Joe Rogan:
What you said when you sat down was absolutely perfect, that the timing could not have been better. Well, tell everybody what you do, Michael.
Michael Osterholm:
Well, thank you. I’m, for lack of a better term, a medical detective. I’ve spent my whole career tracking infectious diseases down, trying to stop them, try to understand where they come from so we can make sure they don’t happen in the first place. But most of all, trying to respond to situations just like this.
Joe:
Just like this. Just off the bat, how serious is this? Is this something that we need to be terrified of, or is this overblown? How do you stand on this?
Michael:
Well, first of all, you have to understand the timing of it in the sense that it’s just beginning. And so in terms of what hurt, pain, suffering, death that’s happened so far is really just beginning. This is going to unfold for months to come yet, and that’s, I think, what people don’t quite yet understand. What we saw in China, I’m convinced, as are many of my colleagues, as soon as they release all of these social distances, these mandated stay in homes, haven’t left their home in weeks and weeks kind of thing; when they go back to work, they’re on planes, trains, subways, buses, crowded spaces, manufacturing plants, even China is going to come back again.
Michael:
And so this really is acting like an influenza virus, something that transmits very, very easily through the air. We now have data to show that you’re infectious before you even get sick, and in some cases quite highly infectious. Just breathing is all that you need to do. So from this perspective, I can understand why people would say, “Well, wait a minute. Flu kills a lot more itself every year than this does.” I’ll remind people that it’s just the beginning. Probably the best guesstimate we have right now, on what limited data we have, I’d say this is going to be at least 10 to 15 times worse than the worse seasonal flu year we see.
Joe:
10 to 15 times worse in terms of fatalities?
Michael:
Yeah. And just illness. In fact, I brought some numbers. We conservatively estimate that this could require 48 million hospitalizations, 96 million cases actually occurring, over 480,000 deaths that can occur over the next three to seven months with this situation. So this is not one to take lightly. And I think that’s what … I can understand if you say there’s only been 10 deaths or 20 deaths or 50 deaths. Just remember, two weeks ago we are talking about almost no cases in the United States and now that we’re testing for it and watching the spread as it’s unfolding, those numbers are going up astronomically.
Michael:
Three weeks ago, Italy was just living life just fine. Now they’re literally in a virtual shutdown in the northern parts of Italy. And that’s the challenge with an infectious disease like this. It can spread very quickly, and it also can affect people. I think maybe to put this into modern terms, this is something we think of often when we think of the pre-antibiotic days, the old time medicine. We have an employee at our Center for Infectious Disease Research and Policy at the University of Minnesota, and she has a dear friend who lives in Milan, Italy. She works at a hospital there, and she texted this to this employee of ours last night, and this was an email that came out yesterday from one of their physicians in Milan at the largest hospital there.
Michael:
And he said, “I just got a very disturbing message from a cardiologist at one of Milan’s largest hospitals. They’re deciding who they have to let die. They aren’t screening the staff anymore because they need all hands on deck, and they have very small areas of the hospital dedicated to non-COVID patients where they still screen doctors. Everybody else is dedicated to COVID patients. So even if they’re positive, meaning that they’re sick, they don’t … but they don’t have a severe cough or fever, then they have to work.” He says that they’re seeing an alarming number of cases in the 40-something age range. “These are horrible cases, so we need to stop thinking that this is only an old person’s disease.”
Michael:
This is what’s going to unfold not just in Wuhan. It’s unfolding in Milan. It’s unfolding here in Seattle. And this is what’s going to continue to rollingly unfold throughout the world.
Joe:
Yeah. Where did this rumor come from that it’s an old person’s disease? Is it just because the majority of the people that have died from it so far I’ve been older?
Michael:
Yes. In fact, that’s the primary risk factor for dying, is being old, and then having certain underlying health problems. For example, in China, those men over the age of 70 who also smoked were … 8 to 10% of them died. 65% of older Chinese men smoke. The case fatality rate, or the percentage of people who die in women in that same age group was only about 2%. In that case, very few women smoke. Now, the challenge we have is that that’s the Chinese data, but there are a series of risk factors that we worry about that if they overlay on this disease are going to cause bad outcomes, and we happen to be right at ground zero for one of the major ones here in this country, and that’s obesity.
Michael:
We know that obesity is just like smoking in terms of its ability to really cause severe life threatening disease, and 45% of our population today over the age of 45 in this country are obese or severely obese. That’s men and women. So one of the concerns we have is we’re going to see more of these what I guess I would call very serious and life-threatening cases occur in our country because of a different set of risk factors than we saw in China.
Joe:
Now, you mentioned that there’s some sort of incubation period, before people become sick they’re still contagious. What is this incubation period, and how do we know about it?
