As Minnesota’s former state epidemiologist, Michael Osterholm was on the front lines of the public health battles to track and contain outbreaks caused by influenza, E. coli O157, Staphylococcus aureus and other menacing pathogens.
Since leaving that post and joining the University of Minnesota, Osterholm has become a rock star in his numbers-driven, normally under-the-radar scientific specialty. When infections strike around the world, he’s often one of the first phone calls for expert assistance made by nations that find themselves at the epicenter. That consulting role has given him a front-row view of the global threat posed by emerging viruses, bacteria and the mysterious proteins called prions linked to mad cow disease and, closer to home, chronic wasting disease in deer.
No one can say that Osterholm didn’t warn us about pandemics and the need to prepare for them. In his 2017 book “Deadliest Enemy: Our War Against Killer Germs,” he and co-author Mark Olshaker walk readers through a rogue’s gallery of infectious agents and their potential to wreak havoc on public health and the world’s economies.
The book’s chapter on MERS and SARS is particularly prescient. These diseases are caused by coronaviruses, the same viral family now fueling the COVID-19 pandemic. Three years before this current crisis, Osterholm sounded the alarm on coronavirus diseases’ disturbing combination — they have a relatively high mortality rate and can spread rapidly in humans. SARS and MERS outbreaks in the last 20 years did not go global, but they were truly were “harbingers of things to come,” as the book states in bold type.
As we grapple with COVID-19, it’s reassuring to hear Osterholm’s familiar voice even if he doesn’t sugarcoat what we need to know. The conversation, edited for length and clarity and abbreviated by the demands on his time, kicked off with a question. The energetic and effusive Osterholm ran with it from there.
Q. Your book came out in 2017 warning us about the very real threat of a pandemic, with emphasis on diseases such as SARS and MERS caused by coronaviruses. Long before that, you were warning us to take a pandemic threat very seriously. Yet it’s been three months since we saw this gather force in China, and we’re scrambling as a nation. Why has it been so hard for people, both in government and just regular citizens, to take this health threat seriously?
A. I think two things: One is, we had almost this sense of invincibility that we had a border that would not allow such infectious-disease agents to penetrate … . We, of course, know that is folly. A microbe anywhere in the world today can be anywhere in the world tomorrow.
The second thing was, we tend to lack creative imagination unless it’s something about a video game or a movie. None of this was really that difficult. It was pretty straightforward right in front of us. People who knew health care knew that health care [had been] carved down to the bone for which there was no resiliency of any substantial nature, no excess capacity, no monies to stockpile large volumes of protective equipment.
[There has been] no real understanding of the vulnerability of this country outsourcing all of its drug supply manufacturing to places like China. And when you don’t understand all that, or elect to neglect it, it’s easy to say another day went by and nothing happened.
I was asked often, what’s the chance of this really happening? I would always reply back, “It is going to happen. I just don’t know if it’s going to be on my watch.”
And it was a hard thing to understand. I think it’s human nature to not want to believe this. Even looking at the leadership in this White House, [they] didn’t believe it for many weeks that this was coming. We sent out a notification [in January]. I do these updates for our group, called the CIDRAP leadership forum — it’s a group of organizations we advise. I said, “I now am absolutely convinced this is going to be a pandemic. This will be a worldwide epidemic. We will see major transmission around the world. And what has happened in Wuhan will happen in other places.”
But even then, people were somehow wanting to believe this was a low-risk situation. That was one of the things that was hard for me, too, continually hearing from Washington, from the administration, [that] this was low-risk. And my sense of what “low-risk” meant was “Don’t worry about it.” I’m sitting here saying, “no, no, no.” This to me was the equivalent of someone standing on a beach, a beautiful sand beach on the Gulf, beautiful blue skies, not a cloud in the sky — but 500 miles south of there is the biggest low-pressure system we’ve ever seen. We should have been telling people back then, this is going to be like a Category 5 hurricane, and instead we kept telling people it’s low-risk.
So even as late as it sitting on our doorstep, people didn’t take it seriously. It was that latter part that was almost more frustrating, because we had enough evidence to say this is for real. And you can’t know how many people said to me overall even when it was in China, “Well, that’s in China.”
People just didn’t understand these viruses don’t adhere to political boundaries — geographic areas are just another place for them to go.
Q. We’re in the midst of ramping up community mitigation here in Minnesota. What else will need to be done that we haven’t seen so far?
A. We’ve been dealing a lot with Minnesotans in terms of what’s going on inside their head. But we have not done a good job of dealing with what’s going on inside their hearts. I think that again I can’t imagine a more compassionate and empathetic [health] commissioner than Jan Malcolm. She’s incredible. Nobody is better prepared.
One of the things I’m trying to do is message about the fact that we can’t shelter in place for 18 months. This isn’t going to work. How are we going to start dealing with both the hearts and the heads of the citizens of this country, and for that matter the world? And, we have to understand it’s going to be more than just giving them factual data or information. This is where leadership is really key. It’s important we don’t forget this piece.
Q. So in terms of closures that we haven’t seen, should we expect regional quarantines or cities cordoned off? Is that coming?
