1779 Michael Osterholm

The Joe Rogan Experience.

Train by day Joe Rogan podcast by Night, all day.

Joe Rogan

Doctor Osterholm welcome back

Michael Osterholm

Thank you very much

Very good to

Joe Rogan

See you again

Michael Osterholm

Good to see you

Joe Rogan

It's been basically two years from the day, and I think when you were on the podcast

For a lot of my friends that was the first real fear that they felt about the pandemic

You scared the **** out of a lot of people?

Michael Osterholm

Well, you know my job is not to scare anyone out of their wits. It's to scare them into their wits and to do what they can to deal with the situation is, you know at that time, March 10th of 2020 no one wanted to believe this is going to be a pandemic

And so

Joe Rogan

Yeah, there was a lot of denial about how it was going to play out and people were thinking that it was

Inflated, or it's not that big of a deal

And then, like I said, when you came on the podcast that, like I got a bunch of calls from friends

Like going Jesus

Michael Osterholm

Yeah, I think the understanding of where we've been, where we're at, and where we're going still, I think isn't really completely

Clear where we're going

Joe Rogan

In particular, right now, as an infectious disease expert, it's very rare that you have an opportunity during your lifetime during your career to examine

A pandemic and to be through it and examine the responses to the pandemic

You know how when you look back at it, what mistakes do you think were made and what do you think was done correctly?

Michael Osterholm

Well, first of all, let me just say that one of the things I think that's been missing from a lot of the response that we've had so far

Is an incredible sense of humility

Humility every day

When I get up the first thing I do is I look over at my night stand and I see this crystal wall that has five inches of caked mud on it

And I try to scrape it off and then decide what do I know for the rest of the day

And I think that we've had far too many answers before

We really had the answers

And while we always want to use that term quote follow the science, I think we didn't do a good job sharing with the public and even within ourselves

What did we really know and not know?

And what did we have to do to learn more?

So I'd say it's humility

Joe Rogan

Do you think?

That it's overwhelming like the reason

Is there a reason why they didn't do a good job sharing the information with the public?

And do you think that some of that might be just the fact that being involved in something?

With such a massive footprint, something that literally overwhelmed the entire planet Earth

That there's so many variables, there's so many things to deal with

There's so many things to manage that that became part of the problem

Michael Osterholm

Well, you know, Joe. I think that if I had to look at it, there were days that I felt like I was trying to plant my petunia's in a Category 5 hurricane

I mean, it was just one of those situations where there was so much going on

Look at the politicization

Look at the misinformation disinformation

I mean, look at the debates

They often work really about the substantive issues of what was happening

And so we had a lot of these counter current issues and the question was what do we really know or not know about this virus?

I mean, I'm sure there are people after I'm on here today

They're not going to be happy at all with what I have to say because I don't think we're done yet

And as I said, a year ago, right now, a year ago, right now, when the world was basically seeing the curve come down from that

Early January peak

And the vaccines were flowing that we were done

Everyone wanted to declare independence from COVID

And I said, no, I think the darkest days of the pandemic could still be ahead of us because of variants

These variants are really challenging. We don't know what they're going to do. They kind of like 10110

Mile an hour per balls

And so I think that even going forward, we surely are in a better place right now, and we're going

To be this for a while

But I don't know what the next variant is going to bring and will it evade immune protection?

Will it mean that the antibody the immune response we've had so far the vaccine protection we've had so far?

What will it be like with the next variant?

I don't know that maybe it's going to be fine

Maybe we're going to see it become a regular old flu like illness every year

But maybe not

And I think that that's the challenge we have is that kind of humility to say we don't know, and that's what's been a real problem trying to help the public understand it because we've had far too many answers when we really

Joe Rogan

Didn't there's an inclination to think that because Omicron is so much more mild than delta?

That this is where the direction of the virus is going, is that correct?

Michael Osterholm

That is the sense, but there's a couple of assumptions there that I think really deserve

Comment number one

The term it's a milder disease was really unfortunate in the sense that it gave everybody the sense that across the population it's a milder disease

If you actually look at what happened, let's say you had 1000 cases of delta and 100 of them would show up in the hospitals, have severe illness and die. Someone would die. Well, then along comes Omicron instead of 100, only 10 people

Get serious illness or hospitalized

You say this is a much milder disease

The problem was you have 20 times as many cases occur

So actually your health care systems are much more overwhelmed

I mean, it wasn't just the total number of cases it was a severe cases and the last 12 weeks have been among the most severest weeks of the pandemic

And it's just because the sheer number

And so I think that that's one thing

First of all, this was a mild disease for a lot of people, but for a whole lot more it wasn't

I think #2 is the fact that you know we don't know what these variants are going to do

They could be milder again, but you know we're in a very amazing place right now with a virus where when you look at its original source from a human to another human

Early on in Wuhan, but you know it had to come from an animal of at some point

Well, now we're seeing all kinds of animal species infected with this virus

Look at what's doing with white tailed deer

I mean, in my 46 years in the business, I've never seen data like I've watched the emergence of this new variant in in wild deer

Joe Rogan

Yeah, it's very strange, right? I mean it's some in some places as many as 50% of the deer

Michael Osterholm

Have antibodies, yeah

Well in fact, even if you look at studies like in Iowa

Where they followed it and actually looked roadkill deer

So that was really random it across the state they actually found looking for the actual virus which was a delta like virus that it actually paralleled the exact experience in humans

So as the numbers in humans went way up, the number of deer went way up where

Joe Rogan

Are they getting it?

Yeah, that's the question, right?

Are they getting it from the captive service industry?

Michael Osterholm

Well, I don't think it's there

Joe Rogan


Michael Osterholm

I think it's something because it's a statewide even where you don't have captive servants

They were seeing the same increase in decrease in cases, so I think what it's really pointing out though, is is that if you look at all the other animal species that get infected and then you look at the potential for humans to continue to get infected

I don't know what the next variant is going to bring and no one can tell you that

And if they do, be careful 'cause they probably have a bridge to sell you

So you could have one

It gets milder and we surely have 4 coronaviruses right now that typically cause milder disease called like symptoms

Maybe it'll go that way

On the other hand, it may reassort, meaning that it swaps out its genetic material like a flu virus

Those with other coronaviruses and we could see a new punch

It could actually evade immune protection

We don't know that, so I think the challenge we have is just being honest with everybody

This is the guardrail

One side is it could go back to another Omak, Ron, like experience, or that may be the last one

I hope for the

Last one being the mild one, but hope is not a strategy, so you got to look at what do we need to do to be prepared and right now everybody in this country wants to back away back off and say we're done, which I want to too

I feel that, but at the same time I have to say

I don't know that we're done, just like I said a year ago, I thought the darkest days were

Still ahead of us

Joe Rogan

Now, when you say that so Omicron is far more contagious than Delta, and far, far more contagious than the original

Michael Osterholm

Variant yes, right?

Joe Rogan

Now, when you say that maybe you know whatever numbers that you used that it's less

Likely to cause hospitalization, but because it's infecting so many people, you actually get more hospitalizations

Michael Osterholm

It's exactly

Joe Rogan

So what are what's the cause like?

Why are some people getting badly hit by it whereas other people it's just a runny nose?

Michael Osterholm

Well and we don't know

We do know a couple of things about protection

Number one is if you've been vaccinated, particularly if you've had the third dose

If you've previously been infected, which also does add to your immunity, clearly those obviously work in your favor. If you have some of these underlying health issues that we've talked about, which you know it's not just about being in shape or not, you know people with diabetes, people with asthma people are immunosuppressed, or 7.5 million Americans right now that are immunosuppressed, either because

Of the disease

They have they're being treated for cancer

All those people

Are at much higher risk of having severe illness and even what we saw with kids, we had never seen this level of activity as we see all with all Micron with kids

And so I think the challenge we have today is hospitalizations

Joe Rogan

For hospitalization

Michael Osterholm

Yes, even for hospitalizations

Joe Rogan

Now the kids that were hospitalized did all of them have comorbidities?

Michael Osterholm

Many of them did

Joe Rogan

So many, some of them were not even obese

Yep and they were hospitalized

Michael Osterholm

Absolutely really

Yep, Omak, Ron clearly really took a hit on kids

Joe Rogan

That's interesting because

In my kids school, a few kids got home across and it was essentially like me or my friends who got it was very mild

Michael Osterholm

If you look at it right now

Through this up till this past month with most of this activity having been primarily in the last six weeks, 13134 kids between the ages of 0 and 17 have died from COVID

Joe Rogan

13134 kids and out of these kids, how many had comorbidities? How many were obese?

