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Top epidemiologist Michael Osterholm on continuing challenges of COVID-19 - transcript

Millions of vials needed for COVID-19 vaccine
Millions of vials needed for COVID-19 vaccine... 02:49

In this episode of Intelligence Matters, host Michael Morell speaks with top infectious disease epidemiologist Dr. Michael Osterholm, who is also director of the Center for Infectious Disease at the University of Minnesota, about the knowns and unknowns to date of COVID-19. Dr. Osterholm reviews the latest data on infection and transmission rates, the likelihood of an effective vaccine, and explains what needs to happen before contact tracing can be effective. He and Morell discuss the U.S. policy response, the need for leadership, and what other challenges remain to containing the coronavirus' spread. 

Highlights: 

  • On the need for leadership: "We need a Winston Churchill moment. We need an FDR moment. We need to bring everyone together and say, 'This is us versus the virus.' Now, I'm not naive. I've been in this business for 45 years. I understand the issue of politics and partisan nature of things. But if there was ever a time we could minimize the partisan issues, whether it's about wearing masks or, you know, any other aspect of opening schools, how we do that -- now is the time for that."
  • Prospect of contact tracing: "Right now, trying to do contact tracing in many locations around this country would be like trying to plant your petunias in a Category Five hurricane. Not possible."
  • Future studies of COVID-19: "This is a disease that we will be studying for decades and decades to come, just by the very nature of its unique presentations, all the different organs it affected, how it impacted on our immune systems and what then happened because of the dysfunction of our immune systems brought on by this virus. And then, in addition, even the long term outcomes and what that means."
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Intelligence Matters: Dr. Michael Osterholm

Producer: Olivia Gazis

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Dr. Michael Osterholm, director of the Center for Infectious Disease at the University of Minnesota University of Minnesota

MICHAEL MORELL: Dr. Osterholm, welcome back to Intelligence Matters, it is great to have you on the show again. 

DR. MICHAEL OSTERHOLM: Thank you very much. 

MICHAEL MORELL: You know, your first appearance on the show was one of our highest rated episodes ever. So the national security crowd is really interested in COVID for a lot of different reasons. Before we start, I want to mention that your Center at the University of Minnesota, which I just mentioned in the opening, now has its own weekly podcast called, The Osterholm Update: COVID19. Where can my listeners find that?

DR. MICHAEL OSTERHOLM: They can actually go to our website, www.CIDRAP.UMN.EDU and they can pick it up there.

MICHAEL MORELL: Great. And I should tell people that it's a great website in general for information on infectious disease in general and COVID19 in particular. So Doctor, let's let's start with your overall assessment on where we are in the coronavirus. Where is the United States today with the virus and with the disease? The first time we chatted, we were using 'waves' as a metaphor. And I've heard you use only recently the word 'forest fire' as a metaphor. So where are we?

DR. MICHAEL OSTERHOLM: Well, one of the things we've done is come to understand that this is not going to be like an influenza virus pandemic. When we first talked, we said, 'Well, we've got a coronavirus here. Maybe it'll act like an influenza pandemic, where you actually do truly have a wave, where you see cases for several months and then for reasons that we still don't understand, virtually disappear.' And you go through a trough period and then you see the second wave often, which is much more severe than the first wave. 

Well, this is a coronavirus that is not acting like a flu virus. It is one where, in two other scenarios, we painted in a discussion of what this might look like in terms going forward from from last spring, is now what I would call a 'raging forest fire.' And it is one where it will continue to burn and it'll burn hot as long as it can find human wood to burn. 

And unfortunately, some areas of the world have figured out that, you know, we have to go in and do everything we can to bring the super forest fire under control. In other words, that terrible term, 'lockdown.' And then, only then, once we have it under control, we start to ease up on the brake a bit and then very slowly bring the world back to its everyday activities. 

We elected, on the other hand, to say, 'Well, the fire is about 60, 70 percent contained; we're done.' And that other 30 percent or 40 percent of the fire, they just continued to rage on. And now it is much larger than the original forest fire that we were trying to put out. That's where we're at today, and that is going to continue. I don't see anything changing in that regard. I think we're having almost a world, today made up of two totally different COVID experiences: One where it's out of control, and one where it's in control.

