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COVID-19: The New Reality | SXSW 2021

Michael Osterholm
Director at Center for Infectious Disease Research and Policy at the University of Minnesota
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SXSW 2021
March 17, 2021, Online, Austin, USA
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About speakers

Michael Osterholm
Director at Center for Infectious Disease Research and Policy at the University of Minnesota
Jane Sarasohn-Kahn
Health Economist, Advisor, Trend Weaver at THINK-Health and Health Populi Blog

Dr. Osterholm is Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP), Distinguished Teaching Professor in the Division of Environmental Health Sciences, School of Public Health, a professor in the Technological Leadership Institute, College of Science and Engineering, and an adjunct professor in the Medical School, all at the University of Minnesota.In November 2020, Dr. Osterholm was appointed to President-elect Joe Biden's 13-member Transition COVID-19 Advisory Board. From June 2018 through May 2019, he served as a Science Envoy for Health Security on behalf of the US Department of State. He is also on the Board of Regents at Luther College in Decorah, Iowa.

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Jane is a health economist, advisor and trend-weaver supporting organizations at the intersection of health, technology and people. Jane advises on strategy via environmental analysis, scenario and strategic planning. Jane works with all health stakeholders: technology, life sciences, providers, plans, retail, food and consumer goods. She founded the Health Populi blog in 2007. Jane sits on many advisory boards and is a frequent speaker. She’s been named one of the Top 100 Influencers in Digital Health, one of the Top 100 Influential Economists in the World, one of the Top 5 Women in Healthcare Blogs, one of 40 Healthcare Transformers, and one of 25 Health Care Leaders You Should Follow on Twitter, among other kudos. She holds an MA (Economics) and an MHSA (Health Policy) from University of Michigan. While Jane loves her work, she is even more passionate about family and home, Slow Food and her local CSA, and living a full and balanced life. Follow Jane on Twitter @healthythinker.

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About the talk

A Conversation with Dr. Michael Osterholm and Jane Sarasohn-Kahn

. In 2017 when Dr. Michael Osterholm published his book, The Deadliest Enemy, he cautioned that the world was utterly unprepared for the next pandemic. Despite clear warnings, the unthinkable did become the inevitable. One year into the COVID-19 global pandemic, we are still grappling with mask shortages and public safety messaging and now challenged with the distribution of the COVID-19 vaccine. Joined by health economist Jane Sarasohn-Kahn, Dr. Osterholm will speak to the SXSW community about what is next in the fight against COVID-19. From the immediate concerns around new variants to the "collateral damage" we face from this pandemic, Dr. Osterholm and Ms. Sarasohn-Kahn will share insights to help navigate public health in 2021 and beyond.

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SXSW dedicates itself to helping creative people achieve their goals. Founded in 1987 in Austin, Texas, SXSW is best known for its conference and festivals that celebrate the convergence of the interactive, film, and music industries. An essential destination for global professionals, this year’s online event features sessions, showcases, screenings, exhibitions, professional development and a variety of networking opportunities. For more information, please visit sxsw.com.

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Hello South by Southwest friends and welcome to the new reality. A conversation with dr. Michael osterholm in me, James Harrison Cohn since the emergence of the covid-19, pandemic. I think we've all search for sources of Truth, and constancy and science, fact. And I am delighted to have the opportunity to speak with one of my True. North Stars dr. Michael osterholm from the great stage wrath. That's the center for infectious disease, research and policy at the University of Minnesota and the first quote from 2012. He gave us was the following to the