Michael Osterholm

Some, some did but but, uh, comorbidity is not just obesity

Joe Rogan

Just some right?

Michael Osterholm

Yes, in fact, let me come back and say somebody who has diabetes is considered having a cold humidity

If you look at somebody who has asthma, which

Which you know about 7% of all the asthma in

The countries and all sorts of autoimmune

Like that, so all of those add to it right?

And and so that's been part of the real challenge we've had

Joe Rogan

With this, but for normal healthy kids, is this something that's more dangerous than delta?

Michael Osterholm

Absolutely, it was

It's absolutely absolutely

It was

Joe Rogan

That is, that is that shocking to you, because it seems like for adults it the the effect that it has on the general population

Michael Osterholm

Yeah, yeah

Joe Rogan

It seems that the consensus is that it's more mild

Michael Osterholm

Yeah, I think that's one of the challenges we have. If you've known the COVID-19 pandemic in 2020

And you knew it in 2021 doesn't mean how well you know it today because things have changed

Joe Rogan


Michael Osterholm

For example, if you look at the infectiousness in kids, the early data we had on how well this virus transmits and kids was before we ever had the alpha variant, which showed up in roughly December of 2020 in two to January 2021

And we found limited transmission in kids limited severe illness

Then Alpha came along and we saw much more transmission

We had places in this country that had large outbreak school based outbreaks then that kind of went away

Then Delta came and added even more transmission with kids than we had seen before in Omak

Ron was the king

And so I think if you knew COVID-19 back in 2020, you didn't necessarily know it today in terms of the infectiousness and what we saw happen

So I think that's one of the challenges we have is just keeping up to date and what it did and how it did it with kids

Joe Rogan

And the variance as they like

So there was the original version and the alpha version is the first variant that was discovered

Michael Osterholm

Well, yeah, that's they what they've labeled them by is the Greek alphabet

So Alpha was kind of the first one there and then we've had subsequence

Joe Rogan

But not not

Not a not the original virus, but the first variant of

Michael Osterholm

The virus, yeah, well what's really interesting with this virus is the fact that if you look at we call the ancestral variant, the one that originated in Wuhan

All the subsequent variants we've seen have actually all gone back in their roots or in that ancestral variant

It doesn't mean that if you had elf, it turns into a delta with a little bit more changes

It turns into Omicron

Every one of them have a distinct line back to the original variant, and that's one of the challenges we have because that's going to continue to happen

Where we're going to continue to see these new variants show up?

Joe Rogan

And as far as the variants that are in play right now, like what percentage of the the infections right now are omicron, what percentage or delta is there any of the original variant left?

Michael Osterholm

The original variant surely is out there because we keep seeing these new variants come from it, so it has to be somewhere

I can't tell you where it's at, but it's really

Joe Rogan

The variants don't come from like Delta, creating a new variant, so it's

Michael Osterholm

It's actually takes take you back to the original variant

So the question on Omicron Sigma issue and right now in the United States, virtually 100% of the variance we see our Alma crime

They've taken a

Joe Rogan


Michael Osterholm

100% in the US and virtually around the world. It's beating out Delta completely

If you look in the United States, there are three sub lineages of that variant. What we call BA1BA2 and BA3 and we're watching a battle going on right now between those subvariants and it turned out BA one was the original 1

We first saw kind of the original Omicron, but BA2, which appears to be more infectious now, is beating out

Almost crime in some countries in the world, it's become the dominant variant in the United States, is still a small percentage, but it's growing

Last week it was 4%. The previous week was 1%, so we don't know what that's going to mean in terms of seeing more of the BA2 variant emerged

Joe Rogan

How do they make the distinction between?

Omicron Delta Omicron and then BA1BA2. Why do they decide that this isn't another variant? Why do they just keep calling it Omicron?

Michael Osterholm

Yeah, and and and this is one of those questions where I clearly I'm not the world's expert on the overall genetics of those virus, but I'll tell you that the mutations that occur surely can accumulate if you look right now

For example, there's more difference genetically between BA1 and BA2 than there is between the ancestral virus and alpha

Really, yes, so it has to do pretty much how it evolved out of that ancestral virus tree

And is it different enough?

And so you know, there's been discussion that there may actually be some effort made to consider BA2 as a new variant of concern by itself, so, but but this is, I think, the message here is. This is what we have to continue to be mindful of

I know everybody wants me to say today we're done and I hope we're done, but as I said, just a moment ago

Hope is not a strategy


Michael Osterholm

I think that we could still see the emergence of new variants that could challenge the immunity that we have already, which is what makes this virus so difficult and so different that we've had before

When you see influenza

Pandemic influenza occurs because a bird virus finally vowels out of the bird gets into particularly a pig because a pig has lung, so it has receptor cells for both human viruses and bird viruses, and when they get into a pig cell in particular, they combine

They mix up the flu

Viruses are very promiscuous and they come up with this brand new strain that causes the next pandemic

Well, when that spillover occurs into humans, that's kind of the Seminole event

The rest of it emerges pretty much in humans

We don't necessarily see us giving it back to the animals. They give it back to us. We give it to the animals, they give it back to us with. Looking at SARS, Co. V2 and the and this particular coronavirus, we don't know what it's going to do. Is it going to?

Go back and forth between animals

I mean I could line list an entire set of all the animals that are now infected with this virus and we don't know what that

Joe Rogan

Means the first ones that we found that transmit transmit from humans to animals or back to in in terms of SARS, Co. V2 was it ferrets like. What was the first animal that they discovered?

That humans can infect and they can infect us with

Michael Osterholm

US, well, there was game animals, mink and so forth in Europe that we saw that, but it became clear because we started seeing zoo animals infected just this past week

We've heard about lowland gorillas, cats

Joe Rogan

Cats and stuff, yeah

Michael Osterholm

We've seen dogs and cats in peoples homes where there were cases and they got the white tailed deer

I, I think there's a whole number of animal species where ultimately they could be infected with this virus, and the trillion dollar question we don't know will that in any way shape or form contribute to a a spill back moment into humans with a new virus that again will challenge our immune systems challenge, our protection?

And what does that mean and

We just don't know

Joe Rogan

Is that the term they use by law or animal reservoir?

Michael Osterholm

Yes, absolutely, that's it

Joe Rogan

So that's any other animal that can catch it now is that is it

Michael Osterholm

Well, catch it and keep it going inside them

So sometimes an animal may get an infection from us and it's terminal

It ends if that doesn't keep going in the animal population, but as we just talked about the white tailed deer, clearly there the virus is ongoing with transmission in the deer population itself

Joe Rogan

Are there any examples of an animal being infected and then like from a human like a human giving it to their cat for instance, and then the cat giving it to another human?

Michael Osterholm

You know it's

Unclear, and when I say unclear, there was surely some data looking at the game farms, where there was thought that some of the transmission was from human to animal animal back to human, you say game?

Joe Rogan

When you say game farms, are you talking about like captive kovid captive cervid rather?

Michael Osterholm

Can we talk in this in this case in this came what we're talking about, our primarily fur bearing animals for pelts

Joe Rogan


Michael Osterholm

Mink ferrets that type of animals

Joe Rogan

So that's where they first started to see the

Transmission in fit

Michael Osterholm

Well, the it's

Suspected it's never been confirmed, but it's been suspected there

There's been some discussion and follow up on peoples homes where somebody got infected

The animal was infected, or the dog or the cat and somebody else got infected in the home

Well, it could just easily been person to person

The animal is incidental, so I don't think we have any

Good examples of a human to an animal and an animal back to a human

There was a recent outbreak in Hong Kong

It's now emerged into a large outbreak where they thought that hamsters were potentially being sold in pet stores were involved with being infected and transmitting, but I think the data still are out on

Did the hamsters really transmit back to people they were definitely infected?

But I don't know if they transmitted back

Joe Rogan

To people now this virus or are there parallels to other viruses that we could look to and and see this kind of similar pattern emerging, but particularly with like?

