Straight answers on Covid 19

All performers know their most valuable asset is good health. In the current pandemic, this is a paramount concern. Please inform yourself regarding what we do and do not know at this moment in time. Stay well, and know we will get through this. Many thanks to SongSalon hostess, Leslie Giammanco, for sharing this informative article.

By Dan Buettner, Blue Zones Founder

We’ve been told alternatively to not wear masks, to wear masks, to stay home, and

to get out and reinvigorate the economy. Hydroxychloroquine and remdesivir both

got our hopes up but now have largely fizzled. We’ve heard estimates that as many

as two million Americans will die and now, with 100,000 deaths, we’ve heard we’re

near the end of the crisis. Is a vaccination forthcoming? How likely we to get the

disease? What exactly should we do with our aging parents who are at the most

risk?

To get some clear answers, I called Michael Osterholm, PhD, MPH, an internationally

known expert in infectious disease epidemiology who has advised both Democratic

and Republican Presidents. I know Dr. Osterholm from the University of Minnesota. He serves as Director of the Center for Infectious Disease Research and Policy. He has also served as interim Director of the Centers for Disease Control.

In short, Dr. Osterholm is arguably one of the most dependable, non-political

sources for straight answers on what COVID-19 means to us and our world in the

immediate future. In his 2017 book, Deadliest Enemy, he correctly foretells a global

pandemic and offers the best strategy for fighting it now and avoiding it in the

future.

Here are the highlights of our conversation. But if you really want to understand this

disease, read the whole interview. This disease may be the biggest event of our

lifetimes.

• 3 months ago, COVID-19 was not even in the top 75 causes of death in thiscountry. Much of the last month, it was the #1 cause of death in this country.This is more remarkable than the 1918 Flu pandemic.

• There is no scientific indication Covid-19 will disappear of its own accord.

• If you’re under age 55, obesity is the #1 risk factor. So, eating the right diet, getting physical activity, and managing stress are some of the most important things you can do to protect yourself from the disease.

• One of the best things we can do for our aging parents is to get them out into the fresh air, while maintaining physical (not social) distancing.

• Wearing a cloth mask does not protect you much if you’re in close contact with someone who is COVID-19 contagious. It may give you 20 minutes,instead of 10, to avoid contracting the disease.

• We can expect COVID-19 to infect 60% – 70% of Americans. That’s around 200 million Americans.We can expect between 800,000 and 1.6 million Americans to die in the next 18 months if we don’t have a successful vaccine.

• There is no guarantee of an effective vaccination and even if we find one, it may only give short term protection.

• Speeding a vaccination into production carries its own risks.

• The darkest days are still ahead of us. We need moral leadership, the command leadership that doesn’t minimize what’s before us but allows everyone to see that we’re going to get through it.

Dan Buettner: The 1918 Spanish Flu broke out in the spring, kind of went semidormant

in the summer and then came back with a lethal vengeance in the fall. Do you

worry we might see a similar pattern with COVID-19?

Dr. Michael Osterholm: One of the things we have to understand is that this virus is

operating under the laws of physics, chemistry, and biology. It doesn’t in any way,

shape, or form bend itself to public policy. Right now, about 5% of the US population

has been infected; although it’s higher in places like New York City and some urban

areas, across the world it’s about 5%.

A virus like this is transmitted by the respiratory route. I call it the leaky bucket

virus because if there’s one little crack somewhere, it will get out and will infect

people. Why is that important? Because we know that it will continue to infect

people into 60 to 70% of the population over time. When this happens, it’s called

herd immunity where these people are immune rods in the transmission reaction.

That means that if I’m in contact with four people and three of them are already

protected because they have antibody from having had the illness or been

vaccinated, I don’t transmit to them. So the bottom-line message here is that this

virus is going to keep transmitting to others until it hits that 60 or 70% level. And

even then, it’s like a plane at 30,000 feet when the pilot announces we’re going to be

dropping for landing. It doesn’t just suddenly land, it’ll just slow down.

