In late May 2020, I, along with over 600 other high school students from around the world, virtually attended the Global Health and Leadership Conference hosted by Harvard College VISION. The conference featured an impressive array of workshops, competitions, and speakers with the mission to inspire students about global health and empower them to become leaders shaping policy for the greater good. From Refugee & Migrant Health to Leadership in Federal Government, the conference was themed around the idea of health in an increasingly connected world, perhaps never more relevant than during the COVID-19 pandemic. In this third part of this three-part series, I want to focus on another one of the speakers who presented at this conference, specifically Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota.

Dr. Osterholm has been concerned with pandemics ever since the 1990s and has previously worked on fighting other coronaviruses, being part of the federal group that responded to Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). These two diseases are well characterized by transmission only when someone is highly infectious, which allows those that are contagious to be identified quickly and isolated. SARS was largely stopped because civets, the animals that transmit the disease, were put down in large numbers. MERS, however, could not stopped in that manner because it is transmitted through camels, which are very highly regarded in the Arabian Peninsula. SARS-CoV-2, more commonly known as COVID-19, is much harder to control because, unlike the other two diseases, it can be transmitted without people being critically ill. CIDRAP has played a critical role in the fight against COVID-19, publicly stating on January 20th that this virus would result in a worldwide pandemic, well before the WHO officially declared it so on March 11th.

SARS and MERS Transmission Pathways

As a world leader in preparing for an influenza pandemic, Dr. Osterholm has spoken out widely about the risk of pandemics. He reminded us that there have been at least eight influenza pandemics over the past few centuries, with the 1918 Spanish Flu being perhaps the most devastating of these pandemics. In 3 months, the Spanish Flu killed more people than World War I had killed in 3 years. Dr. Osterholm brought up a sobering statistic that there are eight times more American soldiers buried in France that died of the flu than died of war. Similarly, about 125 days ago, COVID-19 was not even in the top 75 causes of death in this country, but now COVID-19 is the number one cause of death in the U.S., in front of heart disease, cancer, etc. In his 2017 book Deadliest Enemy: Our War Against Killer Germs, Dr. Osterholm wrote that, with greater crowding of urban areas, the interconnectedness of the world, and our encroaching on the darkest regions of the world, we were bound to have contact with and spread deadly diseases. In Chapter 19 of the book, he laid out a scenario of what an influenza pandemic would look like: the cessation of baseball season, 25% unemployment, and a world travel shutdown. People found all of this ridiculous in 2017, but, if you replace influenza with coronavirus, the resemblances to our current situation are uncanny.

Without an effective vaccine, this pandemic is going to go on for several years at the very least. We invest pennies on the dollar to global health compared to the Defense Department, and our response to COVID-19 shows that clearly. We may one day have a vaccine, but then further issues arise. In whatever country the vaccine is discovered, there will be pressure to keep the vaccine in that country. Additionally, the high demand for the vaccine may make it unavailable to the underprivileged and disadvantaged. There certainly will not be a billion doses in the first year, or probably even the first few years, so the question then becomes who we should prioritize by giving the vaccine to first. Dr. Osterholm was emphatic that it should be frontline healthcare workers because we have inadequate protections for them, and they are the most capable of saving more lives. However, he and his team have already faced pushback around that proposal, with people asserting that Dr. Osterholm and colleagues are just trying to save their own. Dr. Osterholm commented that this debate is public policy and science at its very best: science is only as good as the public policy that makes those findings a reality. Science without policy is a few publications and nothing more; policy without science is frankly dangerous. As a result, Dr. Osterholm is a fervent advocate of having more scientists involved with policy.