Transmitting it into these other animals and then the potential of those these animals transmitting into the people

It seems like there's so many different species that have it

Michael Osterholm

Yeah, you know, we really don't have one like this particular that can cause such widespread disease

I mean, when you think about Omicron, for example, you know when this first emerged in November, I coined the term of viral Blizzard

'cause to me it that's what it looked like was going to be

It was just going to flood the world

If you look at Alpha and Delta and all these other, it took weeks in some cases months before it spread around the world

This one spread around the world literally overnight, and you know we're now seeing major activity in the Western Pacific region

You know in

In Hong Kong

Likely in China we're not hearing enough about it, Korea etc

But most of the rest of the world has already been hit hard and over it

Well, that is like a Blizzard. What it did we've not seen that with any other animal related virus in humans, even influenza hasn't done what omicron's done in that way

Joe Rogan

Now in the beginning of the pandemic you were of the opinion that this was from a natural spillover from the the origin of SARS

Co V2 was most likely from an animal that it spilled over into human beings. Do you still have that?

Michael Osterholm

Well again, let me clarify what I said and and have maintained all along because I too have concerns about the potential for what we call gain of function or or clearly bio security of laboratories leaking out of of labs

I had have not seen any evidence at all that would support the number one

This was a man made virus

Absolutely none, zero, no

Joe Rogan

Evidence that would support that it is a

Man made virus

Michael Osterholm

None, none whatsoever, and I again with my limited expertise in viral genetics, I believe the people who I work with now the question is, could it, however, been in that lab?

And spilled out because somebody got infected

There was a lab accident which surely can happen

And again, we don't have any conclusive evidence that that happened

I think even anecdotal evidence we've had has been very short, but I'm the first one to say I wish we'd had a much more exhaustive investigation into what happened at that laboratory, which much more transparency

I don't think we've had that kind of a transparent investigation yet

To see were there sick people at that time, because if it was going to spread out into the population, there would be sick people

On the other hand, I'm not surprised that it might have emerged in Wuhan, because here is a, you know, an area of over 40 million people living in that whole area for which their food sources come from hundreds to up to 1000 miles away, of which the open markets

There are ripe with the kind of animals that very well could have brought the virus there

And when you look now at the ease at which this virus goes between animals and humans, at least initially or in humans, or back to animals, it's not surprising that it might have emerged there

And so I'm still open to the fact that was it a laboratory accident

I don't have anybody reason to believe it was an intentional one

I know it was

Based on everything we have, it was man

Joe Rogan

Made, but I don't think anybody thinks it's an intentional release do

Michael Osterholm

They no

Well, some people have no

Some people think they shouldn't say yeah, yeah yeah, yeah

Joe Rogan

Well, Carla, I shouldn't say anybody

Some people believe the world is flat

Right, there's some stuff

Michael Osterholm

That's absolutely true too

That's absolutely true too, so I think no, that

But I think that it is fair to say that there still remains this question

Could if it leaked out of that lab and I continue to say I wish we would have an exhaustive, comprehensive investigation, which the Chinese Government would agree to

Joe Rogan

Is that part of the problem, a lack of transparency?

Michael Osterholm

I think it is, but let me let me paint a picture here

That also helps explain the situation

Imagine a brand new virus emerged in the Caribbean

OK, I mean, it came from nowhere

It might be a mosquito borne something OK

Where do you think they might find?

That virus first

Atlanta why Atlanta?

Because it's the it's the transportation hub for the Caribbean

And they have the sophisticated laboratories

They're not even at the CDC, I'm just talking about universities etc clinical

Imagine if that virus was found in Atlanta, a brand new virus

The assumption we made immediately

It came from the CDC

Because it's there, she graphically there it's in Atlanta that has to be

The source I see

What you're saying, and so if that were the case, imagine the Russians and the Chinese saying wait a minute

This was a lab leak out of CDC

We want to come and investigate

We're going to come in and see

Do you think the US would just Willy nilly open up the lab at the CDC to the Russians and the Chinese?

Joe Rogan


Michael Osterholm

So in some ways I I'm not being sympathetic at all of the Chinese because I think they are continuing to make the problem worse by not providing more transparency

But at the same time, if the same thing happened in the United States, I could see where we wouldn't just open up the CDC to everybody in the world to say OK, come on in and look

Joe Rogan

Right, but is the CDC doing gain of function research on coronaviruses?

They're not, they're not well, so if something emerged from there, that wasn't something they were working on, that would probably not arouse the suspicion of the world

I think part of the problem with what's going on in Wuhan was that lab is a Level 4 lab that was working

Bat borne coronaviruses

Michael Osterholm

Exactly, no, you're absolutely right about that

But at the same time, CDC might be working on a lot of the viruses that would emerge in the Caribbean, and they would have labs that were working in that because some of their best expertise is on, for example, mosquito borne viruses in there


Michael Osterholm

So I'm I'm merely pointing out that

It's not just the fact that the Chinese have basically stonewalled us, they have

And unfortunately, I think that that can be interpreted as you know, there's definitely guilt there

Joe Rogan


Michael Osterholm

I think some of it has to do with this issue

They just opened their lab up

I just wish they would and let us let that an independent group from around the world go in

Examine all the records

Was there any evidence of illness around that time?

Was there any unusual activity you know the viruses they have?

But they've self reported were not any that were close to this one in terms of actually

Yeah, that actual virus was in the lab that was suddenly found in Wuhan, so I

I think it's, uh, continues to be a major distraction

Joe Rogan

Wasn't there recently a a version of the virus that was discovered? A very early version of COVID-19 in one of the labs?

Michael Osterholm

A big way

There's been a number of of SARS Co V2 like viruses there, but again this is out of my area of expertise

But the viral Genesis I know would say there surely is not the direct link yet that that virus came from that virus in the lab

And so I think that but, but that's the kind of thing we need to have the transparency on and

And I wish we'd move on

Joe Rogan

That's what slack would

Michael Osterholm

I wish we'd

Joe Rogan

Move on then

So the part of the issue is that there's just not enough data from them to make an accurate, honest

Clear determination

Michael Osterholm

That's what I see and I do see a virus that right now sure is very effective at moving between people 2 animals, so it doesn't surprise me that it could move from animals to


Joe Rogan

Humans now

People that are suspicious that this did come from some game gain of function research

They point to that as an indicator that this is a virus that was at least cultivated in a laboratory, right?

Michael Osterholm

Yeah, and I see no evidence to that and let me just come back and add a context to this

I sat for a number of years

On what was the newly established

The basic group inside of the federal government to look at bio safety and bio security work. OK, the National Science group that did that and you know, for all the years from 2005 to 2012 that I was on that

I was one of the really outspoken people about my concern about doing influenza work in labs where they were trying to understand virus H5 N one, a bird virus that occasionally infects humans, but could it one day become the next pandemic virus in a group of researchers wanted to try to gin up that virus by passing it multiple times and ferrets and looking to see

Can we predict when it might become readily transmissible between mammals, i.e., could infect humans and my concern was all along wait a minute?

What happens if this gets out?

What's what's the challenge?


Michael Osterholm

You could start the next flu pandemic, so I have always considered myself kind of the champion in a way of bunk stothers of looking at bio security as a really critical issue, so I

I come into this with the Wuhan experience feeling the same way

I think this is an important issue

I think it needs further discussion, but again, I don't see any evidence at this point that anyone has provided that shares that this is what happened, but I think we just need that transparency we don't have

Joe Rogan

Yet so there's not enough evidence to draw a clear conclusion in your opinion

None, no. There is some anecdotal evidence right? There was some. I believe there was three researchers at the Wuhan lab who did get ill with a very similar disease to COVID-19 and one of their spouses wound up dying and there was some indication that that could have been the initial source

Michael Osterholm

And I

Yeah, you know, let me first of all just say, in my world, anecdotal evidence is not really evidence

Joe Rogan


Michael Osterholm

You know, it's it's, it's

It's not storytelling, but you know, I see some of these things

Yeah, and you know, I've never seen any of those data cooperated by any responsible group

It's kind of 1 off

You know

It's kind of that whole idea

You know, President Kennedy, secretary was named Lincoln President

Lincoln Secretary is named Kennedy

So there must be a tie between the two assassinations

You know, it's that kind of thing

Joe Rogan

Right, yeah?

Michael Osterholm

I've seen nothing that supports that activity

Joe Rogan

OK, so as a scientist, you're just not willing to make

Michael Osterholm

That leap I'm not willing to make the leap, but I'm willing to make the leap if we get the evidence that it's there

Joe Rogan

If you have the other answer

Michael Osterholm

So I'm not sitting

Joe Rogan

Here saying write it off right, I get it

I get it

Yeah, in the the early days there there was some evidence that was deleted

There was a lot of files that were deleted from the Wuhan lab

And that a lot of people pointed to that as being an indicator that there would not not just not being transparent, but withholding some data

Michael Osterholm

Yeah, I at this point I can't comment on that to say I know exactly what happened

There surely was some evidence that there had been some files moved or deleted

Also, there's been evidence that some of those files have been replaced, et cetera, so I I can't comment beyond that

But again, the people that I most respect in this business who have concerns like I have have not pointed to that as being

Any evidence necessarily that that's what happened was that there was data that they wanted to get rid of, so people wouldn't

See it right

Joe Rogan

It's just again not enough, right is?