So, we’re really confronted with having this virus in our population for months to

years ahead if we don’t get a successful vaccine. So to answer your question of how

we are going to get to that 60 or 70%, that’s what we don’t know. We’ve never had a

coronavirus pandemic infection like this. It may have happened centuries ago, but

we didn’t see it.

If it’s like influenza, of which there have been 10 such pandemics in the last 250 plus

years, three started in our North American winter, two in our spring, three in our

summer, and two in our fall. And in each instance when that happened, there was a

wave that lasted several months, much like we’re seeing now around the world that

seemed to disappear after several months. We don’t know what happens to the

virus and it is not just based on season — it’s always just after a few months. In

every instance the virus came back with a second wave. And when that happened,

usually three to four months after that initial wave was over, it tended to be much,

much more severe.

This is not just the 1918 pandemic because even in 2009 with H1N1, we saw that

same thing happening with a much less severe pandemic. We saw an early Spring

peak of cases when it first emerged in March, April, and May. Then it disappeared

and came back in late August / early September and then took off with a peak in

October. So that’s one model that could happen. But because this is a coronavirus

[not an influenza virus], we don’t know what might happen for sure. Our group has

actually put a paper on our website and the scenarios for what this might look like.

We said, well, maybe it’s not going to be like a flu virus, maybe it’ll just be a slow

burn and just keep doing what it’s doing now for potentially months and months to

come if we don’t get a vaccine. Or we could see more of these kinds of peaks and

valleys where basically certain areas light up for anywhere from a month to six

weeks, and we work hard to suppress it, and then it disappears, but then it lights up

somewhere else. And any of these are still possibilities.

But I can say with certainty, what I call the laws of virus physics, is that this is going

to continue to transmit until we see a large part of the population infected. When

you think about only 5% of this country’s been infected to date, and you understand

the pain, the suffering, the death, and economic disruption that’s occurred with just

5%, then you can imagine what it’s going to take for us to get to 60 or 70%.

DB: There’s no chance it will just mysteriously disappear after the first or second

wave?

MO: We have no reason to think that that will happen. Put it in this context: If we

drop 1000 books, we can pretty well predict moment after moment after moment in

every instance, where each book is going to go when it hits the floor. And the same

thing is true with viruses like this. There’s nothing in our past history that would

suggests that it would just suddenly disappear and die off. While it does change

genetically over time, it’s still a very stable virus. There’s no evidence that somehow

it might just mutate itself away. That’s just not going to happen.

DB: So there’s a lot of hope around a vaccination. But we haven’t been able to find a

vaccination for herpes or for the common cold. Is there any reason to have any greater

hope for COVID-19 than we’ve had for these common diseases that have been around

for decades or centuries?

MO: The one thing we’ve done here is we’ve put probably the hundred best hockey

players we can on the vaccine ice. And so, we’re getting lots of shots on goal and

they’re as good as they’re going to get. So that part is very positive. The world has

responded. There are over 120 vaccine candidates being evaluated right now. But to

go to the heart of your question, will any of them make it in the goal? We don’t

know. There are challenges with coronaviruses. We know that from two other

coronavirus infections called SARS and MERS; in both instances, we were not able to

get easily and effectively applied vaccines.

We also know that it’s possible we could get some short-term immunity with these

vaccines. That means you may not be able to develop what we call durable immunity

that lasts a long time. That would be a real challenge, because then you’d have to

keep re-vaccinating people if that would even work. The final piece is safety as we

do have challenges with this virus. We know that there’s a condition called antibody

dependent enhancement, which is a condition where you make just a little bit of

antibody, but not enough to protect yourself. There’s also an immune enhancement

phenomena where your body goes out of whack in terms of immune response. And

so, one of the things that we are having to look at very carefully is the safety of these

vaccines.