MICHAEL MORELL: So, Doctor, some questions about the virus itself. What what makes it so insidious? Is it the length of time someone is infectious before they become symptomatic, if they ever become symptomatic? Is it the morbidity and mortality of the disease? Is it all of the above? More one than the other? What makes this so insidious?

DR. MICHAEL OSTERHOLM: It's all of the above and more. You know, we're learning about this virus every day. First of all, we have now confirmed that, in fact, if you look at transmission, this virus basically has, in a sense, adopted some of the issues around MERS and SARS viruses, both corona vIruses that were not good. Meaning that in those cases, those viruses had the potential to cause super spreading events, or a large number of cases associated with one individual. And that has happened with this one.

But at the same time, it has also taken on another kind of quality that makes it much worse since SARS emerged, because in the case of those two infectious diseases, one was not highly infectious until day five, six or seven of their illness. And by that time, we could identify these cases, put them in isolation and virtually stop transmission. That's how we ended SARS both eliminating the animal reservoir in the markets and then stopping cases. 

MERS, we don't eliminate completely because we're not going to put down 1.7 million camels on the Arabian Peninsula where this virus is naturally occurring. Instead, we just deal with the spillover into humans when it happens. 

With this virus, what we're seeing is transmission is occurring well ahead of someone becoming clinically ill, several days before they become clinically ill or they don't become clinically or at all, or so mild that they don't recognize they even have an illness. And that type of transmission has been substantial. 

So that when you add in the ability to infect a lot of people, like the super spreader concept, and then you put that at the front end of the infection where you have no way of identifying these people, that's been bad. And that's what we're in part dealing with. 

The second thing about this virus that is very concerning is, from a clinical standpoint, we're realizing that this has many tricks up its sleeve in terms of how it causes human illness. And it's not just one simple - infects your lungs or, you know, it basically causes a respiratory infection - it has many different component pieces that have made clinical care a real challenge. In some instances in turning your own body on yourself, in terms of the infectious process and the immune system actually becoming a problem. 

I think the third issue that this virus has surely created some real challenges with, and that is How do we ultimately develop immunity? Can we develop long term immunity to this virus? We know that with the other coronaviruses, we don't have good evidence that you do develop long-term immunity. And so one of the challenges we've had here is, once you have been infected or been vaccinated, what does that mean for the future? And we don't know.

So I'm quite confident we'll find vaccines that will allow us to have an immune response that may very well provide protection. But how long will it last and how good will it be? 

And we're even now raising that very same question with people who have been infected: after so many months, can they get reinfected? Now we're hearing more reports of that happening. There's still very few of those. And I think they need to really be investigated carefully to be sure that that's the case. But imagine if we end up finding that this illness is not going to go away through the concept of what we call herd immunity, where you have substantial number of people in the community infected, recover, have immunity to the virus or are vaccinated and have immunity. And then ultimately, you know, we don't worry about them again -- they're protected. What if we can become susceptible again, over and over again?

MICHAEL MORELL: So, Doctor, a couple more questions about immunity. Is there any evidence that some people are naturally immune?

DR. MICHAEL OSTERHOLM: At this point we have no evidence to support that. We surely do understand that people have very different expressions for the disease. Some who have this asymptomatic infection, who have no idea that they even were infected, surely have one kind of response to the virus, which would support that there is something unique about their immune response or the way that they got infected, that is different than those who obviously develop serious illness and die.

But in terms of a population being innately protected -- meaning I can walk into a crowded bar tonight, and even though there's lots of transmission going on at the bar, I'm OK, I'm not going to get it -- we don't have any evidence of that.

MICHAEL MORELL: And you raised the issue a couple of minutes ago, whether once infected and sick, whether you can get reinfected, those folks who had the virus five or six months ago, is there any research being done on those folks to see whether it's possible to be reinfected?

DR. MICHAEL OSTERHOLM: There is research going on. And of course, we only have a limited number of individuals who had confirmed cases in March or April who then recovered sufficiently enough to say, 'Well, they don't have some ongoing condition occurring,' and then therefore did get reinfected. 

Again, I want to be very cautious about this. I don't think that we have enough data to support that that actually can happen. But theoretically, it might very well be happening. I maybe might be a little bit surprised that we would see a lot of people in the first months after having recovered from infection, because what data we do have says at least antibody stays around for some time. 