Minneapolis star-tribune. He says dating back to Hippocrates influenza influenza has been one of the Lion, King's of infectious diseases dr. Osterholm has a way of making data and concept accessible like using that Lion King phrase and he's my calming voice in a storm. So I don't welcome dr. This is South by Southwest conversation out of the new reality. Well, first of all, thank you very much for having me. I'm actually very honored and humbled to be here with you and happy to share. We can in terms of the new reality and looking at the

covid-19 situation. So I'm looking forward to our conversation. You know, I have to do first stuff, we're going back to an Oster home quote from very recently. 2020 in December, you were talking with CBS News, and you said, the challenge we have right now is the Last Mile. And the last inch. The Last Mile meeting getting covid vaccine out to the people who need it and right now state and local Health departments have no resources to do this. So, we're here at South by Southwest, which is I said, has a film festival and get

vaccines all over. The country has been compared to like a Hunger Games situation, Hunger Games, the covid Edition. So, here in the new reality, dr. Osterholm How do we fix the Last Mile and the last inch? I'm happy to report actually. It is getting better. I did a podcast in early December before the vaccines were being sent out from the operation, warp speed activity as part of the previous administration. And let me just make a comment about what happened under operation warp speed. This was a very Innovative and frankly

comprehensive effort to move a virus as we know it to a vaccine to an evaluated vaccine to a manufactured vaccine and then basically sent out to the state that really was remarkable and I'll come back to that in a moment about the issue of the name. But the challenge we had is the vaccine in just literally got dumped in the states and there had not been any financial support to plan for how to move this vaccine, into those who most needed it. On top of that, not only did the State Health departments and will cause problems. Have resources, but that the federal

government changed the ground rules, The last moment when they had been telescoping, those to the fact that it was probably going to be essential workers that we're going to get the vaccine first and then all the sudden changed it to healthcare workers and those when living in long-term care. So some of the planning that was done no longer was applicable for this moment. So that's created a challenge and the electronic systems to collect people's names to get them signed up. None of that really existed in the way that we needed it. So, that was the last mile that was a real challenge.

Now, that is changing still. The rib challenge is not having enough vaccine for the people who want it. And then there's a second problem, this developing and that really goes to the issue of the last inch. But I said that in early December, I was thinking about the fact that a vaccine is only a vaccine. It doesn't become significant. It becomes a vaccination tells in your arm that last inch of the needle into your arm. And we know that there are number people They want this vaccine, there's not enough to go around, but when we do meet the needs of that group, what we're really

concerned about is that there are a number of people who won't take the vaccine, which could have big impacts in our communities and terms ongoing transmission. For example, we have data now showing anywhere from 20 to 40% of healthcare workers are saying a few months and see what the safety looks like on these vaccines. We see in the communities of color, particularly in the black male population of Great hesitancy to take this vaccine and yet some of the highest rates of covid-19 are in that group. And this is all because of the fact that when operation warp speed to started but had

a horrible name that made it sound like somehow safety was being forgotten with the idea of speed or something, you know, Star Wars like event. Then on top of it, the military were involved from the logistic standpoint, but this appears to be a military vaccine and then, of course was right around the election. There was a lot of debate about the vaccine come out now or not in people, talk to do is actually a political thumb on the approval scale when there really wasn't. So all of that right there gave it a really, really bad name, but then on top of it, we're now using a new technology

to deliver the vaccine. A technology that actually has been studied for many years and one that I think is really a major Advance called messenger RNA mRNA vaccines, which does use genetic material to help the piece of material. We want your body to respond to to get into the human body and and make that happen. It doesn't have any impact on your jeans. It doesn't have any impact on any of these aspects of your own genetic yet. The issues right now, they're about misrepresentation. Disinformation about this is scared. A lot of people. So my big concern is after

we get this initial Rush of vaccine out for all the people that want it, We're going to be sitting here saying, I'll wait a minute, we've got a lot of vaccine, where are our customers? Where are the people who we got a lot of work to do to make sure that we get as many people in this country and for that matter around the world vaccinated will now I think people listening and can see why dr. Osterholm is a clear voice here, dispelling, some myths, really need to be devant. So we've we've talked for the first few minutes about some of the clinical virus and

logistical issues. So confounding all of that complicating, The Last Mile and the last inch is that the Pentatonix affecting so many other aspects of Our Lives. Besides the clinical physical, there are the economy of course or a social and civil issues that have come out looking at this as you talked about vaccine hesitancy and the blackmail and general black community justifiable reasons of History. Social determinants of health. So you were quoted in the May 2018. This is a prescient man. You said a

