health measures.
The conversation covers critical mistakes in pandemic response, including the approach to lockdowns and delayed recognition of aerosol spread. Osterholm also addresses the development of mRNA vaccines and outlines necessary preparations for future pandemic threats, particularly concerning newly identified coronaviruses that could combine COVID-19's infectivity with higher mortality rates. The discussion highlights the importance of improved respiratory protection, ventilation systems, and science communication strategies.
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1-Page Summary
Osterholm's Background and Expertise as an Epidemiologist
Michael Osterholm brings over 50 years of experience in infectious disease epidemiology, split between academia and public health service. Since the Reagan administration, he has advised every U.S. president on infectious diseases, served as a State Department science envoy, and participated in the Biden-Harris transition team. His extensive work includes responding to major outbreaks like SARS, MERS, and HIV/AIDS, and he authored prescient books predicting the devastating impact of a future pandemic.
Early Warnings and Messaging About the Covid-19 Pandemic
While Osterholm and his team initially believed Covid-19 could be controlled like previous coronavirus outbreaks, they quickly recognized its unique threat due to high infectivity. By January 20, 2020, Osterholm declared it would become a pandemic, and in March 2020, he accurately predicted approximately 800,000 U.S. deaths over the following 18 months. However, his science-based communications faced challenges in a politically divided and fragmented media landscape.
Covid-19 Transmission Science: Airborne/Aerosol Spread Importance
Osterholm explains the crucial distinction between droplet transmission, where particles fall within six to eight feet, and airborne/aerosol transmission, where smaller particles can remain suspended and travel across rooms. This understanding was critical, as initial resistance to acknowledging Covid-19's airborne transmission led to ineffective "hygiene theater" measures like plexiglass barriers. Osterholm advocates for investing in more comfortable and effective masks for future pandemic preparedness.
Lessons and Mistakes in Covid-19 Response
Osterholm identifies several key mistakes in the pandemic response. Instead of prolonged lockdowns, he had advocated for a temporary "snow day" approach to prevent healthcare system overflow. While praising mRNA vaccines as a remarkable achievement, he notes that messaging and distribution could have been better. Additionally, he points to the delayed acknowledgment of airborne transmission as a critical misstep that hampered effective prevention measures.
Preparing For A Potentially More Deadly Future Pandemic
Osterholm warns of newly identified coronaviruses that combine Covid-19's high infectivity with the higher fatality rates of SARS and MERS. To prepare for this potential "big one," he emphasizes the need for improved respiratory protection, better air quality and ventilation systems, and more effective science communication strategies based on lessons learned from Covid-19.
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Actionables
- You can create a personalized pandemic preparedness kit that includes high-quality masks and hand sanitizers, ensuring you're ready for any future outbreaks. By selecting masks that are both comfortable and effective, you'll be more likely to wear them consistently. Consider masks with adjustable straps and filters that can be replaced, and pair them with small bottles of hand sanitizer that can be easily carried in a bag or pocket.
- Develop a habit of regularly checking air quality in your living and working spaces using an affordable air quality monitor. This will help you become more aware of the air you breathe and take proactive steps to improve ventilation, such as opening windows or using air purifiers with HEPA filters, which can reduce the risk of airborne transmission of viruses.
- Educate yourself on the differences between droplet and airborne transmission by reading accessible scientific articles or watching educational videos. This knowledge will empower you to make informed decisions about when and where to wear masks, how to interact safely in various environments, and what measures to take to protect yourself and others during respiratory disease outbreaks.
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Osterholm's Background and Expertise as an Epidemiologist
Michael Osterholm is a celebrated figure in the field of epidemiology, bringing over five decades of dedicated experience to bear on some of the most challenging infectious disease crises the world has faced.
Osterholm's 50+ Years in Infectious Disease Epidemiology and Pandemic Preparedness
Osterholm's impressive career spans 50 years, with 25 years of service shared between academia and a state health department, followed by a 25-year tenure exclusively at the University of Minnesota.
Osterholm Aspired to Be a "Medical Detective," Studying Infectious Disease Epidemiology, and Working At the Minnesota Department of Health and University of Minnesota
Since the seventh grade, Osterholm dreamed of becoming a "medical detective," a passion ignited by reading medical mysteries in The New Yorker. This fascination led him to the University of Minnesota, where he pursued graduate studies in infectious disease epidemiology while concurrently working at the Minnesota Department of Health.