Michael Osterholm

That what you're saying

Yeah, in fact, I wouldn't even say not enough

I would say I'm still waiting for even a limited smoking gun to come forward and say that I just haven't seen

Anything like that?

I'm open to it, I'm willing to it

I've said time and time again

I wish that there are Chinese would allow for an exhaustive outside review of what happened there to cooperate

All these pieces of information or basically show that they're not true, and I think that would put us all in a better place

Of trying to move

Joe Rogan

Forward is there proof that they deleted evidence?

Michael Osterholm

I don't have any proof of that, I I would I don't know you don't know

I don't know if

Joe Rogan

There was proof that a lot of files were deleted

Would would that give you?

Michael Osterholm

Pause well, I'd want to know why you know we delete files all the time on research things after things are completed

On the other hand, laboratories typically are keep everything forever

You may have to go back to it at a later date so you know I I can't comment on that other than to say that should be pieces of evidence or pieces of investigation that would address that now



Joe Rogan

One of the things I think that you said early on in the pandemic was you didn't think that it would, that it had emerged from a lab you thought it was a natural spillover, just simply because of the design of the virus itself that we wouldn't design something like that

Michael Osterholm

Yeah, and I still say that that's the case

I mean, this thing is so effective at infecting humans and it only got better over time

Think what it did in Mother Nature since the first omicron or since the first variant occurred up to Omicron, and you can see it just got better and better at infecting humans without any hand of a man made

Event and so this thing was an evolving virus right from the start that was basically capable of infecting humans and got better at infecting humans

As time went on

Joe Rogan

So the accusations?

Or the people that think that it was made in a lab?

How do they think that something like that would be created?

And why do you think that that's not the case?

Michael Osterholm

Well, again, this is out of my sphere of expertise

I am not the person who can tell you from a genetic standpoint how to manipulate this virus and want to do it as an update geologist

I can tell you, you know, I've seen these other spillover events I've been very involved with investigating SARS back in 2003 when it first emerged in China, spread around the world. I've been very involved with the work with MERS, the Middle Eastern Respiratory Center another


Michael Osterholm

Coronavirus and in each one of those you can show clearly the spillover event from animals to humans

In fact, with the camels being the Bane reservoir for MERS in the Arabian Peninsula, we keep having MERS cases because nobody is going to put down all these camels

You know we're not going to get rid of them, and so we watch those spillovers occur from time to time into humans

So corona viruses emerging out of an animal reservoir in of themselves are not unusual

It's not somehow like a + B + C Plus miracle ended up with the answer, so I haven't seen anything that would tell me that that was any different than that

But again, I'm wide open to whatever new data can come forward, and I hope we do exhaust

Look at those

Joe Rogan

Now when they perform gain of function research can you can you explain how that's done?

They're they're using different coronaviruses and and various viruses and infecting human respiratory tissue

And they're also doing experiments on ferrets because they have very similar

Base two receptors to human beings

Right is that the case?

Michael Osterholm

Yeah, I can't comment on what research they're doing

I don't know you

Don't know?

I don't know that

Joe Rogan

But you do know how gain of function is done right?

Michael Osterholm

Well, gain of function

First of all means that you're adding something to the virus like I talked about with influenza was a gain of function

We were trying to see if you could make it transmissible between, in this case an animal species and a human, or you're trying to make it so that it is actually more infectious

Or you're trying to make it so that it kills it

It does more damage, and those are all considered parts of gain of function

In other words, trying to make it do something else, so in terms of the coronaviruses, I've not seen any evidence of again gain of function because this virus is pretty damn functional on its own, is doing very well

And is teaching us by just watching it, how it's changing to become almost a sense of a gain of function of Mother Nature

Joe Rogan

Right, but the way that these experiments are done are when they're infecting human respiratory tissue

When they're infecting ferrets, and they're doing it purposefully for these experiments, aren't they allowing selection and evolution to do the work for them?

I mean, I don't necessarily think they're manipulating the virus, aren't they allowing the virus?

To go through its normal processes, but they're doing it purposely, right is

That the case

Michael Osterholm

Yeah, in the principle of what you laid out, that's the case

What I'm saying is I don't know that they're doing that

I have not seen any evidence that it could exist

I just don't know I

I'm not trying not to answer doing any of those studies where they're trying to make it more transmissible, or that they did do that

Joe Rogan

You don't know that they're

Michael Osterholm

I just don't know

Joe Rogan

I thought that was the entire argument that that even the NIH had laid out that they had done

Michael Osterholm

Well, that had come up and as you know, equal alliance, the group that was doing the work just Equal Health Alliance actually

Joe Rogan

Ecohealth alliance

Peter daszak

Michael Osterholm

Just yeah, just agreed with that

So that's not what's being done

Joe Rogan

They said they disagreed with it

Michael Osterholm

Yeah, and I so I can't comment I

Don't know, right?

Joe Rogan

Because this was like the argument between Rand Paul and Doctor Fauci, and you know it was get very contentious about the definition of gain

Of function

Michael Osterholm

Right, right do you think?

Joe Rogan

It's just splitting hairs

Or do you think this?

Michael Osterholm

Is well, I think anytime you consider getting a function for any virus, it's an important issue because of the potential for it to do more harm, particularly if it's accidentally released, which can happen

Again, I don't have any first hand or second hand knowledge that that was what was being done

In Wuhan, but

Joe Rogan

If they were doing gain of function, that's how they would do it

They would infect human respiratory tissue

They would infect various animals and they would study how this virus progresses and how it evolves and selects

Is that the?

Michael Osterholm

Case, well, that's one way to do gain a function, but because I'm not a coronavirus viral agist, I can't tell you if that's what they're doing with this or not

They have done that

I just don't

Joe Rogan

Know right and do you know if someone or laboratory had done something like that and they had gone through these steps to use evolution in terms of like infecting this human respiratory tissue?

Infecting ferrets who have the similar HT receptors that this would somehow or another?

Make a virus more more

Michael Osterholm

It transmits yeah yeah yeah you know

Joe Rogan

Visible to people

That's the idea behind it

Michael Osterholm

Yeah and again I just

Come back to the fact that

You know you don't need to set up a research study today to do gain a function with this virus

Watch it in people, watch what it's doing on

Joe Rogan

Its own

But that's once it's been released, correct?

Michael Osterholm

That's once it's been released

Joe Rogan

But what if we're if we're looking at the origins of it?

I mean, this is what's concerning to people, right?

Yeah, they're wondering like was this?

Avoidable like is is like during the Obama administration, didn't Obama put the kabash on gain?

Of function research

Michael Osterholm

It was limited in the sense that it was for all gain of function of research on how you actually were going to go about doing it and showing the safety steps you had in place to make sure that

That it couldn't be

It would be

A release, a good example is we do want to know if flu viruses leave a mark that says we're about to become a human to human transmitted virus so we can plan for that

So we do want to do some of this, but we want to do it safely and what I'm suggesting here is I don't know what happened in this lab or how it did it

I'd love to see that transparent information come out

I just can't comment

Joe Rogan

Is it safe to say that?

That this kind of research is important to understand how these viruses evolve, how they become more virulent, how they can infect people and jump species that it it has to be done safely, but it's

Michael Osterholm

There's benefit, there surely can be benefit, and there's risk

And this is all about the risk benefit equation, and I think that's what the whole purpose of what the NIH evaluation was of

When can we?

Declare that there's a benefit here, and this is the risk, and we can actually address the risk and therefore the benefit is worth doing

And you know you can't unring a bell, so I'm one of those people that am very concerned

I don't want to find out later

I wish we had taken more caution


Michael Osterholm

OK, my problem is I for this discussion I just can't comment on what happened

Because I don't

Joe Rogan

Know of course, well you're a scientist

Then you look at the evidence you look at it, it has, and there's just not enough of it, right?

Is that safe to?

Michael Osterholm

Say yeah and and I'm open to any new information

As I said before, that comes forward

Joe Rogan

Did you read any of those emails where there was discussions that was were about the narrative of whether or not it had come from a lab leak and deterring that narrative?