I would say at this point we can all be hopefully optimistic. But we know hope is not

a strategy. I think the key message is that, first of all, is that if it does happen, it’s not

going to happen soon. The idea that we’re going to have a readily available vaccine

by the end of this year is just not realistic. And while we all want to be aspirational,

we also have to be highly practical in how we plan. I think the second piece of it is

that if we do get a vaccine, it’s not going to happen overnight in terms of making it or

distributing it. There are 8 billion people in the world that want this vaccine right

now. What happens if China has an effective vaccine before we do, are we going to

get any of it? And so, there are still many challenges yet that are before us in terms

of what happens even if we do get an effective vaccine.

DB: Good answer. A Blue Zones core value is honoring older people. For people who

have aging parents or relatives, do they need to sit at home by themselves for the next

year? Or how do we best protect them?

MO: This is a challenge that is as daunting as any I’ve ever faced in my public health

career, including HIV / AIDS or any other condition. How do we try to protect those

people who are at the highest risk of having a severe outcome? And right now, if

you’re over age 65, you’re male, if you have underlying heart disease, hypertension,

diabetes, renal disease, certain lung cancers or blood cancers or if you’re moderately

to severely obese, then these are all risk factors for developing the disease. And I

might add to the obesity piece, which is something very near to the hearts of your

readers here — healthy lifestyles are so important in reducing your risk for severe

disease.

Right now, among those people who we see having severe disease under

age 55, obesity is the number one risk factor for COVID-19.

So what do we do to protect these people? We don’t have a ready answer. Locking

people up to bubble them from this virus for 18 or more months, or however long it

might take to get a vaccine, is a severe challenge. Mental health-wise — we have to

understand the issues. I categorically reject the concept of social distancing. It’s

physical distancing. I hope we never social distance, ever.

Minimizing your contact with large groups, numbers of people, will surely help. We

know that you can reduce transmission that way. Beyond that, wearing a mask will

reduce your risk and not in a major way, but it’s another possible means of reducing

transmission. But in the end, this is why we so desperately need to get a vaccine.

DB: Let’s say you have two 80-year-old parents who live in a house by themselves.

What do they do for the next year?

MO: Again, I would limit the number of contacts they have outside the home. If they

are out in public, they can wear a mask but that’s of limited protective value. When

outside, stay away from large groups. Don’t spend lots of time next to someone. This

virus doesn’t magically jump between two people — it’s time and dose.

Don't spend lots of time next to someone. COVID-19 doesn't magically jump

between two people -- it's time and dose.

For example, if you’re riding in a car with someone who’s infected, you may become

infected yourself by just breathing their air within 10 minutes. If they have a cloth

mask on, then that may move it to 20 minutes but it doesn’t eliminate it. The same

thing is true if you’re going to a large social event, like a church event. The problem

is that this virus is transmitted largely by what we call aerosols, those little things

that we breathe, and we put out hundreds of thousands of these every minute when

we talk.

If you’re in church setting, particularly where there’s singing, we know that there

have been a number of outbreaks that have occurred where the source has been

someone infected in a church setting. So, should they go to church on a Sunday?

That’s a real challenge. Again, if they’re at increased risk for severe disease, I have to

tell them that they are taking this risk on. This has been a very difficult part of this

pandemic to try to provide meaningful and thoughtful risk-based information that

doesn’t scare people needlessly, but at the same time, doesn’t put them in harm’s

way for what can happen.

To give you some perspective on what this virus has done: 85 days ago, this virus as

a cause of death was not even the top 75 causes of death in this country. Much of

the last month, it was the number one cause of death in this country. Nothing

has done that since the 1918 influenza. That gives you some sense of the impact that

this has had.

DB: To summarize a few things that you’ve said: we’re going to herd immunity of 60

to 70%, and it’s people over 65 who are at highest risk. It almost seems like a death

sentence to let your 80-year-old parents go outside over the next few years.