pants would be the least of our problems. It would be natural damage. We have to deal with, and we're doing nothing and then you noted, it's a different world. Today, we came to Public Health, the way we did at twenty Thirty forty years ago, you said public health is a never-ending investment need. That's what I want to focus on now, cuz we have a new Administration in Washington and new Secretary of the Treasury. Janet Yellen was talking about going big on his estimate in general. So does America have the appetite to go big on public health investment? Do you

think you fit in this game a long time? So, I'm interested to see what you think about a location of investment for Public Health. Well, thank you for actually doing a very good job of laying out the topic for me and you did a lot of my work. Let me just say that what you've hit upon is one of those issues that you kind of scratch your head sometimes and say, you know, why are we so penny-wise? And pound-foolish, if you look at any of the major Economist today in this country, they'll tell you that if we can do anything to bring this pandemic under control, I don't care how many

billions of dollars it cost to do it because in fact, it'll be cost-savings. That's what public health is about in a less than 3% of the US budget for health, goes to public help preventing problems from ever happening. You know, I say over and over again and when I was the state of the allergist, at the Minnesota Department of Health, I used to tell her staff, you know, the job that you do here everyday is the reason why a mom, or a dad gets to kiss her kid. Good night tonight, and talk him into bed. That child is there because of something you didn't know. I don't know it. They won't know

it. You won't know it but what you do weather and safe food, safe, Vaccinations all these things that we do that basically prevent problems from happening. And now I think we're beginning to understand that with this particular pandemic. The other thing they were really beginning to understand is the fact that I had an illness is much more than that is. You very kindly stated from one of my previous post. I was quoted recently in the Atlantic saying that we're trying to get through this pandemic with vaccines, but without exploring our soul. I can't tell you how much I think this

pandemic is opened up our souls. First of all mental health over the last year we all have suffered miserably some much much more today. We have to understand the mental health toilet that has taken us in and start right up front with our health care workers who have been there day after day. After day after day, trying to save lives, you know, just a few months ago I had an intensive care physician one of those. Real kind of you call Macho, guys who has served in the military, who had done a number of tours of Duty in the war zones of the, of the

Middle East and Afghanistan. And on this particular evening is telephone call. I had with him, he broke down because he said, I can't do this anymore. I'm broke. And I can't do this. And he explained to me, how just that very day, he has had the four different occasions uses iPad to let family members outside the hospital, watch their loved one died because I can't do this anymore. Well, that is happening all over. One out of eight American families. Right now, our food deprived financially people have been ruined businesses, have been ruined. I've take it

with some real. I asked what I hear people say to it, while she told people dying, you know, when did life somehow lose its quality or his character or its value. Because somebody was old, when I look at the issue of racial disparities, and the fact that this has just reported Lee, affected are committed to color the bipod Community. Why? Because they're many of our essential workers. First of all, they had to go to work. So you and I could post it on Zoom or that we can get our food through the grocery stores. In addition, their living

conditions. How do you tell somebody to basically quarantine when you're a single mom living with your mother and three young kids in a one-bedroom apartment, just trying to keep food on the table and a roof over your head. And now you lost your job at the restaurant because they had to close. So, I think one of the issues that were also learning, is it? Public Health when it is done. Well, and preventing these kinds of situations from occurring. Actually has a spill over into so many other parts of our Lives. We don't even think about all the things I just

talked about think how they might be different today if this pandemic had been controlled right from the start if it hadn't happened like it did. And so I think this is a very important message today and so hopefully we will see investments in public health in the future. New vaccines, a new ways to basically control these diseases. How do we do? Testing better? All those things, if we pay for them, now, it'll be much cheaper than we have to pay for them later during a pandemic. So I really appreciate you asking this question. I think it's such an important one that if there's any lessons to