Michael:
When we call something an incubation period, we’re talking about from the time you and I got exposed, meaning I was in a room breathing the air that somebody else who was infected with the virus was expelling out, I breathed it in. How long from that time period until the time period that you get sick, and what is that? That’s what we call the incubation period. So that’s when case numbers can double or triple every so many days. In this case, it’s about four days.
Michael:
And we actually have data there from people who were exposed one time or one time only, and we know when they were exposed, where they were exposed, and how soon do they get sick afterwards. So the chauffeur in the car where the individual was sick or showing symptoms, then the chauffeur gets it four days later. They were there one time and one time only.
Joe:
And if the chauffeur does not show any symptoms, he’s still contagious? He can still get it?
Michael:
He could also be contagious too. And that’s one of the things that’s challenging here, is you and I might get exposed to somebody who is totally asymptomatic, no symptoms, that virus would appear, well, that’s not a very strong virus. But in fact, when it infects us, it could kill us. So we’ve seen cases of fatal disease that were exposed to people that had minor symptoms themselves.
Joe:
Wow.
Michael:
This is what’s unfolding here, and this is what I think is such an important … I said why the timing is so important, because Joe, we’ve really got to get information out to the public. There is so much misinformation right now. We’re going to be in this for a while. This is not going to happen overnight. And I worry. I keep telling people we’re handling this like it’s a Corona blizzard, you know, two or three days, we’re back to normal. This is a Coronavirus winter, and we’re going to have the next three months or more, six months or more, that are going to be like this. And so far this thing has been unfolding exactly as we predicted it. We, in our center, put out a piece on January 20th and said this is going to spread worldwide.
Michael:
At the time, people said, “No, it’s just China.” We put out a piece the first week of February and said, “This is going to pop probably the last week of February, first week of March.” Because what happens is it has what’s called an [R not 00:00:07:19], or a doubling time of every four days, so increase is doubling every four days. So if you go from two to four to eight to sixteen, it takes a while to build up. But when you start going from 500 to a 1,000 to 2,000 to 4,000, that’s what we’re seeing happen in places like Italy. We’re beginning to see it in some ways up in Seattle. It’s what happened in China. When people are confronted with that, suddenly this low risk phenomena that everybody talks about isn’t so low anymore, and that’s what we need to prepare people for.
Joe:
Now, what can be done? What can the average person do? I see people walking around with masks on, wearing gloves. Is that nonsense?
Michael:
Largely, yes. First of all, let’s step back. The primary mechanism for transmission is just the respiratory route. It’s just breathing. In studies in Germany, which just have been published literally in the last 24 hours, they actually followed a group of people who had been exposed to somebody in an automobile manufacturing plant and then they had nine people that with this exposure they said, “If you have any symptoms at all, contact us. We want to follow up.” And they all agreed. Well, they got infected, and so in the very first hours just feeling bad, sore throat, they went in and sampled their throats, their saliva, their nose for virus.
Michael:
They did blood. They did stool. They did urine. And they found that at that very moment when they first got sick, they had incredibly high levels of virus. Sometimes 10,000 times that we saw with SARS in their throats, meaning they were infectious at that point already and they hadn’t even had symptoms yet of really any nature. They weren’t coughing yet.
Joe:
Wow.
Michael:
That’s where we’re concerned, because that’s the kind of transmission … I always have said trying to stop influenza virus transmission is like trying to stop the wind. We’ve never had anything successfully do that other than vaccine, and we don’t have a vaccine here. So what’s happening is that people in public spaces are getting infected. And the way you need to address that is, unfortunately, if you’re older, over 55, you have some underlying health problems, which unfortunately a lot of Americans do. We have obesity. Then right now you don’t want to be in large public spaces and trying to potentially get infected. So you can take care of that part. As far as what can public health do? We can talk about this. We’re not going to have a vaccine anytime soon. That’s happy talk.
Michael:
We can close schools. One of the big challenges we have right now, if we close schools, what do we accomplish? In influenza virus, we close schools during outbreaks because it turns out kids get infected in school and they’re like little virus reactors. They come home and they transmit it to mom and dad and brothers and sisters, and so we close school sometimes. Christmas breaks are always great for kind of putting a dampening effect on flu. In this case, kids are not getting sick very often at all, which is one of the really good news features of this disease. In China, only 2.1% of the cases were under 19 years of age.
Joe:
Why is that?
Michael:
We don’t completely know. I’m going to come to that in a second because they’re getting infected it turns out. One study showed that they still get infected with the virus, but they don’t get sick. And we’ve had that happen. There’s a disease called infectious hepatitis, hepatitis A, where we have outbreaks in daycares. And the way we know we have an outbreak is because it’s transmitted through the stool, fecal-oral, is mom and dad and the daycare providers all get sick, and the kids no symptoms. We go in and test the kids, they’re all positive.