MO: The message I think we have to say is being outside is really a very important

thing [for Covid-19]. It’s getting fresh air, and being able to move and exercise. It

turns out that being in the outside environment dissipates these aerosols very, very

quickly. Of all the outbreaks that happened in Wuhan, China where people get

together with one infected individual and then transmission occurred — all but one

of them occurred inside.

Being outside is really a very important thing for Covid-19 because you're getting

fresh air and movement. It also turns out that being in the outside environment

dissipates these aerosols very, very quickly.

So, I think this is the time of year when people need to take advantage of parks and

walks separated by 6, 10, 12 feet knowing they can feel very safe about that. It’s

time and dose, so you’re not going to get infected by passing somebody on the

path. That’s the good message: Get people out, get them exercising, and take them

out.

The challenge is going to family events. We’ve had a number of outbreaks where

funerals, weddings, and family events in general were the source because people

congregated together in tight spaces for a long period of time. But if you’re not doing

that, then I think the risk is actually quite small.

DB: Another one of our core observations from Blue Zones research is that people

living long lives are eating more plant-based foods. What role do you think the

industrialized meat production plays in the emergence of diseases like COVID-19?

MO: Well, one of the things that is very clear is that the human-animal interface is a

very, very important source for these infectious agents. When you’re looking at

bushmeat or something from the wild that may come from any number of exotic

animal species, in many parts of the world this is an important source of protein for

families. One of the things we realize though, is in the process of contact with that

animal — cleaning it, preparing it for food, consumption — these all contain

exposure to blood or other body fluids that might transmit any number of different

viruses or agents. We know certain kinds of bats are much more likely to harbor

some of these exotic viruses that don’t kill the bats but can transmit it to humans or

other animals.

So the wild bushmeat is a very important area, in the kinds of market situations we

see largely in Asia but also in other places around the world. Africa also can play a

role, as we saw with the Ebola virus. So that’s the one area with animal contact

that’s by far the highest risk.

In terms of domesticated animals like cattle, hogs, pigs, etcetera — the risk there is

just common food-borne disease where we continue to see huge challenges there

like with salmonella and e. coli. These all play an important role in human disease

and particularly today in antibiotic resistance transfer because we’re seeing the

increasing use of antibiotics in raising these animals. Because they too are suffering

from infectious diseases, and the more antibiotics used the more antibiotic

resistance you get, which means the more antibiotics you use. So we don’t see the

exotic viruses for the most part with domesticated animals except for very

occasionally.

DB: I read the theory that the 1918 flu virus mutated in a pig and then jumped to

humans.

MO: We don’t know the exact origin of the 1918 virus. We call it a swine flu because

the genes on it look very much like it probably spent time at a pig. Pigs are very

important animals in making viruses for humans that can be very dangerous. The

reason for that is that flu viruses originate in aquatic birds, particularly ducks and so

forth. These viruses can very rarely jump to humans, but typically humans can’t

then transmit them on to others.

But when a pig becomes infected with one of those bird viruses, they also have the

ability to get infected with human viruses because of the receptor sites in their lung

cells. And when those two viruses get together in a pig cell, they often swap out

genes, which then makes a virus that’s unique, new, and now able to infect humans.

Pandemics begin when a brand-new virus infects a human who also at that point is

able to transmit the virus to other humans. So, it’s not just to humans, but

transmission by humans. The 1918 virus is one that we’ve resurrected because we

didn’t even have the ability to grow viruses back in 1918. We didn’t really

understand them. But now we can come back to it and say that this virus likely

emerged out of a pig source with a human virus involved and then somehow it

jumped into humans. But where it jumped into humans is still a question that we all

have.

DB: Great answer. Let’s say you have the full support of the president and a sufficient

budget. If you were willing and took on the job of “COVID-19 czar,” what strategy

would you pursue at this point?