be learned from this pandemic, it's we don't want to do this again, like this amazing points and important for us to think about what I want to bring up, which is a quote about Not a Sprint. So we've talked about the fiscal investment of capital investment, are we, we have the stomach to spend on public health, but we've also invested last year, in terms of time and mental health, as you point out. So you said to the post Washington Post last April, just a couple months into this

country were unprepared mystically. But mentally for the next phase of covid 4, a Sprint and a marathon are very different and as a country, were utterly unprepared and then you compared as we weren't, we were talking about earlier off-camera, you compared the pandemic to a forest fire and more recently to a cat's a category 5 hurricane. So here we are in the hurricane and as you've been talking about very recently, the variance We're in the midst of trying to get vaccinations into people. We have vaccination hesitancy and we're in a hurricane. So can you talk to us about what this new

reality be over the next few months? You don't love me, just start by laying out what I think, has been a critical lack of understanding right now. And what I call shifting bass lines, when you think back on this pandemic, when it began to look at the really first moments, when I think people begin to understand, its significance was in April. When at that time, New York was a house on fire. We saw increased cases in Chicago, Detroit Atlanta and New Orleans in Seattle and parts of Southern California. But most of the country really kind of

yawn and said, what's us all about? We got to 32,000 cases a day in mid-april and already said, boy, this is as bad as going to get. This is terrible. Then we did all those things to try to reduce case is the distance to anything shut down we only got down to 20,000 I say only it wasn't like we drove this 2-0 believer. Twenty thousand cases on Memorial Day. Well then pandemic fatigue that situation where I'm kind of done with it. I'm done, I don't the viruses but I'm done. And then pandemic, anger, that piece of society that doesn't believe the pandemic is real, and it's just all a political

kind of event and when that happened together was just people doing their daily lives. We saw from Southern California to Southern Georgia into South Carolina house on fire event in July, these dates were dramatically impacted and guess what happened? We got the 70,000 cases a day in Late, July much higher than the 30, mm before. But then we drove that number back down. And we got it down to about 26 to 28 thousand cases by Labor Day. And many of us could see this coming in facts right around

Labor Day. I was publicly saying that we're likely to see two hundred thousand cases by Thanksgiving. No one. No one wanted to hear that, or believe that. Well, guess what happened? We went back into a tailspin, the Upper Midwest in particular. The first week of November, we had two hundred thousand cases, add a report in the United States. Then we got a little better for a while. It's in the northern Central States. Started to slow down number's came down to a hundred and sixty thousand people to die without a new lower base. Remember, when the base used to be twenty

thousand for the lower base while we're out a hundred sixty thousand. Guess what happened by? December 8th, we were back up to a hundred. Two hundred thousand cases by January 8th, we are back up to 300,000 cases not remember that. Baseline 30 mm cases, seem unbelievable. We could all argue while I wish we were there. We look at where we're at today. Today, we're sitting at about a hundred and thirty thousand cases a day. We're still talking about 3,500 yesterday and we still have 95,000 people hospitalized and guess what, the variance those new viruses we

just talked about where they have the mutations occurring, where they can do, one of three things or all of the three things, one be much more transmissible much higher rates of transmission in the community to they can cause much more severe illness or three we even have one now. They can evade the immune protection of natural infection or vaccines and some of the variance contain, all three of those, we have a variant right now, circulating widely in the United States, has just started to pick up. It's a UK variant is what we were saying in England throughout many countries

now in the European area and well as the Middle East and this is Rick havoc. If you look at in London, for example alone before they were able to bring this under control with a complete lockdown, I'll complete lockdown their hospitalization rate actually. The number that they had would have been equivalent here in the United States. If we actually had had a hundred and ninety thousand individuals Housewives, everyday, 60,000 more than we were at our Peak, which was then a tragedy, this is on the horizon. So when you raised the issue about the

hurricane, where I see is right now, you and I are sitting on the beach with some colleagues friends, neighbors, whatever and it's a crystal blue sky up there you know the waves are coming in from the ocean. Very gently, the wind is blowing very very softly, it's 80°. We're having a great time and I'm sitting there saying we got to evacuate, we got to evacuate and people look at me like what? What what they can understand is that category 5 hurricane is 450 miles offshore and is coming in. I worry very much that what we're going to see happen in the next six to 12 weeks will