Osterholm: Advisor on Infectious Disease, State Dept. Science Envoy, Biden-Harris Transition Team Member
Throughout his illustrious career, Osterholm has advised every U.S. presidential administration since Ronald Reagan's presidency, where he played a substantial role in addressing the HIV/AIDS epidemic during the 1980s. His contributions have also extended to the global stage; he acted as a science envoy for the State Department focusing on pandemic preparedness under the Trump administration in 2017-18 and took part in the Biden-Harris transition team.
Osterholm's Experience: Responding To Sars, Mers, and Hiv/Aids Outbreaks, and Publishing On Future Pandemics
Osterholm is an accomplished author, with a body of work that includes the prescient book "Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe" and "Deadliest Enemies: Our War Against Killer Germs," in which he eerily pr ...
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Osterholm's Background and Expertise as an Epidemiologist
Additional Materials
Clarifications
- Osterholm advised the Royal family of the United Arab Emirates on MERS, which stands for Middle East Respiratory Syndrome. MERS is a viral respiratory illness caused by a coronavirus. His expertise was sought after due to his extensive experience in infectious disease epidemiology and pandemic preparedness.
- During the MERS outbreak in the Arabian Peninsula, Michael Osterholm conducted fieldwork and investigations in the region to study the spread and impact of the virus firsthand. This involved working closely with local health authorities, healthcare professionals, and affected communities to gather crucial data and insights. Osterholm's on-the-ground efforts aimed to contribute to the understanding of the outbreak dynamics and inform response strategies to contain and mitigate the spread of the Middle East Respiratory Syndrome (MERS ...
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Early Warnings and Messaging About the Covid-19 Pandemic
Osterholm's experience with SARS and MERS led to a belief that Covid-19 could initially be controlled, but he quickly realized its potential for severity and faced challenges in communicating its dangers due to a fragmented and politicized information landscape.
Osterholm's Team Initially Thought Covid-19 Could Be Controlled Like Previous Coronavirus Outbreaks
Osterholm and his team leveraged their extensive background in dealing with previous coronavirus outbreaks and began analyzing the situation in Wuhan as early as December 30, 2019. Aware that it was not an influenza virus, they initially believed Covid-19 could be controlled similarly to SARS and MERS.
Osterholm Quickly Saw Covid-19's Higher Infectivity, Unlike Sars and Mers, and Warned Early About the Pandemic's Severity Potential
Osterholm's understanding of Covid-19's traits evolved rapidly. While SARS in 2003 and MERS in 2012 were not very infectious and had high death rates, Covid-19 proved to be highly infectious with a lower fatality rate. Osterholm recognized the distinct possibility of airborne aerosol transmission of Covid-19, observing people becoming infected from a distance and without awareness of their infectious state. This realization led him to adjust his initial perspective on containment.
Osterholm Faced Skepticism Despite Accurate Covid-19 Death Toll Predictions
By January 20, 2020, Osterholm declared Covid-19 to be the next pandemic. His warning was met with reluctance from many who found it challenging to accept such a dire prediction. During a March 10, 2020 appearance on the Joe Rogan show, Osterholm projected approx ...
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Early Warnings and Messaging About the Covid-19 Pandemic
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Counterarguments
- It's possible that Osterholm's initial belief that Covid-19 could be controlled like SARS and MERS was based on early data that was later understood to be incomplete or inaccurate, which is a common challenge in the face of emerging infectious diseases.
- While Osterholm did realize the higher infectivity and potential severity of Covid-19, others in the scientific community also recognized these factors independently, suggesting that this was not a unique insight but rather a shared understanding as the data became available.
- Predicting death tolls in a pandemic involves a range of epidemiological models and assumptions, and while Osterholm's predictions were close to the actual outcomes, other experts made different predictions that could have been based on varying models or assumptions about the virus's behavior and the effectiveness of public health interventions.
- The assertion that the fragmented ...
Actionables
- You can enhance your critical thinking by comparing initial assumptions with evolving data on current events. When you hear about a new health crisis or any significant event, start a journal to record your initial thoughts and predictions. As the situation develops, regularly update your journal with new information and reflect on how your understanding has changed. This practice will help you recognize patterns in how events unfold and improve your ability to anticipate future developments.
- Develop a habit of seeking diverse perspectives to counteract misinformation. Create a list of credible sources across the political and scientific spectrum and make it a routine to consult these sources when evaluating new information. This approach will help you build a more nuanced understanding of complex issues, like a pandemic, and avoid the pitfalls of a fragmented information landscape.