MO: The first thing I would do is identify an FDR or a Winston Churchill. Because I

know that over the months ahead, we’re going to have a great deal of difficulty

working through this pandemic. The darkest days are still ahead of us. And we

need that moral leadership, that command leadership that doesn’t minimize what’s

before us but allows everyone to see that we’re going to get through it. And we will

— we’re going to get through this. We need that kind of leadership. It’s not a

partisan statement. It’s not anything about the politics of the day, it’s just what we as

a society are going to need to get through. That may seem simple, but that is right up

there with the magic wand issue of also having a vaccine.

I would continue to push forward everything I could on vaccine research and

development, looking at drug therapies, and also doing anything I could to improve

on the production of protective equipment for healthcare workers. Right now,

over 600 healthcare workers in this country have died as a result of Covid-19

infection acquired on the job. They are now on the frontline of this war against this

virus. And because of our lack of preparedness, we don’t have enough respirator

masks and the kinds of things that they should have on to protect themselves when

working with patients. They don’t have all the protective equipment they need. And

our consumption of it has been so high just trying to provide care to the patients,

that we haven’t been able to get ahead. We’re always falling further and further

behind what’s needed. That has to be a very high priority.

Finally, I would really work on and develop the kinds of protocols and information

sources for the public to better understand what’s going on. Right now, I think the

public feels whipsawed back and forth. What is my risk? The questions you asked

me — how do I protect my aging parents? Is it safe to go to work? What do I have to

be concerned about with my kids in school? We really need to have as much

information in the hands of the public. We can’t answer all the tough questions. We

can’t solve all the tough problems, but we can be a partner in helping the public

understand what we know and what we don’t know. I call it straight talk. Not happy

talk, just straight talk. If I were czar, I would make sure that all the people that I

worked with would espouse that very important goal.

DB: Two final questions: What do you think the best-case scenario and the worst-case

scenario are for COVID-19?

MO: My worst-case scenario is that we see it suddenly start to disappear from this

country right now. And people say what, how could that be worst case? That’s the

worst because if that happens, it means that it’s not disappearing due to human

behavior or anything we’ve put in place to reduce transmission. That would tell me

that this is now acting like a flu virus even though it is a coronavirus. If it looks like a

pandemic flu virus, then that would suggest that in late summer or early fall we

could have a very significant wave of activity that would overwhelm society as we

know it, healthcare wise and otherwise. That would be really a very unfortunate

situation.

My best scenario is that this just continues to burn on — it’s with us, but it doesn’t

ever overtake us. We learn to live with the virus, and we are able to suppress it

without destroying society as we know it. And we get a vaccine in 12 more months,

and we’re able to get that into people and it works effectively, at least for the short

term. So we’re somewhere between those two. What we don’t understand is exactly

where yet.

DB: In that worst-case scenario, given the fact we have to get to some form of herd

immunity – can you estimate how many Americans die?

MO: Well, I think you can do your own math in the sense that if 5% of the

population has been infected to date and we have 100,000 deaths, it’s a 12-fold

increase to get to 60 or 70%. Now, some of these people will be at lower risk of

dying than the people in the first 100,000 deaths, because we are, in a sense,

burning through long-term care facilities right now in a really terribly, terribly

tragic way. But they’re developing herd immunity in many of these facilities because

there have been so many cases. So, the death rate per hundred thousand people will

drop as we have more people infected. But because we have so many more people

that are in that top of the pyramid, that smaller part of the population distribution,

we still will have lots of deaths. So it would not be unreasonable to say based on

what I just shared with you with 100,000 deaths for 5% of the population infected,

that somewhere between 800,000 and 1.6 million people could easily die from this

over the course of the next 12 to 18 months if we don’t have a successful vaccine.

DB: Well, that is scary. There’s this strongly held view by some that we should follow a

modified Sweden model. They point out that there’s all this death and pain and

suffering from a collapsed economy. And that if we’re going to herd immunity and as

long as the healthcare system can absorb the cases, we should just speed to herd

immunity. What’s wrong with that thinking?