You read any of that

Michael Osterholm

I did not, I didn't, I you know I didn't really, you know if if something substantive come out, but I, you know

You know, I already spend way too many hours today working on coding


Michael Osterholm

The last thing I have time for is basically getting into these

Ticks, you know, as you know

I mean it, it's

Oftentimes, the kind of almost entertainment debate about wait

He did this

He did that

Who did this?

What did that and trying to trace it all back?

And so for me, you know if there's substantive information I want to read it

I want to know about it

If I can't understand it, I want to ask people who do know because there's a lot of the parts of this as I said

With humility I don't understand as an update geologist I think I have a pretty good handle on what the virus is doing in terms of how it acts in people, but this particular area really does require a really level of scientific excellence in this area, for which we have people who have continued to pursue this, and so we'll go for it and I would like to see what they come up with

Joe Rogan

So as an epidemiologist, you are just trying to follow the facts of disease and avoid the weeds

Michael Osterholm

Exactly and and and and and be really clear about this is that

I think that

We have to have these discussions with how we have them

They have to be based on data

What we can't do is more

You know, it's like the candidate Lincoln analogy

I just used and now it proves the point

So therefore analogy assumption as well

They are linked, let's I can tell you the CIA of you know of the 1860s were still active back then. They're still active in the

Kennedy era, you know, that does not help, and to me that's where a lot of people find they spend time

I don't

Joe Rogan

I don't know if that's a good analogy, like see what you're saying, but we actually have the the actual people that were trying to say that it seems like this is coming from a lab and then and these were credible people from legitimate universities and then you had some other people that were trying to say we need to disparage these people and we need to

Look at them as if they're fringe conspiracy theorists

Michael Osterholm

Yeah, I think in the early days that happened in a way that

Joe Rogan

Why would happen?

Michael Osterholm

You know I can't comment

I wasn't part of that discussion

I did not get involved with that discussion because I felt like it was a, you know, it was in the weeds in a way that you know, I was trying to figure out what this virus is going to do to kill people and how I could stop it from happening


Michael Osterholm

So to me again, I will let the experts who have that kind of expertise deal with it, and rather than he said, she said

I just I stay out of it

Got it

Michael Osterholm

That's why when I tell you what I know, you better count on

It's true when I tell you that I don't know something, then you can take that to the bank too

Joe Rogan

I believe

Michael Osterholm

And say he just didn't know

Joe Rogan

I appreciate it

What about what one of the weird things is of this virus in the early days was how many people were asymptomatic?

And you know

And it didn't matter

By age

It seemed like there was quite a few older people that were asymptomatic

That got it

And do you think what do you think the reason for?

Michael Osterholm

That is, I don't know and I can tell you right now that is a point of discussion I've had

Oftentimes with my colleagues, we do know that it's not like they tide to dose

Originally, and I was a coauthor in a paper

Joe Rogan

You mean by viral load?

Michael Osterholm

Yeah, by viral load, how much virus is there didn't dictate how seriously, at it, it doesn't mean you didn't get infected or not, and we're still looking at that

But it does indicate is clearly having these comorbidities adds to the likelihood that once you get infected, you're going to have severe illness

Right, but as you just pointed out and is absolutely true, we've seen people have comorbidities who've had mild disease

We've had people for unexplained reasons

We don't know why have had serious disease

Younger, healthy, no underlying comorbidities

You know, physically fit, and so

Generally speaking though, you can say that no

In fact, if you have these comorbidities, you are much more likely to have severe illness, but it's not totally the rule

There are those exceptions we see, and as I just mentioned these kids, you know a number of these kids did have comorbidities, but some didn't

And why they got infected and died

I don't know

Joe Rogan

Is it a?

Is there a parallel to any other disease that you've ever studied before or that scientists have studied?

Like, is there any disease that behaves this way?

Michael Osterholm

Well, clearly there are a number of viruses where the seriousness of the illness can vary a great deal by age

For example, let me just take one that is not a respiratory transmitted agent, but the virus that causes hepatitis A or infectious hepatitis

In young kids, this is often a very mild, totally asymptomatic infection and is transmitted from fecal oral

You know if you have diaper changing, etc

It's not

Hygiene is not there

We would often pick up outbreaks of hepatitis A

Because parents would come down with it and they'd get really sick

Their livers would be in trouble, you know

They get very yellow and jaundiced and we go back and test the child and sure if the child had been infected already and brought it home to mom and dad and so in a disease like that

The percentage of people who have serious illness who get infected and have illness in general

Is much higher than the older population that is in the younger population where it's almost a mild disease, so we have examples like that that do happen

It's not as if it's an unusual situation, and for some diseases the vast majority of illnesses are mild asymptomatic

You only pick them up by doing blood studies in populations for other diseases well

Rabies is of course, the classic example. It's virtually 100% fatal, and so it it varies across all the viruses we have

Joe Rogan

So is the the percentage unusual of people that are asymptomatic with this disease?

Michael Osterholm

Well, you know I

Think Joe, that's one of those questions again, that it kind of begs the very issue of what is this hours?

Co V2 virus all about because if you go from the beginning of the COVID pandemic to now look at how different

The ancestral variant illness was to alpha

The delta to Omicron it just in a matter of

Two years

Brian, I mean it's amazing how how much and the question you asked me earlier about the issue with Omicron, you know why do we see so many infections out there?

Because it's much more infectious

And I think that what we're watching here is a really real time evolution of a virus that you know we could never, you know, suggest for a moment that the measles virus is going to change a whole lot in two years

It hasn't changed basically in decades and decades and decades, so I think this is one of the challenges we have is that?

And when I answered your question earlier about what is the future of this pandemic, it's 'cause this virus keeps throwing 10210 mile an hour curveballs at us

And I don't know what the future is going to bring in

Maybe one of these variants is going to spin out of those that is going to again 'cause very UN large number of cases

Some of its severe and is going to evade the immune protection

That we have already

Joe Rogan

I've read some articles that seem to indicate that there there may be some immunity that certain people have because of previous infection

For other coronaviruses other coronaviruses meaning common coronaviruses that somehow or another that may have imparted some

Michael Osterholm

Yep, Yep

Joe Rogan

At least some kind of either immunity or some kind of protection from SARS, Co V2

Michael Osterholm

And that is currently being studied, and in fact, if you look at

The issue of just take

Immunity from SARS Co V2

If you look at the data for delta

You could actually show that basically those people who had previous infection did better

Than those who hadn't had previous infection and were vaccinated

I mean actually add more protection

But if you go back to Alpha

People who had previously been infected were more likely to get reinfected than people who were vaccinated

Joe Rogan

So people who caught the alpha variant could catch it again

Michael Osterholm

Yes, well everybody look at DD the same way people we have

Joe Rogan

People called delta more than once

Michael Osterholm

But it's not

I'm sorry I'm talking about when they actually have the

Next variant so people have who had had alpha did get delta people who've had delta got Omicron, and it's really too early for us to say what happens with BA

1BA2 can you get oh makrana second time we don't know yet, but so when I was talking about

For the alpha issue we were talking about people with previously been infected with the ancestral variant

Now actually with alpha

We're basically more likely to be protected by vaccine than previous infection

For Delta, if you had delta, basically you were less likely to be protected from vaccine and more so from previous infection, and So what is pointing out is this is a fluid situation and and we're still trying to learn with Omak, Ron

We had a lot of breakthrough infections with Omak, Ron, you know?

What was it that?

Protected you or didn't protect you with Omak, Ron, and and we're still really looking at that issue

Joe Rogan

And that is with people that have been previously infected as well as people who have been vaccinated

With Omak, Ron correct

Michael Osterholm

Right, right? So if you if you look at just hospitalization alone. If you were unvaccinated you had about a 79.6 per 100,000 people were hospitalized

If you were fully vaccine is only four point 4% OK?

Joe Rogan

So 79 people out of 100,000 were hospitalized or unvaccinated

Michael Osterholm

If you're unvaccinated and it was 4.4, if you were in fact previously vaccinated

Joe Rogan

Four people, 4.4 people versus

Michael Osterholm

For over 100,000 people

Joe Rogan


So a lot of people thought it was a lot higher than that, like there was an impression that when you got infected by SARS, Co V2, that there was whichever variant

Yep, that you had a high likelihood of being hospitalized

Michael Osterholm

Yeah, and this is for Omicron

Remember, we just talked about the fact that for many people who are infected, you know you didn't even get seriously ill


But for those that did, yeah, they were seriously ill

The number of deaths were elevated

Joe Rogan

Do you, do you think that there was a wasted opportunity to discuss metabolic health, metabolic health in terms of weight loss in terms of taking care of yourself and eating correctly, and vitamin supplementations and exercise?