And so I think at this point we're going to be doing a lot more research over the next year in terms of both clinical cases and what happens to their outcome as they go forward. And also, people who get vaccinated. What happens with them? Do they have protection today but not have protection four or five months from now? Both of those are going to be really critical questions to answer.

MICHAEL MORELL: Is there any indication, Doctor, that it's mutating in any significant way?

DR. MICHAEL OSTERHOLM: Well, first of all, any virus will change, genetically. It'll, in a sense, mutate. But we have to be very mindful of what that means. There are those kind of mutations that are part of the aging process, you might say, of an infectious agent. If I could liken it, it would be like, Mike, if we had a picture of you and you were five, when you were twelve, when you were sixteen. And now that you're thirty-nine, you know, what would it look like in terms of being you? Same you.

But none of those change who you are. And we're surely seeing those changes in this virus, where it ages, we can see that change. But there's been some suggestion that a different strain has emerged from what originally was present in Wuhan that now makes this a more infectious virus. Some even suggest that it might mean that it has a higher level of ability to cause serious disease. And those data are really lacking, I think, right now to support that that's the case. You know, we have to keep an open mind to that. And I'm not a coronavirus virus researcher as such. But I sure spent a lot of time with the people who are the world's experts on coronaviruses. And I have not yet seen one who would say that there's evidence that this virus has changed in a fundamental way that would either, one, change its transmission, or two, its ability to cause serious disease. So it's you know, we're gonna have to pay attention to this part of the picture also. But right now, I don't think there's a problem.

MICHAEL MORELL: And then one more question on the virus, which begins a transition, I think, to other things. But why is the virus having a disproportionate impact on Black and Brown Americans?

DR. MICHAEL OSTERHOLM: It's a combination of multiple factors and including some we still don't completely understand. One is that one has to look at underlying comorbid conditions, whether they be due to increased heart disease, diabetes, obesity issues. If you look at all of those, they surely have been well-documented to occur at a higher incidence in those populations. And these are underlying risk factors for the disease, in terms of a serious outcome, including dying. 

Now, in addition, we know that lifestyle itself, meaning lower socioeconomic status, not having access to, you know, more nutritious food sources, etc., surely all play to that issue, too. And so this is an important area that needs immediate attention in terms of what this virus is illustrating. 

But in addition to that, epidemiologically, we know that if you look at essential workers and look at the disproportionate number of essential workers that are Black or Brown, they were made to go to work. They had to go to work.

In fact, if you look at many of the meatpacking plant outbreaks in this country, primarily made up of Black and Brown individuals who, number one, were made essential workers, had to go back to work. And number two, if they didn't go to work in some states, they were even denied unemployment benefits if they decided the risk was too great and they had to to leave that area of employment. So that kind of work experience plays a huge role. 

Then if you look at just living conditions and, in this case, the number of multigenerational families that are among the Black and Brown populations is higher than it is among the White population. Well, you know what? If I'm grandpa and grandma and I'm doing everything I can to protect myself in terms of distancing, but I've got a son or a daughter or a grandson or granddaughter who live in the same apartment with me, who have to go to work and they get infected and they come back into my apartment. What distancing have I done? What can I do? And so we saw that as a situation also. 

So there are a number of factors that come to play here. And if nothing else, as this pandemic is addressed in the future, we have to understand that this just really opens up and illustrates the disproportionate impact that the Black and Brown populations have in this country for health and why we have to address so many more of the issues around that piece.

MICHAEL MORELL: So perhaps we can shift to medical protocols and ask you about testing. So where are we on testing in terms of the quality of the testing, the speed at which somebody gets results? The quality of the antibody tests, enough tests to go around. Can you talk about that?

DR. MICHAEL OSTERHOLM: Oh, my. This is one of the big challenges, and it's a source of great frustration for me. 

You know, I wrote about this back in April. The challenges that we would have with testing the shortages at a time when the mantra was, 'Test, test, test.' Our group actually put out a viewpoint paper that's available on the CIDRAP site on smart testing and how we had to use these tests, testing the right population with the right test at the right time for the right result to actually, then, didn't take the right action. 

And meanwhile, again, we just kept having the mantra of 'Testing, testing, testing' that anybody who wanted to test could get it. They were readily available. And we had some who wrote pieces that said, 'Oh, my, we should be testing millions and millions of people every week in this country.' 