MO: First of all, the Sweden model no longer exists. It was a myth to begin with. And

it now is even being heavily criticized within Sweden to the point where there’s

actually a criminal investigation going on about what did or didn’t happen in their

long-term care. Sweden has one of the highest death rates in the world in terms of

number of people that have died per population. They have not advanced any

meaningful way towards a herd immunity level and are not much higher than the

United States is right now. And they recognize in retrospect that maybe they didn’t

accomplish all that they thought they were going to.

The adjoining countries of Denmark, Finland, and Norway – who did go into more

extensive lockdown activities — have kept their death rates significantly lower than

Sweden has. And they’re bringing back the economy, very similar to Sweden is

doing. So, I think that one of the problems we have is everybody seems to have a

magic answer for what’s going on. And my response is that it might be a magic

answer today, but let’s wait a week and see what happens. And that has happened

time and time again. We’ve heard about how China was successful in tamping down

that initial outbreak in Wuhan and throughout Hubei. But now we see they’re having

a resurgence of infection with large parts of Wuhan now being tested again and

other major outbreaks in China. So everyone may have a perfect solution today, but

following my leaky bucket concept it may not be that way tomorrow at all.

DB: So we should be continuing to lockdown and wear masks and proceed with

caution.

MO: I think one of the things we have to understand is we can’t just lockdown. I

look at this with two guardrails. On one side is a guardrail where we are locked

down for 18 months to try to get us all to a vaccine without anyone having to get

infected or die. We will destroy not just the economy but society as we know that if

we try to do that. The other guardrail is to just let it go and see what happens. We

will see the kinds of deaths we just talked about and we will see healthcare systems

that will literally implode. And not just for COVID-19 care, but for heart attack,

stroke, and all other causes of disease in our communities. That’s not acceptable.

And so we’ve got to thread the rope through the needle in the middle. The very

question you asked me about, what do we recommend to our older citizens of this

country — our parents, our grandparents — what do we tell them? That’s the part

that we haven’t done a good job of addressing. We have to learn not only how to

die with this virus, which tragically we’ve had to do, but we also have to learn

how to live with it.

Those are the kinds of discussions we need to have now. If we’re not going to lock

up and we’re not going to open up willy-nilly, then what is the approach? And what

we’ve been trying to do is facilitate those very discussions so that people can make

hard choices. What are the things that we can do to change society that will help us

maintain society to the best we know but at the same time also reduce

transmission? That’s a key activity right now that public health needs to be playing a

very important role in.

DB: What a phenomenal and articulate informed answer, Michael.

It’s not binary. We need to find the Goldilocks — the sweet spot.

MO: And then consensus. I see what this is doing to our country — it’s tearing it

apart. I’ve said this to others that for years and years, I could never stand what it

must have been like to be a father who sends half his sons off to the north to fight

and half to the south during the Civil War. Today, I’m seeing families going through

exactly that over these issues. It’s really tragic. What is happening with COVID-19 is

that it’s not just about the severe disease, but it’s also exacerbating many underlying

issues we have in this country today. I think this is a real point of learning for us.

DB: I have a final personal question. My 60th birthday is coming up. I live on Lake of

the Isles and I was thinking of putting an open-air dining room up for a dinner party of

10 people or so outside. Is that a bad idea?

MO: If you’re outside, the aerosols dissipate much, much faster. So any air

movement at all will help move those. Again, I can’t say that it’s perfectly safe.

Remember the choir participant who sang for two hours and transmitted the virus

to 42 out of 60 people. But exposure as a dose is a combination of time and amount. So, if you’re in a situation where you are basically spending an hour or two in an outdoor area, it’s

likely that even if somebody was infected there, you wouldn’t have the same dose at

all. As I pointed out before, virtually all the outbreaks we’ve seen have occurred

indoors.

DB: Okay, so I can go ahead or are you advising against it?

MO: [laughing] Well I can’t say yes or no, I’m giving you the best advice I have.

We’re all looking for the Holy Grail right now.