All these things were kind of ignored during the pandemic

Michael Osterholm

Well, you know I'm

I don't know if I agree with that because I mean I surely have heard it over and over again that this was important, but it's important for everyday life

I mean basically whether you have

Oh Mccran or Delta or SARS, Co V2 at all? These are important things that you should be considering, OK?

Joe Rogan

Right, do you think that that was reinforced by the government?

Michael Osterholm

Oh, I think particularly around body mass index a lot, you know?

Oh yes, I think

But I mean, I've, I've

Gave many talks where I was talking about

Joe Rogan

You might have given many talks, but I mean this is not something that was like echoed by the White House where they were talking about it openly in


Michael Osterholm

Public hey folks, you gotta lose weight

Well, I think that if you look at

Just even the recent weeks in terms of the discussions about comorbidities and what they are, you have to separate out those ones which you can control, such as as you said, you know the exercise, that type of thing, those which are, unfortunately just a part of your health profile

Diabetes, asthma, autoimmune disease, autoimmune diseases, etc

So you know, I I fully support the fact that we should be emphasizing this issue around body mass index, meaning IE should lose weight

Joe Rogan

Obesity, it said, but body mass index is a weird one because like I'm technically obese

Yeah by the body mass index

Michael Osterholm

Yeah, and in that sense you're right, you're right, it's really about weight

Joe Rogan

And the weird thing about

COVID-19 also is the the way it attacks fat cells, correct?

Michael Osterholm

It can, and that can be part of the amplification of this immune response issue that we work on

Yes, absolutely

Joe Rogan

That is that really unusual or I mean, how much of a factor is obesity in terms of just a general immune system?

Michael Osterholm

Well, I can't say again I I'm not the expert in metabolic disease issues, but we know for a number of conditions that if you have increased weight

IE body mass index like measures that you are at a higher risk of having the additional problems because there is

From an immunological standpoint, some activity with fat cells that can surely enhance an over vigorous immune response and remember, with SARS, Co V2, it's a combination of directly what the virus does to impact you, but also

What does your immune system do?

One of the examples were all very concerned about

Today is long COVID

And with Long Cove, it is clear that that is not evidence that it is not evidence at this point

If it's ongoing infection, it's not that the virus is still proliferating and we just haven't gotten rid

Joe Rogan

Of it, so can you explain what Long Cove it is?

It's just

Michael Osterholm

Technically, you know I can't, and other reasons I can't

It's not 'cause I'm not even an expert 'cause most people

Can't it's a hole?

Series of different conditions

The brain fog, the fatigue, the cardiac involvement, the heart

You know as we see the heart, the lungs and it's not really clear what is going on

If you just take a step back, remember before COVID ever existed, we had chronic fatigue syndrome, a real condition and people were really suffering

Joe Rogan

And when you say chronic fatigue syndrome, is that something you can have a test for?

Michael Osterholm

No, that's the whole point is that it was kind of a general term, a catchall that basically covered people and most often it was associated with people who had had an infectious disease of some kind, which may have triggered this ongoing immune response so often

Joe Rogan

Is there a like a specific infectious disease?

Michael Osterholm

Well, you know, Epstein Barr virus has been often implicated as being a part of this picture, but what it's really pointing out is it's really about this ongoing immune response that we don't yet understand, and I think if there is any area right now that we need tremendous efforts

Joe Rogan

Well, the origin

Michael Osterholm

Put into it's long COVID you know there are these new centers starting right now to try to address this

You know, overall we estimate that there may be newer from 3 to 10%. Some say as high as 18 to 20% of people without regard to whether it was serious COVID they had or milder COVID go on and develop this long COVID

Joe Rogan

There's an interesting parallel with fighting

And I can talk to you about this with MMA fighters that some MMA fighters who have had COVID

Particularly ones that didn't

I don't know, I, I don't

I don't want to speak that they

I don't want to say that it didn't take it seriously

Maybe they didn't recognize that they needed to rest more and allow themselves to recover and they train through it

And guys that train through COVID-19 tended to suffer long term consequences from. It is several examples of this and

After those bouts of COVID-19, there's a thing that happens with fighters

At the very highest level and one of the things that I study with the UFC is I'm studying like the elite of the elite athletes like championship level fighters and just a small drop off of performance is is is noticeable when they face other elite athletes and you're starting to see some of these folks

That have had COVID-19 then competing and not looking as good. Eight year. Eight months later, a year later, post infection, and I'm wondering like what is this long Cove? Is this like a milder form of long COVID 'cause clearly they're in shape clear they look great

Michael Osterholm

Yeah, yeah

Joe Rogan

But when they're competing, they're not

Maybe some of them are not quite at the level that they used

To be

Michael Osterholm

Well, I think you raised two very important points when you asked me earlier about risk of going on in developing COVID and what the long term impact may be here, you got some of the finest fit people in the world

Joe Rogan

Yeah, that's why I

Michael Osterholm

So there yeah, I know

Joe Rogan

Brought it up you

Michael Osterholm

I think the issue around the immune response in the host and things like inflammation. You know the fact that the you can actually find that that your body's ongoing activity, and we've seen this with people who against chronic fatigue with chronic Lyme disease. People have talked about this kind of same concept and we really I think are

At the opening of what I think will be a huge, huge effort to really look more at long term impact of immune response on something once it gets triggered

Remember our immune system is like skating on a razor blade

You want to make sure anything that shouldn't be there shouldn't be there

But you want to protect everything you can that's yours, and you don't want anything to happen to it bad

And where that really gets interesting is for example in pregnancy, where you know that fetus is not totally all that mother, but at the same time the body is working to protect that more than it's done anything ever to make sure nothing bad happens to it

And when that dysregulation occurs

Where the immune system tips a little bit more in one side or the other

You can see ongoing problems, and I think that's what this virus is doing

Is is creating this environment where this ongoing immune response is occurring?

And I think you're going and and it's not just one thing, it's it's a series of different issues, but I think the most important messages is

And if anybody listening to this?

The effort here is that there is

People there are

People right now working on this and that

This is not something you have to live with, hopefully forever

Looking at drugs treatments

What can we do to deal with lung COVID?

But right now it's a daunting challenge and I think the example you just gave very well could possibly be a part of

A long COVID picture

Joe Rogan

Now long COVID as described as the way, the way we're talking about it is essentially people that feel like they're not the same now as they were before the virus

They never have recovered fully

Is that a fairway to?

Michael Osterholm

Yeah, I think it's it's really important

Joe Rogan

Or they were damaged

Michael Osterholm

It's really important to just

If you've spent

The last three and a half to five weeks in an intensive care unit

I don't care whether it was for an automobile accident or it was for COVID you have a long term recovery in at hand and it's going to take a while before you begin to feel like yourself again

You know what will happen so you have to distinguish that

Which is not necessarily

You can't get Long Cove it that way, but you also would just have that no matter

What where it's really becomes very clear is people who've had milder COVID

Who then, in the second and third week, thinking they're getting better all of a sudden start feeling tired?

They feel like they forget things. They're feeling this brain fog and that's where it's really most noticeable. Because these were people whose bodies were not quote UN quote, insulted in such a way with COVID to have mid bedridden for days and weeks

And you know trying to recover from that, and I think that's the one example where you can say

It's clear that there is an aftermath of this COVID, for which some people experience and some don't

I mean, I know many people who have fully recovered from COVID, and you know they are doing perfectly fine

Joe Rogan

No, so you're saying some people with mild COVID still show some sort of a decrease in in their physical response like there

Michael Osterholm

I've actually known people who had milder COVID, and they'll tell you that there Long Cove it was much more severe than when they had the acute infection

Joe Rogan

But what do they mean by that, like when?

Michael Osterholm

Meaning meaning when I had COVID itself, I was test positive I was tired, you know, but I was kind of around the house and you know not feeling that bad now here I am

8 to 10 weeks out and I some days feel like I can't get out of bed

Joe Rogan

So something happened

And do we know is it measurable?

Is this like?

Can you get a EKG?

Is there there's something you can show, whether they have a higher resting heart rate?

Michael Osterholm

All of those things

Almost all those come to play, and that's what these new centers that have been set up are actually studying

Is there a mechanism that can explain this or is it a series of mechanisms?

Why do some people have more cardiac and lung involvement?

Other people have more brain fog

You know where, clearly neurologically something is happening?

You know?