And several things converged to really create the crisis we're in today. And I call it a crisis. 

Number one is we didn't have the kind of federal leadership that actually took control of this. It was almost as if every air traffic control tower in the country was responsible singularly for getting their plane from City A to City B and nobody else was involved. Imagine air traffic control would look like in this country. 

And so we didn't have a national plan for how to bring the private sector together with what we needed in the public sector, including the public health labs. And looking at things like reagents. Looking at sampling devices, etc.. And we laid that out in our smart testing document that this was desperately needed. And it didn't happen. It didn't materialize. 

And so part of it is has been kind of like the Wild, Wild West. And I think that's been a challenge in itself. And we're seeing that today. I get very concerned when I keep hearing people touting, 'Well, we're going to have new technologies coming down. Look at so-and-so has announced a new machine that's coming out or a new test is coming out.' 

But every one of them are subject to the same supply chain issues, and all of them, I don't care how many new ones come out, if you can't test it, and you don't have it in a timely way, what good is it? 

I think the second piece of it was the oversight of testing really was challenged. Early on when the CDC was unable to deliver on its primary test approach, you saw a response, that 'Oh, my. We're way behind in testing.' So the FDA basically opened up testing in again, another Wild, Wild West way. 

And we had a number of tests that came on the market that had serious, serious challenges in terms of their sensitivity and specificity, how they operated. And this was allowed to go on for some time, both for the virus itself and the antibody test. And so this didn't help us because we did have tests in some cases, but they were terrible. They were literally terrible. And even some of the tests that we did have, for example, antibody, you know, you had basically a 50-50 chance in a testing environment where you had a false positive result. 

So how are you going to tell somebody you're positive, I don't really know what it means because I don't know what antibody means yet. And by the way, half the time, you're not really positive. OK. So we had real challenges with that. 

And then we created this mantra, again, 'Testing, testing, testing,' world that anybody and everybody who wants to be tested could be tested. And as we saw the number of cases increase around the country, more people became very concerned. And we know many, many people just said, you know, 'I just go in every couple of days, get tested just to be sure.' 

And so what happened is we've used incredible resources for testing that shouldn't be done. In smart testing. Basically, you really want to, first of all, test the population who is at greatest risk of having this disease, i.e., those who are sick. They should be able to get tested on the very day that they become ill. And those results should be back within 24 hours or less. 

Today, we have many people waiting seven, eight or nine days to get results back, which have very little meaning to them clinically or from a public health standpoint. So that's a challenge. 

Number two is then we can use this testing, and if it's done quickly, to do the kind of contact tracing follow up, if, in fact, we're not a house on fire. Right now, trying to do contact tracing in many locations around this country would be like trying to plant your petunias in a Category Five hurricane. Not possible. 

And so we've got to bend that curve. We've got to get it down. And then if we weren't seeing, you know, 70,000-plus cases a day in this country and we were back down into that range of a thousand or less cases a day, which other countries have achieved per population rate, we would then have a much, much, much lower demand for testing that we could then match up with what we have with that testing. 

And so to make a long story short, there are many problems with testing today that are not being addressed. And I don't see anything coming down the pike right now from the federal government level or the private sector level that's going to address this.

MICHAEL MORELL: Doctor, where are we in terms of treating the disease compared to, say, where we were three months ago?

DR. MICHAEL OSTERHOLM: Well, we are in a much better place in treating the disease, on one hand. And then let me share with you, I think, the emerging tragedy that's coming. 

On the upside. I give great credit to the intensivists of this country, the doctors and nurses and support staff that work in intensive care units. They have learned a great deal about this very, very complicated disease caused by this very unique virus. This is a disease that we will be studying for decades and decades to come, just by the very nature of its unique presentations, all the different organs it affected, how it impacted on our immune systems and what then happened because of the dysfunction of our immune systems brought on by this virus. And then, in addition, even the long-term outcomes and what that means. 

And so in a number of the intensive care units in this country, in the earliest days, we saw up to 70 percent of the people who were put on mechanical ventilators who died. Today, that number is down around 20 percent. And it's a remarkable testament without even any additional drugs per se, just how to manage these patients in a much more effective way. 

