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Infectious Disease Epidemiologist
Offers Key Points To Consider About COVID-19 In Extensive USA Today
Interview
Michael Osterholm,
the epidemiologist director of the Center for Infectious Disease
Research and Policy at the University of Minnesota is a frequent
spokesperson on television and in other media on topics related to the
COVID-19 pandemic.
Osterholm prides
himself in offering what he calls “straight talk” about the pandemic
and he often has a different perspective on current events in
epidemiology.
He was interviewed in
mid-May by the Editorial Board at USA Today and provided answers to a
long list of questions. Many of his answers offered useful metaphors
and insightful points to consider about the pandemic. Some of these
useful metaphors and points to consider are described below, including
selected excerpts from the interview.
Seasonality
One of the questions
on everyone’s mind is whether or not COVID-19 will manifest a marked
seasonality this coming summer as does influenza virus and other
respiratory illnesses. If it does, we assume this will give everyone a
breather and will be welcome news. Not Osterholm. He told USA Today
“Right now the thing that scares me more than anything is that
suddenly, in the next two months, cases in the US suddenly drop off
dramatically… It would give people a premature sense of euphoria… but
to me it would look a lot better if we kept in this slow burn…If we
have a big fall peak, it’ll redefine us as we are as a modern
society.”
Danger of a Second
Wave
To better explain his
concern about the danger from a second wave next fall, Osterholm
indicated that in most areas of the country the estimated percentage
of persons with a history of COVID-19 is in the single digit range.
Unfortunately, population level or herd immunity will have to reach
60-70% in the opinion of most experts before the US is protected from
large numbers of infections.
According to Osterholm,
“Think what we have to go through. This damn virus is going to keep
going until it affects everybody that it possibly can.”
Leadership & Plan
Missing
One of the themes that
has been struck by Osterholm over and over again in his many
interactions with the media is the question of leadership and another
is the lack of a coordinated plan.
He told USA Today, “I
have a major, major concern about leadership right now. We’re not
where we need to be, either from an execution standpoint or
understanding the problem. We’re just in the second inning of a
nine-inning game…My job is not to scare people out of their wits, it’s
to scare them into their wits.”
Tradeoffs
A major tension
throughout the pandemic has been the tradeoff between the public
health benefits of control measures and the benefits of maintaining
the economy. According to Osterholm, “This shouldn’t be dollars or
lives. This should be, how do we integrate both and bring them
together? How do we make tough choices? That’s not happening. That’s
leadership again…It’s not a partisan issue. It shouldn’t be.” He adds,
“We’ve been out there trying to get this discussion going, and it just
falls on deaf ears because it’s too hard.”
Lack of Readiness
One of the perplexing
elements of what has taken place in the decision of many states to
loosen their social distancing measures is that they have done so
without having in place the testing, tracing, and tracking
infrastructure that public health officials have been saying the US
will need if it is to effectively contain new cases as they emerge
after a decline in cases takes place.
Osterholm notes in his
interview that “Four weeks ago we had everybody agreeing that we’re
going to reopen once we have 14 days of reduced occurrence of illness.
Then, when it got another couple of weeks along and that wasn’t
happening, we just threw all that out the window without ever saying
we did.”
Riding the Tiger
When it comes to
controlling the pandemic, the point is often made that because
SARS-CoV-2 is a new virus, there is no easy way out of this challenge
short of developing a safe and effective vaccine. Osterholm makes this
point about the difficulty of controlling the situation by saying
“…we’re not driving this tiger, we’re riding it…We are not going to
determine the course of this pandemic beyond potentially flattening
some of the peaks or in some ways limiting high-risk people from
potentially getting infected and having bad outcomes.”
Contact Tracing Not A
Panacea
Osterholm is one of
the few epidemiology commentators to point out the difficulties of
implementing the much touted contact tracing that will need to be done
effectively to contain cases. That’s because contact tracing only
works when you have a relatively small and manageable number of cases.
According to Osterholm, “Once you see a big escalation in cases,
you’ll be having contacts by the many thousands and thousands and
thousands, and it’s just not going to work…It’s not a panacea.”
A recent report
documenting that a new vaccine being developed by Moderna has shown an
immune response similar to that of persons who have recovered from
COVID-19 is good news on the vaccine front. There are multiple
scientific challenges that will need to be overcome to successfully
create and test a safe and effective vaccine. However, there are also
many ethical and practical issues that will need to be addressed.
According to Osterholm,
we have no plan in place for what to do once a vaccine is in hand.
“What if the Chinese get the vaccine first? What if we get it first?
Will we share it with anybody? Boy, I’m going to tell you right now,
the answer I’m getting out of this administration is “hell no”. Well
then, why would the Chinese want to share a vaccine with us? Why would
the Europeans want to share vaccine?...We don’t have enough of a way
of sharing.”
D-Day Like Plan
Needed
He adds using another
analogy, “If
there was ever a time that we need to have a unified response plan,
and I know this sounds trite, I liken it to D-Day. I want my
Eisenhower right now with every allied country around the table and
when Ike calls it, it goes. That's what we need right now. We need a
D-Day plan. We don't have it.
I
worry we're going to have all these different countries marching to
their own drummer. To me, that's the biggest challenge that nobody is
talking about. The R&D is huge. Safety is huge. But in the end the
biggest tragedy would be to have a vaccine and not be able to get it
used in the way it should be used.”
To read the interview
in full, visit:
https://bit.ly/2XoXMy2 ■
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