Winter 2021

“What we’re seeing globally is a house on fire”

The U of M’s Michael Osterholm on the COVID-19 pandemic and where we go from here

Courtesy School of Public Health

Michael Osterholm has been warning us for decades about a coming pandemic. And when COVID-19 emerged, it was as if he had been preparing his entire career for that moment. “As humans, we haven’t had to deal with this kind of pandemic that continues to occur month after month since the plague during the Middle Ages,” he says.

As Regents Professor, McKnight Presidential Endowed Chair in Public Health, and director of the Center for Infectious Disease Research and Policy (CIDRAP), Osterholm is a leading voice on infectious diseases and our preparedness for a pandemic. In November, he was named to president Joe Biden’s 13-member COVID-19 Advisory Board.

Here, the U’s top epidemiologist shares his thoughts about his new role, our progress in combatting the virus, and what the vaccine will bring.

What went through your mind when you learned you’d been selected for the COVID-19 Advisory Board?

I’ve served in the last five presidential administrations, including a year and a half as a science envoy for the State Department in the Trump administration. As a soldier in the public health army trying to fight these viruses, my role has always been nonpartisan. It was clearly an honor to be asked to do this. Any of us who can help needs to and must help.

Have the virus and our response played out the way you thought they would?

In terms of the potential impact on society both from a human health and economic standpoint, this has played out pretty much as I thought it might. Looking at influenza pandemics, they typically wipe through communities in six to 10 weeks.  A second or even a third wave will appear several months later. Then, they’ll largely be gone. We saw it in 2009 with H1N1.

This has been one big coronavirus forest fire. It keeps burning and burning and burning and doesn’t go away. How much you do to suppress transmission will in part dictate how much it burns.

One of the things I hadn’t fully appreciated was what the politicization of this pandemic could do to our response, how that made it much more difficult in terms of bringing people together to take on the virus as opposed to taking on each other.

The second thing is that pandemic fatigue is very different with this virus than with influenza. This is unrelenting. There is no space or place you can go today to avoid this virus.

Where do we stand right now?

What we’re seeing globally is a house on fire. Most days, we have over 200,000 new cases in the United States. The first week in January, the numbers were turning up again in the upper Midwest. And the new variants are potentially a real game-changer. We could see a substantial increase in transmission of this virus in the course of several months.

People are starting to get the vaccine. What challenges do you foresee as it becomes more readily available?

We have a major challenge ahead of us to help people understand how these vaccines were made, what they were made from, why we believe they’re effective and safe, and why they are a game-changer.

The racial disparities with this have been enormous. It’s been very clear that the BIPOC (Black, Indigenous, people of color) community has been adversely affected in ways the white community hasn’t. The percentage who’ve been infected and the seriousness of their illness have been substantially greater than in the white population. It has nothing to do with their skin color. It has everything to do with the social and economic conditions they live in, the work they do, their current and previous access to health care, their trust in government. What are you willing to accept from a government that has a history of having misled you about health issues?

I think we have a special obligation and a special need to make certain that in the BIPOC community, the response is largely led by the BIPOC community. They have the expertise and we need to do everything we can to support them.

Once we start seeing critical mass in terms of immunization, which could be as early as this summer, do we go back to normal? Will there still be risks?

There are two kinds of risk that we’re dealing with. One is the actual physical risk. Will we continue to see this virus surface in our community? The answer is yes.

The second risk is much more difficult to describe: What has it done to our mental health? What do we think of closed spaces, where we’re exposed to indoor air? What modes of travel feel safe? At what point will we find it safe to talk about not masking anymore? Will we want to sit next to someone in a crowded theater?

We have a lot of work to do to understand what we must do from a public health standpoint to reduce the recurrence of the disease, and what we must do so people move forward in terms of how we interact in public and private spaces.

Since 9/11, we’ve never flown on an airplane in the same way again. And I think we will have a new normal with air. We have to stop swapping air.

CIDRAP conducts research and provides news, information, and analysis on the prevention, control, and treatment of infectious diseases like COVID-19. How important has philanthropy been to this work?

We are a bit of an unusual university activity. We combine public health science, public policy, and crisis management in one pot. We tackle issues from pandemics to antibiotic resistance. We still act in some ways like an emergency response organization. We could never do this job if we survived on the typical NIH or CDC contractor grants that take months to secure.

In December of last year, we turned on a dime to reprioritze what we were doing, how we were doing it, and what we were involved with. We were able to begin covering news about the pandemic extensively in its very earliest hours. Philanthropy is the lifeblood that allowed that to happen.

What have we learned from the COVID pandemic that can be applied to things like the flu and the common cold?

People are now recognizing that it’s cheaper to prevent these situations from happening than having to respond to them. The one magic tool we have in public health are vaccines.

I think we’re going to see a renaissance of vaccines over the next year or so. People think, Wouldn’t it be something if we could take the coronavirus pandemic off the table? What if we could vaccinate ourselves against common microbes that cause antibiotic-resistant infections?

What gives you hope?

It’s remarkable that in 11 months we have gone from a virus we hadn’t seen before to a global vaccine initiative that is highly effective and safe. The vaccine will go down one day as having been our modern public health Manhattan Project.

Kim Kiser is editor of Legacy.