Second of all, we have had an improvement in drugs, as many of you know, Remdesivir has surely had some positive impact, although I think we have to be careful to understand how much, as well as dethamexazone, the antiinflammatory drug. That also has been very, very helpful. Those two together add some incremental improvement. We don't know how much, but surely is something. 

But I think the challenge we have right now is where I worry that we're going to see the case fatality rates or the percentage of people who, for example, get in intensive care who will die. And the reason for that in a number of locations around the country, we have basically what I call the Case Cliff. 

The Case Cliff, is where if I can support 47 people in our intensive care unit here, you know, I've got the staff to do it, the expertise in terms of our doctors and nurses and support staff who really understand the very, very sophisticated, complicated medical practice of intensive care medicine. And that is great. 

But when you overflow that intensive care unit -- they can open up more beds and call them intensive care units. But now we're starting to see the staffing is diminished. And I can tell you, personal experiences, we have seen intensive care units throughout the country where they would have one intensive care nurse, very highly trained, incredibly talented, who would care for a single patient because they were that complicated in terms of their clinical picture. 

Now, today, that same nurse is responsible for five cases, with two junior nurses to help support her or him in that activity. And when that happens, when you hit the Case Cliff, it's not just about beds now. It's about the expertise and what you have for access to care. And I think you're going to start seeing case fatality rates increasing again, just because of the fact that some of these hospitals are just overwhelmed. And that would be a real tragedy for that to happen.

MICHAEL MORELL: OK, vaccines. Several questions here. Is getting to a vaccine guaranteed? If we can get to one? How long will it take to get to one that we know that works and is safe? And how long for enough doses to go around? So, in short, tell us what we need to know about vaccines here.

DR. MICHAEL OSTERHOLM: Well, since we have the next seven hours to do this… [laughs]

Well, let me in a snapshot say that, yes, I think we will get to a vaccine. More than one, in fact. And what is still unclear as to how well they'll work and how safe they'll be. That's going to be the huge challenge. And how soon will we know that? 

The issue right now is we know that, just on the preliminary data that we have from at least four or five vaccines, you can make this neutralizing antibody, the kind of antibody that's most protective. You surely may elicit a response from your T cells, another type of cell that is very important in supporting the immune response. 

The question is, what we don't know is how long that kind of response lasts. And is it something that despite the fact that recent studies show that the antibody levels dropped precipitously after a clinical illness, at least we're still looking to see what happens with vaccines. Are we, like the other coronaviruses, going to be compromised in terms of long term protection? 

So surely we'll all take a vaccine that may work only 50 percent of the time, or 60 percent of the time. And we even may take it if it only works for six to 12 months. But those conditions are going to be really critical to understand in terms of just how applicable such a vaccine will be for the world. 

You know, we have to revaccinate eight billion people over a year, or even more frequent to maintain protection. And that's a challenge that's very different than just, Does the vaccine work? Well, it works sometimes for so long. 

The second piece of this is going to be safety. We still have lots of questions about the safety issues here. Not that I'm suggesting that there's going to be safety problems, but we have to answer that. And I think we've played into the worst fears of the antivax crowd with the idea of Operation Warp Speed. That was the worst name. Whoever came up with that name, I wish they would have retired because it gives people the sense that we will just, you know, do everything we can to get to a vaccine status, including walking through, running through, blindly ignoring safety concerns. And, you know, we can't do that. It just can't be done. If we have one safety concern with a vaccine, it will have a measurable impact in a very negative way and all of our vaccine work. 

So I don't know when this vaccine or vaccines are going to be available or how well they'll protect. Those are all big questions yet. 

I think the final piece is, how well can we anticipate a vaccine coming and start producing doses even ahead of time? And what does that mean? And I think that's still a huge challenge on a global basis. You're gonna be hearing about, this month, vaccines from China, vaccines from England, vaccines from the United States. How, on a worldwide basis, do the supplies match up with what we need? Do you actually have, for example, enough vials, enough syringes? You know, a vaccine is just that: doesn't mean anything until it's a vaccination, when it actually is in the individual. So I think that's still a challenge, too. 

And I can just say at this point that, you know, stay tuned. This surely would be a miracle game-changer if we could find a vaccine that was safe, had durable immunity, that required very infrequent dosing again or boosters. But I don't know if we're going to find that. And I think that's what we're all waiting for.