Imperativeness of Science with Policy

Concerning preparation, Dr. Osterholm commented that we were woefully unprepared for this virus. In 2005, Dr. Osterholm wrote about this lack of preparedness in an article published in Foreign Affairs. In the June/July 2020 edition of Foreign Affairs is a similar piece by Dr. Osterholm with the exact same first and last paragraphs. Unfortunately, Dr. Osterholm revealed that we were better prepared in 2005. The warnings have been out there for decades, but nobody has listened. No administration, Democratic or Republican, took the national preparedness stockpile seriously; nobody believed that something like this could occur. Dr. Osterholm also lamented that we do not have a national plan to fight COVID-19. We are currently just muddling through, not knowing if we are trying to shave the peak, keep cases below a certain level, wait for second wave, or something else entirely. We know that we cannot let the virus run rampant with life going as usual because we would suffer an innumerable loss of life, and our hospitals would be overwhelmed. We know that we cannot entirely lockdown and stay in our homes for weeks on end because we would then destroy our economy and society as we know it. However, the United States government does not know where it stands between these two extremes. On top of that, we still face significant challenges with a lack of personal protective equipment (PPE) and our not testing the right person at the right time with the right test to get the right outcome. That being said, Dr. Osterholm declared that we should never waste a crisis. We should take this worldwide disruption to prepare for future pandemics and address other national issues that are rising to prominence now, such as mental health and globalized supply chains for vital drugs.

Dr. Osterholm made it clear that the virus will continue to affect humans in the foreseeable future, so the question is, how do we get to 60-70% infected so that we have some herd immunity that slows down the transmission of the virus. If we look at who has already been infected by the virus, it is no more than 5-15% of the population, even in Sweden where they never shut down. All this pain, suffering, and economic devastation has come from only 5% of the population being infected, which underscores how we still have a long way to go. But how do we get from 5% to 60-70%? Dr. Osterholm outlined three scenarios for this. The peaks and valleys scenario suggests that that virus will keep showing up over and over again throughout the world but never enough to overwhelm hospitals. Subsequent waves will progressively decrease in magnitude. The influenza model predicts that, based on history, there will be a wave of the virus, a rest period that comes about without rhyme or reason, and then a more deadly second wave. Lastly, the slow burn scenario proposes that there will be no significant outbreaks but a gradual continuation of cases over time. Because of the second scenario, Dr. Osterholm worries about cases suddenly dropping off because we might begin to celebrate our victory before a second wave comes back with a vengeance, so much so that the current state of affairs appears mild in comparison.

Potential Pandemic Wave Scenarios for COVID-19

Dr. Osterholm cautioned that we need to step back and admit our humility because we do not know how this virus transmits, why it peaks, etc. As a result, we should be careful in interpreting what a drop in cases means. Furthermore, while we have shaved the curve in Wuhan, New York City, Iran, and other places, Dr. Osterholm warned that we might have only postponed those cases for the future as the virus is not going to let go of humans. This postponement is largely why the development of a vaccine is so crucial; the more we can delay being infected, the greater chance our immunity comes from the vaccine rather than the deadly virus.

 

References

CIDRAP. Possible Pandemic Wave Scenarios for COVID-19. Bring Me the News, bringmethenews.com/minnesota-news/osterholm-reiterates-that-covid-19-going-dormant-this-summer-could-be-bad-signal.

De Wit, Emmie, et al. The Emergence of SARS-CoV and MERS-CoV. PubMed, pubmed.ncbi.nlm.nih.gov/27344959/. Accessed 22 June 2020.

McIntyre, Emily. Why We Need Scientific Literacy in Government to Solve the Problems of 2020. 31 Jan. 2020. Genius Lab Gear, geniuslabgear.com/blogs/science-2020-policy/why-scientific-literacy-government-solve-problems-2020. Accessed 22 June 2020.

Osterholm, Michael. “Public Health & COVID-19: An Ultimate Battle with Professor Michael Osterholm.” Global Health and Leadership Conference, 23 May 2020. Lecture.

Stubbe, Glen. Michael Osterholm. Star Tribune, www.startribune.com/coronavirus-pandemic-what-s-normal-now-what-s-next-an-interview-with-michael-osterholm/568978932/. Accessed 22 June 2020.