Why do some people feel such severe fatigue and others?

Don't so one of the things is there's not a hallmark of long COVID that just says if you have this symptom this symptom, this simple, you have long COVID it's a combination of different conditions that are happening to people

Joe Rogan

And are there any methods that they're utilizing that seem to be effective in treating people?

That have this

Michael Osterholm

At this point

Or just any emphasis on that, and that's as I said, just a moment ago, this is going to be a critical part of our ongoing efforts with COVID is just the study of and trying to understand what's happening

First of all, as you pointed out, we have to know why you're having these findings, what's going on, and then once we do that, what can you do about it?

Joe Rogan


Michael Osterholm

What kind of treatments could be effective?

And giving people hope because I've seen people who at 12 months after their COVID infection who are feeling like they've kind of lost their life

They they they don't have the energy to go to work

They don't have the energy to be with family and this this is really a challenge

Joe Rogan

And have you read anything about hyperbaric?

Therapy in relation to recovery from

I haven't you haven't no

If you've read anything about, is there anything else that stands out like stem cells or anything that they seem to think would be effective?

Michael Osterholm

I think right?

Now it's in that stage of just trying to define what it is you know before they can even know necessarily the interventions that they can look at

You know what are the markers?

How is your immune system operating?

Do you have evidence of certain immune markers that are elevated?

You know why?

Might you have some evidence of?

Some heart involvement or your lung involvement

So part of it is right now, just taking very seriously that long COVID really exists and that we're trying to figure out first and foremost, what might be the mechanisms that are causing it

And then I think you're going to see a large number of efforts trying to address treatment itself

Joe Rogan

So it's still ongoing

Michael Osterholm

It's still ongoing, absolutely, and you know one of the things that's going to be a challenge is to find out how many of the people had omicron, even in their mildest stages, that go on in develop Blanco

But we don't know that yet

Joe Rogan

It's such a strange term long

I know, yeah

You know, because

Joe Rogan

It's like you don't really have COVID you're you're COVID is done, but you have the deterioration of your your physical abilities, yes

Yeah, very strange, right?

Is there is there?

Michael Osterholm

Yeah, well, you know we saw it again

Joe Rogan

No disease, that's like that

Michael Osterholm

As I said with chronic fatigue syndrome, you know that's the term that many people have had to suffer with for years and years and years


Michael Osterholm

And you know, we didn't have the major research initiatives around that that I think COVID now is drawing the resources towards and hopefully you know people who have

That condition also can be helped by learning what what did COVID do?

Why did COVID cause us?

Joe Rogan

Are there any?

I know there's some new treatments that are on the horizon that Merck has and that Pfizer has

There's a bunch of different antiviral medications and pills that they're putting forth

Is there anything else that's I think there's also?

Isn't there an attenuated vaccine attenuated form of the virus?

Michael Osterholm

Yeah, well, first of all let me just say I think the treatment area right now is

A very exciting time in development

You know, I look back to my work in the early 1980s and HIV AIDS

And at that time, a diagnosis of HIV was a death sentence

Simply a death sentence

And with the emergence of drug therapies, even in the absence of a vaccine, we've taken HIV for many people to manage chronic disease

And I think that you know as we look at the vaccines as clear, we have challenges with waning immunity

How well will they work?

How many booster doses can you give et cetera and so vaccines remain really the foundational response for dealing with COVID, but I think the drug therapies are going to become

Really, really critical and we're learning more

I mean, for example, I know a topic that you have been of interest about and the the show that I've ever met and you know there are five big trials going on right now

They're going to be announced

The results in the next weeks to months that really have looked carefully at ivorra mekton, including high dose I ever baked in

And you know, I've again, as a scientist, reserve judgment

You know I didn't close my mind and say no, yes, whatever I want the data and we got to have these double blind placebo controlled trials

You know studies where neither the investigator or the patient know which they got, you know, and then objectively find out what's happening

I think there's a whole series of drugs coming down from

Several companies that surely have that potential if given very early and the one you mentioned from Pfizer, for example packs love it

While it has some contraindications with underlying health conditions that might already exist on a whole, it is really a very very fantastic drug

But the problem we have right now with that is that we have many, many places in this country where during the surge of all mycron I couldn't get tested for three, four or five days

Joe Rogan

Why is that?

Michael Osterholm

Because we just didn't have the testing capacity

Joe Rogan

See, that seems like something that would be much more easily

Michael Osterholm

Well, that's what I'm going to

OK, that's exactly

You you you you


Michael Osterholm

Hit my line for me

Thank you, OK?

Is the fact that we need a comprehensive system with surges, where in fact when a surge occurs you can scale up quickly

So if I need to get a test done, I can get it done the same day and get a result back the same day and then I can get into a system automatically

That makes sure I get these drugs

You know, if you're someone in the community and you know, and you know one of the things that I have been so challenged by, is what this is done by race

I mean, this disease has been cruel. If you look at the number of deaths you know if you look at blacks twice as likely to die from COVID as whites Hispanic 2.3 times as likely to die from COVID as whites

American Indian Native American 2.4 times

Joe Rogan

Isn't this?

Hasn't there been correlations drawn between vitamin D deficiency?

Michael Osterholm

There has been some and again, this is another area of study that needs to be done

But I mean if you look at these issues here, getting the drugs to those populations

OK, what can we do it?

Whatever their risk is, so that if you have a community where I don't have a doc, I don't have one

I don't have access to health care in general, you know, I I go to a community clinic

So what I think this whole issue around drugs, the point you just raised is really highlighting is now's the time to address this issue of health disparities and just generally our health care system. You know, we have a disease care system

A disease care system, not a health care system

And by the way it has been under attack for two years

It's it's, it's incredible what's happened

By COVID I mean what it's done to care in general and it was done to our health care workers

OK, so we need to take a look and step back and say OK So what could we do to improve on that?

Well keep the vaccines

But we know we're hitting a wall on that

OK, some people are just not going to get vaccinated no matter how we try to share the information

But we should be able to get people to understand if you do get sick

These are the drugs that can be helpful

This is how you get them quickly and try to reduce the hospitalizations of serious illness and deaths

And make this more of a treatable type disease like I talked about with HIV and the impact in the communities of color

For example, you know will be huge if we could do that and it would improve health care in general

So to me, that's one of the things I'm working on right now

Is trying to understand surge capacity for testing

Let me give you one last example

I think that helps illustrate this

If you look

At the fire departments in the state of Minnesota

One of the best well funded fire departments in the entire state is the Minneapolis Saint Paul International Airport Fire Department and thank God we have them

I support every penny we give them to cap that fire department going, you know, large number of units, people well trained

We've not had a plane go down there on the airport itself

Since its inception, any big plane, the two that did went down in South Minneapolis in the 50s and were handled by the Minneapolis Fire Department

Will we pay for that every day 'cause we wouldn't operate that airport without him?

We should be paying for test capacity

So if we have a lull in it, it doesn't mean that everybody gets laid off or we don't do that

We will use them for other things, but as soon as that surge occurs we could put testing back into place so everybody can get a test at first day and I don't care where they live

I don't care who they are, they can get on those drugs and Joe, we could do so much

To reduce, if not eliminate, the serious illnesses, hospitalizations and deaths just with that alone

Joe Rogan

Just with testing

Michael Osterholm

Just testing and then the drug availability

The drugs you just talked about

I mean, I think we're going to see more and more drugs become available that I think are going to have real positive impact

So I see this as kind of the silver lining

Of this pandemic, is that people are now beginning to do that, and we can do that around the world if you knowing about HIV drug distribution, you know some of the most remarkable improvements in health have been in Africa, where we've been able to distribute these drugs for HIV day in and day out

So we surely can do this for a COVID like situation, so that's what we need to focus on

And that's where we need as a globe

Global community understand how can we improve testing so that we make sure we get people on there and then how can we make certain that they

Get their drugs

Joe Rogan

Now you covered a whole bunch of things, so let's start from the beginning

First of all, you talked about testing

Now one of the things that I thought

Was shocking

I was watching this

Press conference where Ron DeSantis was addressing the claim that they had let a bunch of COVID tests expire

And that they were no longer useful

And I was like, wow, I didn't know COVID tests expired, so they have a shelf life

Michael Osterholm

They do, they do

Joe Rogan

Is that why is that?