MICHAEL MORELL: A couple of questions about public health policy. The first is something that I've actually heard from folks who say something like the following: 'Epidemiologists say that this is not going to stop until we get to herd immunity. So why social distance? Why not speed up the process of getting to herd immunity?' What's your response to that sentiment?

DR. MICHAEL OSTERHOLM: Well, there's a price to pay if you speed it up. The price is: a lot of people are going to get infected. And a lot people are going to die. 

And I think even recently, with this surge in cases that has happened in the United States in young adults, we're now seeing that the overlapping epidemic of obesity in young adults is putting a lot of young adults at a very high risk of serious disease and dying. And that that by itself, people hadn't necessarily anticipated the big impact that would have. 

Also the number of cases where we're seeing spillover today from young adults who are infected, who then infect mom and dad, or grandpa and grandma, or colleagues at work, where now they are at high risk of having a serious outcome. 

I'm aware of a situation near my hometown where I grew up as a boy, where there was a graduation party held in June and they had an indoor party activity as part of it. And everyone showed up and there was an outbreak that occurred, transmission that occurred of the virus there. And in the past week, both grandpa and grandma have died as a result of their infection, having attended the graduation party. 

Those were the kind of consequences that will be very real and have, I think, an impact in a way where people say, 'Is that what I really want to do?' 

So our job is to try to do the following - and I've said this on my last time with you here, Michael – we're trying to thread the rope through the needle. What we're trying to do is not destroy our economy, not destroy our society as we know it, but at the same time, limit transmission as much as we can so that we can get to, basically, a time where we'll let vaccine do the work of achieving that herd immunity. 

And, you know, I think one of the things that we now have the data for, look at the countries in the world that have done that – that they really acted on the data. They did drive it down sufficiently so that they then could do test and trace effectively, and that they could hold back this number of cases. 

You know, here we are in the United States, 70,000-plus cases a day. And I look at countries like Germany and others where there are 200, 300 cases a day. You know, we have missed the first opportunity to do something here. I hope we don't miss a second opportunity. 

Just to give you some perspective, to get to herd immunity in this country: If we know today that about 15 percent of the cases that occur are ones that get tested and reported -- So if you look at the number of cases we have today in the United States, over three and a half million cases, that actually represents about 24 million, almost 25 million actual infections. That's still only about seven to eight percent of the state of the country's population. 

If we look at what it would take to get up to herd immunity in the United States, 60 percent of the population infected, hopefully protected, that would mean 65,000 cases of reported infection every day for the next 365 days. That's what it would take. That's what I don't think people understand. That's what we're up against. Unless we can come to our wits and say, 'We got to contain this, we got to do a better job,' which means you don't have to go back and revisit what it means to to shut down or slow down and get these case numbers at a much lower level, and then test and trace our way into the future.

MICHAEL MORELL: So, Doctor, if you were advising the president, what would you tell him he should do? Would it make sense to call a do over here and start again and shut down the country for two weeks and then start testing, contact tracing, et cetera? Is that what we should do?

DR. MICHAEL OSTERHOLM: Well, the first thing I would do is something maybe not obvious and some people would maybe even frown upon it. But we need a Winston Churchill moment. We need an FDR moment. We need to bring everyone together and say, 'This is us versus the virus.'

Now, I'm not naive. I've been in this business for 45 years. I understand the issue of politics and partisan nature of things. But if there was ever a time we could minimize the partisan issues, whether it's about wearing masks or, you know, any other aspect of opening schools, how we do that -- now is the time for that. And if we could just all come together to say, 'How are we gonna do this?' 

And that's -- if you look at countries where they've been successful in getting this under control, that has been one of the most important leadership qualities of the individual in that country, was to help people all understand, 'This is us versus the virus. It is not going to last forever. If we can get it taken care of now, we can minimize the impact and then go from there.' So that would be number one. 

Number two is just what you just said. We have to understand why we're going to need some short-term pain again. And I understand the pain. I've had a dear friend lose a business. I know many people who've been out of jobs, who are desperate right now for work, single moms who don't have the money to pay the rent this month, and they can't go back to work because they've got three kids and the schools may or may not be meeting in session, but rather online, and the only backup care they have are grandpa and grandma who are both at risk of serious illness, and they're beside themselves. I understand that. And I know that we have to address that. We have to address that in a meaningful way.