Michael:
So some diseases will manifest primarily when you’re adult but not as a child. This one appears to be the same. So do we close schools or not if we’re not really spreading the disease? Because it turns out that if we close schools, a recent study done showed that 38% of nurses today in this country who are working in the medical career have kids in school. And if suddenly we’re closing schools for two or three months, who’s going to take care of those kids?
Michael:
One-fourth of the American population has no sick leave. If we close schools, they don’t get paid if they have to stay home. So when you ask, well, can we do it, we have to really be thoughtful about what we do. Are we doing more harm than good by closing schools, for example, even though everybody will say, “Oh, we got to do everything we can?” Or do we just tell people it’s going to be limiting your contact as much as you can, and that’s really about what we can do.
Joe:
Limiting the contact, is that really going to help?
Michael:
It does because it’s like putting rods in a reaction. If you don’t have as much close contact, you can not transmit it as much. If I’m sitting in a room with a hundred people and we’re kind of sharing air, the transmission’s remarkable. Right here, off the coast of California, you’ve got your cruise ship. Cruise ships are notorious for recirculating air inside the inner cabins. We’ve had a number of outbreaks.
Joe:
That’s why they’re having these outbreaks on cruise ships?
Michael:
Yeah. And then you leave them on there. I think the cruelest human experiment we’ve done in a long time with humans is leave them on these ships. Get them off right away.
Joe:
Should they get them off right way?
Michael:
Absolutely.
Joe:
What should they do with them?
Michael:
Well, they can put them in quarantines of some kind if they want and follow up on them. But you’re guaranteed they’re all going to keep getting infected day after day.
Joe:
It seems like we’re not really prepared for something like this, although the CDC has been telling us for a long time that we should be.
Michael:
We are not prepared at all in this sense. I wrote the book Deadliest Enemies that was published in 2017.
Joe:
Right here, ladies and gentlemen.
Michael:
Thank you.
Joe:
Go get it. Read it. Panic.
Michael:
Chapter 13, the title of the chapter was SARS and MERS: A Harbinger of Things to Come. We predicted this. And then I wrote a chapter in there what a flu pandemic would look like if it emerged in China. And if you read it, it’s exactly what’s happened. The supply chains went down, China locked down the country, it spread to other countries. People all pointed fingers. It’s the kind of thing where we hear it and hear it, but we don’t get prepared. Five years ago I gave a talk at the Mayo Clinic. First time I had talked about this. I’ve talked many times afterwards. And I showed a slide of Puerto Rico, a picture of Puerto Rico. And then I showed the map, and then I showed a picture of a building in Puerto Rico, a nondescript building, and I said, “This is our next big disaster.”
Michael:
Turns out that 85% of all the world’s production of IV bags, the saline that we need desperately, were made in these plants in Puerto Rico. And all we needed was one category five hurricane to come through and take it out. Maria came through a year and a half ago and the world went into a major crisis with a shortage of IV bags. Now, that was so obvious that was going to happen, and yet we don’t prepare.
Joe:
That’s so foolish.
Michael:
I know. I agree. Hopefully, this is a wakeup call. The business community hopefully will wake up. One of the other things we’re doing right now, Joe, this is really … one of the things that has me the most concerned about this whole situation is our group has been studying for the last year and a half with support from the Walton Family Foundation looking at critical drug shortages. It turns out that we identified 153 drugs in this country that people need right now or they die. I mean, it’s on the crash cart. It’s acute critical drugs. 100% of them are generic. All of them basically are made offshore to the United States, and a large part of them are made in China and India.
Michael:
And at this point, we have shortages anyway every day just before this crisis happened. Now these supply chains have gone down. Our group is actively helping the United States government try to figure out where they’re going to get these drugs. Now just think of this, if I came to you and said the Defense Department was going to outsource all its munitions production to China, you’d look at me and say, “Come on.” You know what? The U.S. Defense Department has no more access to these drugs than anybody else. They are beholden to China for these drugs.
Michael:
690,000 Americans have end-stage renal disease right now. Most of their primary drugs are coming from China. And now with the shutdown and what’s happening with this, and this is what I talked about in the book, why I was so concerned, because we are at risk. So even as the situations unfold, it’s not just about what the virus does to you. It’s about what the entire system is rigged up to be and what this virus does once it gets into it.
Joe:
Jesus. You’re making me nervous.
Michael:
Well, before we get done here, we’re going to talk about what we can do to get people not nervous because this is …
Joe:
It’s too late.
Michael:
No, no, no. What I mean is we’re going to bring you around to … My job is not to scare you out of your wits, it’s to scare you into your wits.
Watch the complete interview here >> Joe Rogan Experience #1439 – Michael Osterholm