be this UK variant taking off here in this country. And again, remember the baselines. We're starting from a much higher spot. Now, they know we're not falling off the curb. Now, we're falling off the roof. And so, if we see a big burst in cases, on top of already a high Baseline, we've got some tough days ahead. Now, the vaccines are coming, they're here and I mentioned earlier that some of the variants may actually defeat some of the protection from the vaccine for sure. We've not had any evidence he had in this country that we're seeing widespread of either of those variance to do

that. So we're now I'm basically trying to get as many people vaccinated as soon as we can, so we have fewer people that would be impacted by these new variant. Should they take off. So you're absolutely right. In terms of trying to understand the future is often very, very difficult but to ignore it is also at our own peril. I have one for you and you've talked about love. You said to Meet the Press in October about love. You said, this is our covid year talking about 2020 less accept it, it's not like last year and

hopefully going to be like next year now. So if you really love the people that you have in your family through this and do them, the greatest gift of all and that is distance yourself this year and don't expose them. The folks is South by Southwest call to action group of makers and doers so I know they'll want to know from you. What is the call to action for each of us to take on to help make this better? What can each of us do for each other for help for health citizenship to come through this

in a loving kind of away? Well, thank you for that opportunity because it is an opportunity to say. I think. There are two things you can do. Number one, be kind in the Ostrom update. I emphasize that every week we need an epidemic. A kindness right now because it is by far, one of the most powerful tools we have in dealing with this virus. That means doing things that you wouldn't normally think about doing be kind to yourself and and we are seeing a pandemic, a kindness right now that is not making the virus go away, but it makes a living with it, a better place. And so I I

can't say that new may sound kind of funny to you make kind of Market who's this guy, you know? But I'm telling you, I've had more people say to me, you know, it's gotten the gotten into a new groove, a new way of looking at life every day, I say find one way, you can be kind of people, you know, it may not even near people but what you do, how you do it, the notes, you sent what you doing, say and what you do say. So be kind Second thing I would say is the fact that love those who are around you and if they're not protected Don't Put Them In Harm's Way. I have had far far far

too many situations a family's getting together out of pressure because even though some of the family didn't want to get together because of the fear of infecting grandma or grandpa, or Mom or Dad if it was an anniversary, was their birthday or something there for it was compelling and it's very compelling, went three weeks later, one of them dies because somebody unknowingly brought the virus home. And, you know, this is at covid year again. It's not going to be like next year. We hope so very much. And so the ultimate Love In some cases is doing hard love for yourself of a void in that

contact. Now if you can basically quarantine yourself for 10 days or if you've had two doses of vaccine, any of those things then get together, we'll get through this vaccines are coming. I wish there was more of it here now than there is, but they're coming. And I think that The message of Hope and that we're not going to let this virus take assign. Let me just conclude by a story. I told opening last week's podcast, it was about the Battle of the Bulge a very famous battle in Europe. That occurred some months after the D-Day invasion and which American troops were surrounded by a stone in

Belgium. And they were basically in pretty bad shape. The German Commander sent a note and demanding that they surrender and that they do it immediately or they would be under immediate fire and of course, just losing many lives, General collar, who got the message, looked at it and said, nuts nuts. And that's what they sent back to the Germans who couldn't figure out her first what it was and that was his way of saying this is crazy. I'm not going to and they held out 3 Days Later George Patton and his tank Battalion came rest of them

and and that's it. Story that allowed us to move forward in the end of World War II. My message, she was nuts to the virus nuts to the virus. We're not going to give in and I think that's the message we all want to take away. I love that your home. Thank you so much for sharing your wisdom and please everyone subscribe to the Oster home update covid-19. I got no given that game but it'll be worth your while. Derosier home be well and everyone go forward. The safe be well, and be loving. Thank you for joining doctor. Oster home in me.

Thank you.

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