But having said that, we're going to keep going through what we're doing right now if we don't change our approach, meaning, get these cases from, you know, 100 to 120 cases per 100,000 to below that of a few cases per 100,000. And then we can move through for the next six, eight, 10, 12 months, however long it might be, in a much, much more safe, relaxed and financially/economically stable world. And so I don't know any other way to do it. And I know people get upset when they hear me say this. I'm just the messenger. I'm not the message. And I think people just still have a hard time understanding it.

MICHAEL MORELL: What about what about the school issue? What's your view on this school issue in the context of what we just talked about?

DR. MICHAEL OSTERHOLM: Well, several things. First of all, we have to educate our children. I mean, this is a critical part of it. But we also have to understand we're in a very unusual period of time. And for the next year, I hope we all can come together and just acknowledge that there is no one right way to do this. It's going to matter where you're at in terms of the number of cases that are occurring in the community. It's going to matter what age the child is. 

We have to protect our children, but we also have to protect our teachers and school-related employees. And we have to protect our families so kids don't bring home a virus from school that then might infect mom and dad or grandpa and grandma in another big way. 

And so, first of all, my one response is, Please be flexible and understanding. I am so impressed with all the school superintendents I've dealt with on this issue -- and there've been many. Same with their teachers. They all want to open schools. They want to be back with their students. But they realistically also have challenges with that in terms of safety. 

And when you look at the number of teachers in this country or support staff who not only are older, but who also have underlying health problems, about a fourth of all the teachers in this country today are people who would be at high risk for having a bad outcome if they got infected. So how do we protect them? 

My bottom-line message is, this should all be locally decided. I think school districts and of themselves are the experts about their populations, their students, their parents, their faculty, staff, and we need to let them make the decision. It should not be a top-down decision. Everyone wants to get our students back. 

Number two is, I think it's really important that we understand if there was anything we should be supporting right now, it's helping schools do that. And that's going to take federal support now. They can't wait another four or five months. We're trying to get them into school now. And so I can't emphasize the urgency of moving, you know, the money from D.C. to the States and then to the local schools. It's got to be done. And if they don't do it, we're going to have a challenge. 

I mean, I find it very hard that, you know, we can support bars and restaurants right now in a way that we're doing much more than we're supporting schools. And I think if there was anything we're going to be remembered for is how we handled schools in the end. And when they look back on this pandemic, you know, 10, 20, 40, 50 years from now, one of the areas it will be examined for is how did we handle our health care delivery, who got access, and how did we do schools? I think those are the two things we got to remember.

MICHAEL MORELL: So, Doctor, one last question here. Given everything that you just talked about, given what we know and don't know about the virus and the disease and our likely policy course through at least the end of next January and American culture here, how do you see this playing out? What do you expect between now and, say, the end of January when at least the leadership question might change?

DR. MICHAEL OSTERHOLM: You know, I, I don't know. Nor does anyone. But let me just give you a scenario, I think, that's going to come more important every day. You know, you and I are busy people. We're driving down the freeway late for a meeting and we're going, you know, eight miles over the speed limit. But we're late, so it makes sense. And then we come upon the scene of an accident where they're trying to extricate somebody from a car. And, you know, we see it and our heart starts to race and we slow down and say, 'This is nuts. Why am I doing this?' OK? And I'll be going the speed limit for the next 24, 36 hours, and then I'm kind of back at it again.

On the other hand, I get a call at 2:00 in the morning and one of my family members who I love dearly has just been killed by a drunk driver. And you know what? I never forget that the rest of my life. I make it my life's passion to deal with that issue. 

And I think what's going to happen is, is that as much as we hear about COVID and what's happened in our various communities and people may kind of come upon like the extrication scene I just talked about, I think we're going to see all these counties, all these states that were once red or blue by somebody's definition turn into COVID-colored. And I think over the next few months people are going to have very different attitudes about this when their loved ones begin dying and then they realize, 'Oh, my, this is real. This isn't an argument anymore about some rights or civil rights. This is about real lives.' 

So we'll see what happens between now and January. But I think this particular fact of life is going to have a big impact.

MICHAEL MORELL: Doctor, thank you very much for joining us. And just a reminder to my listeners to check out your podcast. It's absolutely terrific. Great education. Thank you. Thank you so much.

DR. MICHAEL OSTERHOLM: Thank you, Michael.

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