A. We’ve got to change all this. I’m trying to change the discussion. We can’t keep this suppressed. We’ve got to find a way to thread this huge rope through a little tiny needle. I’ll be damned if I’m not going to try to do that. One of the messages we have to give is getting people back to the middle. We have to say, “What are we trying to accomplish here?” We don’t have a national goal. What’s our goal? Is it to prevent everybody from getting infected? Is it to prevent people from being in the hospital? Is it to keep the economy at least viable? We don’t have a goal. That’s one of the challenges at the national level. And I’m tired of hearing people say, “We’ll do everything even if we overreact.”
I don’t know what that means. And so one of the things I’m trying to drive … is saying we need to think about what we might see when we loosen up society again, knowing that transmission will occur.
[At that point], we make every effort to … protect those most vulnerable. And we continue to emphasize social distancing, all the things that happen there. We don’t want people to be isolated … [but we have to] keep the hospitals from being overrun. We keep doing that until we get a vaccine.
It won’t be perfect. Some people will get sick, some may die. But it’s a way to get us to a place where [we can live with COVID-19].
Q. When will we return to normalcy?
A. I have no pretenses about what will ultimately happen. I get asked this all the time. I say straight-faced [that] we will never ever go back to normal. We will have a new normal, just as airplane flights took on a new normal after 9/11. I think that’s where we can thread that rope, to try to get there. At the same time, we also want to do what we can to help people psychologically work through this. This is really tough.
I get asked multiple times a day by the media: Aren’t you afraid you’re going to panic everybody talking about what you talk about? My first reaction is: You know what? The only people to talk about panic are the media. Have you seen anybody out rioting in the streets or burning cars or hurting people? Have you even seen one fight that occurred in a store over the last roll of toilet paper? I haven’t seen that. People are really concerned. They’re scared … but they’re not panicking. They want straight talk. They just want you to tell it to them, what you know and what you don’t know.
We just need to tell the truth. I worry that the truth is being lost in the politics of the moment, and I must say that’s not true in Minnesota … . You know me well enough to know that I’m not a partisan. I am very impressed with [Minnesota Gov.] Tim Walz and how he was worked with the commissioner and the state Health Department and made an attempt to reach out. He’s talked to all the former governors. He’s communicated with both sides of the aisle. He’s been forthright about what they’re trying to do. And that’s what we need. We need the straight-talk express right now.
Q. Do you want to say anything more about where things are being lost in the politics of the moment?
A. I think at the White House — I know this will be taken by a segment of the Minnesota population as I’m being partisan. I’m not. You can’t go from “It’s not a problem” to “It’s war” in two weeks without everyone understanding how you got there and what it means. When [they said this week] that the government can go in and take over these companies and make sure everything you need is going to be produced … that couldn’t be farther from the truth. Couldn’t be farther.
First of all, the companies that could be making protective equipment and ventilators have been going nonstop for weeks and weeks well before the U.S. government showed any interest in that, OK? Number two, is the fact that even if you were going to try to boost up the capability of manufacturing, you just don’t do this overnight. You can’t turn a mousetrap into a cathedral overnight … . Just think about after the Pacific fleet was largely destroyed in Pearl Harbor [in World War II]. It took us 38 months before we restored the Pacific Fleet. I just want people to understand there’s not some magic that’s going to happen because of this change in what’s there.
Yesterday, when the secretary of defense and I were on CNN together with Jake Tapper, the secretary very proudly talked about having donated 2 million N95 [masks] for health care workers. That’s a great thing. But the White House led you to believe that this was a big problem-solver. We’re still about 300 million short of what we need. I welcome every little donation but that’s where I think we just need the honesty.
Q. Is there a reduction in case numbers, or are there other metrics, that would signal when we as a society can “loosen up”?
A. I think we have to figure out where we can loosen up relative to what the data is. [A recent British scientific paper] said crowd size really makes no difference. We really have no data on crowd size. Their modeling says we have to have contact … that if you shook hands with all 50,000 people in an arena, you got a problem. But if you didn’t, the risk of transmission is not nearly as great as people think it is. We also don’t have good data that we have major transmission in schools from kids to kids and that they take it home to Mom and Dad.
We just need to think clearly. We’ve got to stop playing this like I play checkers with my 10-year-old grandson. We’ve got to start playing like chessmaster, who thinks 10 to 15 moves down the board with every move. We’re not doing that. That’s what will help us understand when we can free things up. This one makes a difference, this one doesn’t. This is what we need to be thinking about.
Q. Do you have any sense for when we can send kids back to school?
A. I think we can have that discussion right now. Look at how Singapore and Hong Kong approached this. Clearly they have the ability to do something that most other countries do not. But the bottom line is that Singapore did not close schools. Hong Kong did. We saw no difference. And you know me. You know I would pull the trigger in a heartbeat if I thought this was going to make a difference. I do know it makes a difference in saving lives in a hospital when you take out 20% of nurses, doctors, respiratory therapists who can’t work because they’re at home [to watch their kids]. I know that is a risk in putting grandparents in so that some can keep working. That I know. That’s why we need to have these discussions.
Q. Are you hopeful about new potential treatments for COVID-19, such as chloroquine, that are being studied right now?
A. I am hopeful, but hope is not a strategy.
Michael T. Osterholm is a public health professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Jill Burcum has worked for the Star Tribune since 1998 and joined the Editorial Board in 2008. She was a 2015 Pulitzer Prize finalist for editorial writing. She previously worked for Mayo Clinic and for ICAN, a startup founded by Osterholm.