- Practice communicating compl ...
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Covid-19 Transmission Science: Airborne/Aerosol Spread Importance
Michael Osterholm discusses the critical differences between droplet transmission and airborne/aerosol transmission of respiratory viruses, highlighting the importance of acknowledging airborne spread in Covid-19 prevention efforts.
Droplet vs. Airborne/Aerosol Transmission of Respiratory Viruses: Key to Effective Prevention
Droplet Transmission: Larger Respiratory Particles Fall Quickly, While Airborne/Aerosol Transmission Involves Smaller Particles That Remain Suspended Longer
Osterholm explains that droplet transmission involves large respiratory droplets that fall to the ground within six to eight feet, meaning someone 20 feet away in the same room typically would not be exposed. Conversely, airborne/aerosol transmission is characterized by finer particles that can cover much of a room and stay airborne, traveling great distances.
Resistance To Acknowledging Airborne Covid-19 Transmission Led to Ineffective "Hygiene Theater" Like Plexiglass Barriers
The conversation shifts to initial resistance in admitting Covid-19's aerosol spread, resulting in ineffective prevention measures. Osterholm points out that a significant number of people still do not believe in airborne transmission, influencing the prevention methods for Covid-19. Sam Harris mentions that barriers such as plexiglass would not stop an aerosol-based virus, referring to such measures as "hygiene theater."
Osterholm criticizes these theatrical measures, particularly the reliance on plexiglass barriers that did not offer real protection against airborne respiratory viruses.
Osterholm: Prioritize Investing In More Com ...
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Covid-19 Transmission Science: Airborne/Aerosol Spread Importance
Additional Materials
Clarifications
- Droplet transmission involves larger respiratory droplets that fall to the ground within a short distance, typically within six to eight feet. Airborne/aerosol transmission involves smaller particles that can remain suspended in the air for longer periods and travel greater distances. Understanding this distinction is crucial for implementing effective prevention strategies against respiratory viruses like Covid-19.
- Resistance to acknowledging airborne Covid-19 transmission stemmed from initial beliefs that the virus primarily spread through larger droplets, leading to delayed recognition of the role of smaller aerosols in transmission. This resistance resulted in the implementation of measures like plexiglass barriers, which were ineffective against airborne transmission. Overcoming this resistance was crucial for adopting more appropriate preventive strategies, such as emphasizing the importance of ventilation and wearing masks to mitigate the risk of airborne spread.
- "Hygiene theater" is a term used to describe the implementation of visible hygiene measures that may not be effective in preventing the spread of airborne diseases like Covid-19. This concept criticizes actions like installing plexiglass barriers as a form of security theater rather than implementing more impactful preventive measures. The term suggests that these visible actions, while they may make people feel safer, do not address the actual modes of transmission effectively. In the context of Covid-19, "hygiene theater" highlights the importance of focusing on measures that specifically target airborne transmission, such as improving ventilation and wearing appropriate masks.
- Plexiglass barriers were criticized for their limited effectiveness in preventing the spread of airborne viruses like Covid-19. These barriers were initially imple ...
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Lessons and Mistakes in Covid-19 Response
The conversation around the Covid-19 response brings to light several lessons and mistakes, as analyzed by epidemiologist Michael Osterholm. He discusses the over-reliance on lockdowns, issues in vaccine messaging and distribution, and the detrimental delay in acknowledging the virus's airborne transmission.
Osterholm's Covid-19 Response Mistakes: 1) Over-Reliance on Lockdowns, 2) Vaccine Messaging & Distribution Issues, 3) Poor Airborne Virus Communication
Osterholm Suggested a Temporary "Snow Day" Approach to Ease Hospital Strain
Osterholm, writing in early March of 2020 for the Washington Post, advised against prolonged lockdowns. He argued they would likely be unsustainable over the duration of the pandemic. Instead, he proposed a "snow day" approach during the early pandemic phase, when there were no vaccines and limited drug options. The core of this strategy was to temporarily close public events and possibly schools, on a voluntary basis, to prevent healthcare systems from reaching capacity and ensure the provision of supportive medical care, thereby keeping mortality rates as low as possible.
Effective mRNA Vaccines Were a Remarkable Achievement, but Osterholm Believes Messaging and Distribution Could Improve
The development of effective mRNA vaccines has been hailed as a remarkable scientific achievement. However, Osterholm suggests that their impact could have been maximized with improved messaging and distribution strategies. By enhancing communication around vaccine availability and efficacy, a broader acceptance of the vaccine could potentially have be ...
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Lessons and Mistakes in Covid-19 Response
Additional Materials
Counterarguments
- Lockdowns were a complex response tool that many public health experts and governments believed were necessary to control the spread of the virus, especially in the absence of vaccines and effective treatments early in the pandemic. They were part of a suite of measures intended to reduce transmission, and their use varied widely across different countries and contexts.
- Vaccine messaging and distribution faced unprecedented challenges, including combating misinformation, logistical hurdles, and vaccine hesitancy. Some argue that given the circumstances, the rollout was as effective as could be reasonably expected.
- The understanding of Covid-19's transmission evolved over time, and public health agencies like the WHO and CDC had to balance the urgency of the situation with the need for scientific rigor. Some experts contend that caution in communication was warranted given the changing landscape of evidence.
- The "snow day" approach, while aimed at reducing strain on hospitals, may not have been sufficient to control the spread of the virus, given its high transmissibility and the later discovery of asymptomatic spread.
- Despite the challenges in vaccine messaging and dis ...
Actionables
- You can create a personal "snow day" plan to minimize your exposure during peak illness seasons, similar to how schools plan for snow days. Start by identifying local health trends and forecasts, then establish a set of criteria for when to work from home, avoid crowded places, or wear masks to reduce your risk of getting sick. For example, if flu cases spike in your area, you might decide to telecommute for a week to avoid the increased risk of transmission.
- Develop a habit of staying informed about health protection strategies beyond mainstream advice by following diverse sources. This could involve subscribing to newsletters from international health organizations, following experts on social media who specialize in infectious diseases, or joining online forums that discuss the latest research. By doing so, you'll be more likely to learn about protective measures like the importance of ventilation for airborne diseases, which you can then apply in your own environment by ensuring good air circulation at home and in the workplace.
- Volunteer to assist with loc ...
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Preparing For A Potentially More Deadly Future Pandemic
Osterholm warns of new zoonotic coronaviruses that combine the high infectiousness of COVID-19 with the deadlier fatality rates of SARS and MERS.
Osterholm Warns New Zoonotic Coronaviruses Have Covid-19's High Infectiousness With Sars and Mers's Higher Fatality Rates
Osterholm has identified new coronaviruses in the wild that are highly infectious like COVID-19 but have the potential to kill at rates similar to SARS and MERS. He explains that these new pathogens carry both the genetic makeup that allows for rapid spread and the genetic components that could lead to severe mortality.
"Preparedness Crucial for Catastrophic 'Big one' Event"
Emphasizing the gravity of the situation, Osterholm speaks of the essential need for preparedness against what he calls the "big one," a future pandemic event that may result in a higher case fatality rate than what was seen with COVID-19.
Preparedness Priorities: Invest In Respiratory Protection, Improve Air Quality and Ventilation, and Learn From Covid-19 Response to Communicate Science Effectively
In a discussion with Sam Harris, Osterholm emphasizes the necessity for advances in respiratory protection, such as the development of masks that are easier ...
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Preparing For A Potentially More Deadly Future Pandemic
Additional Materials
Clarifications
- Zoonotic coronaviruses are viruses that can be transmitted between animals and humans. These viruses have the potential to cause diseases in both animals and humans, leading to outbreaks and sometimes pandemics. Understanding zoonotic coronaviruses is crucial for predicting and preparing for future infectious disease threats.
- The case fatality rate (CFR) is the proportion of diagnosed individuals with a specific disease who die from it. It is expressed as a percentage and is a measure of disease severity. Unlike mortality rate, CFR focuses solely on the outcome of diagnosed cases, without considering the entire population or time factors. It is a critical metric in assessing the lethality of a disease and can vary based on treatments and disease characteristics.
- An N95 mask is a type of respirator that ...
Counterarguments
- The prediction of new zoonotic coronaviruses with higher fatality rates is speculative and may not materialize, as virus evolution is unpredictable and does not always lead to increased virulence.
- While preparedness is important, the specific nature of future threats is uncertain, and resources may be better spent on broad-spectrum public health improvements rather than focusing on specific scenarios.
- Investments in respiratory protection and ventilation improvements, while potentially beneficial, must be balanced against other public health priorities and resource constraints.
- Learning from the COVID-19 response is critical, but it is also important to recognize that ...
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