Michael Osterholm

Because basically the reagents in there can degrade over time and you want to make sure you have exactly the right one so they do have

Joe Rogan

A shelf life, so they must be manufactured in accordance to the need, and they're going to have a surplus

And then you have to abandon those

But you have to keep up the

Michael Osterholm

Supply well and also it's not just surplus

But we do what we think called vendor management control

So you know you basically rotated in your shelf, so you have a place that says OK, I will help vendor managers product, so I'll make sure that of all the locations out there somebody is not sitting on some stuff and others are using more

I'll make sure that the most the one closest outdating gets out there and the ones that are

Joe Rogan


Michael Osterholm

Farthest back, basic out hold so that we don't lose and with vendor manage you can do a lot to actually reduce that problem

Joe Rogan

So that was the accusation from the Florida administration that they hadn't distributed those things they could have done that and got them out there before they expired, and it seemed like they

Were hoarding them?

Michael Osterholm

Yeah, and I and clearly this again is part of that whole testing issue is

Some of it's going to be search capacity because there's only so much you can actually put in surplus stock with the fact that some of it basically will in fact expire, and so then it's a matter of OK, so what's your surge capacity?

How do you then say I can bring on board and and you can't make it at the last minute?

It's kind of like if fire department goes out and tries to buy their fire truck with the 911

Alarm comes in and so you got to have people ready to go

You have to have manufacturing capacity to go

So when you have a surge, you can do that

Now here's the challenge

If you believe that Omicron is the last of the variance, you believe that COVID is done, why would you invest in that?

And that's where I come back and say, well, I hope it's the last one

But hope is not a strategy yet


Michael Osterholm

Gotta be prepared

What if another variant shows up the challenges again, we're going to have the same needs

We're going to have the same issues ahead, so we're going to have to plan

For that, what kind of shelf life do?

Joe Rogan

Those tests

Michael Osterholm

Have it varies

I can't tell you

Test by test, but it it it?

It's it's months, but it's it's not years

It's not years, yeah

Joe Rogan

Let's go back to vitamin D, sure

So when you were talking about how disproportionate amount of Hispanics and black folks and and and Native Americans, essentially people with more melanin in their skin, people with more melanin in their skin have traditionally had lower levels of vitamin D that live in urban areas, especially in like cold climates where they're

Cover it up

How much of a correlation do you think there is between low levels of vitamin D and and more severe code infection?

Michael Osterholm

Well, I can say that they're clearly have been studies done that demonstrate reduced vitamin D levels in cases coming in into the hospital

Joe Rogan

Was like 80

Percent at one point in time of people in the ICU had insufficient levels of vitamin

Michael Osterholm

Yeah and I can't comment at the question we have

With vitamin D, is it a marker for something else, meaning people who have adequate vitamin D?

Is it because of their behavior what they eat?

Is it because they have access to access to certain foods, et cetera?

What does that mean?

And so we still have to figure that out

Joe Rogan

Well, vitamin D isn't really like effectively supplemented through food, is it?

Michael Osterholm

But my point

Well, sunlight and some degree food, meaning I take a supplement

Joe Rogan

Sunlight yeah

Michael Osterholm

So I'm talking about taking a supplement

Joe Rogan

Yeah, OK

Michael Osterholm

You know, if you're if you're basically living from paycheck to paycheck and you're having a hard time just feeding your kids, are you as likely to go buy vitamin D to supplement?

That's what I'm saying

Joe Rogan

Got it

Michael Osterholm

And so it's that kind of issue there

So, but I think the point that you're raising here is, again, this is another example of what the kind of studies we need to say

Could that help improve?

You know, much like we did with niacin and milk and so forth

You know where we basically were able to show that we can get health benefits in some cases by supplementing

Joe Rogan

Fill they supplement vitamin D in milk

Michael Osterholm

As well, to some degree

Yeah well by black milk is just a higher level but but I think the point being is exactly what you're raising is

This is another example of can we have an indirect benefit to the public by learning those and actually helping people have adequate levels of vitamin D?

I think that's critical, but I do want to make one comment in this, so because I think this has been sometimes misunderstood about

Race and the issue of risk for COVID and for serious illness

If you look at the real correlation, which again is not cause and effect but is who are the frontline workers, who are the people that left largely unprotected?

Who did the

Critical service for us even in health care

During the course of this pandemic it was often

You know our communities of color

And people from that community I could stay home and work in my computer in my office at home

I didn't have to be out and about

I didn't have to sit there and confirm, you know and have close contact with the public and so one of the challenges also is of course, how do we protect these people from a work standpoint and that's why getting vaccines to them is really really important

In supporting the issues and we've seen some really novel ideas, probably the most in fact, you would find this interesting is the fact that one of the most novel programs I've seen has been a new movement among black barbers in black stylists who basically work to talk to their clients in their chairs and who trust people more than your Barber

And they talk about all the issues of health and it's a program that was started at the University of Maryland, and it's been fascinating of how it's actually having a really positive impact on health

But they do kind of like what you talk about all the health issues not

Joe Rogan

Just I'm confused, so you're saying there's a program to educate barbers to talk to their clients?

Michael Osterholm

There actually is, and then they actually look at the outcome in their clients

And they've been able to demonstrate major increases in people getting vaccinated people seeking out screening for cancer issues, et cetera, because the barbers use that time when you're sitting in the chair or the stylist to talk about health

So how?

Joe Rogan

Are they doing this through seminars?

Like how are they educating these people?

Michael Osterholm

It's a major program

Doctor Stephen Thomas, who heads this up who is just a very creative, innovative guy and it's starting to spread around the country

It's actually one we need to duplicate replicate in other places where you can actually get the message out to help people you know

Where do they?

Where do they hear it?

You know?

Well, I hear it in the Barber chair

Who do you trust more?

I trust my Barber

Joe Rogan

I don't

Know well I don't have a Barber, clearly

Wait, wait

Michael Osterholm

I I I I kind of was making that inference

So I was talking about this when I started

Joe Rogan

But when I did, I had I had a lady cut my hair and she was great, but I wasn't taking

Medical advice from her

Michael Osterholm

Yeah, well, you know

If she was highly trained she may

It may be a good time

For you to listen maybe

Joe Rogan

I don't know

She tell good stories

But you know?

So when you're talking about front frontline health care workers, one of the things that

It is a real point of contention is folks that were frontline health care workers that were infected that were covered and then they were facing vaccine mandates

What are your thoughts on?

Michael Osterholm

That well, first of all, I think it's critical that we add in previous infection as a dose of vaccine for certain

Joe Rogan

So why didn't that happen with those folks?

Michael Osterholm

Still working on it, still working on it, still working on it

Joe Rogan

But in the I know, but in the middle of a pandemic, when you desperately need

These people that risked their lives in the early days of the pandemic when there were no vaccines, and many of them were infected with COVID recovered and had robust immunity, but yet they were fired because they refused to get vaccinated

Yeah, well

Michael Osterholm

Well, let me add a little more detail to the story

It's not

Joe Rogan


Michael Osterholm

Quite it's not quite that

It's not

No, it's not

And again I I'm already up front saying I believe that to be considered fully vaccinated or whatever status you're going to call it, you should at least include previous infection as a dose

Joe Rogan

So we need to add that

Michael Osterholm

Now I shared with you a few minutes ago that's been very interesting

If you look at either Alpha, Delta or Omicron

It mattered which variant it was as to who did better

People who clearly had had previous infection, or people who had previous infection were vaccinated and across the board

People who were infected and had vaccine did much better

OK, so

Joe Rogan

Infected and then got vaccinated

Michael Osterholm

And then back got vaccinated

Added one more dose on and it really did boost them up and they if

Joe Rogan

And how do you study that?

Michael Osterholm

Basically, as we look at people then who during the Omicron

Surge who got infected and if we the data are actually out there right now looking at that, and in fact if you look for deaths, for example, if you were unvaccinated

Your deaths during this most recent was about 974 per 100,000. Among people infected. OK, but if you were fully vaccinated only

And and you got .71 cases per 100,000 big drop and then fully vaccinated with a booster was .01

Much lower even yet

Joe Rogan

And this is death

Michael Osterholm

Yeah, this is

Joe Rogan

Death and you're talking about death from delta

Michael Osterholm

In this case

This is even almost is omicron, but the point I'm trying to get at is if you looked at the array of these

Those who were had fact who had previous infection and were

One dose like a boost actually did very well, so I'm willing counter those, but let me tell you why I have a problem with

Health care workers

Who aren't vaccinated and I support health care worker mandates?

If you look across the board

99% of doctors got vaccinated they did. I mean the data are there where we saw the lesser levels of vaccination were in the technician group

Nurses not as high as doctors, but were there

And why is that important?

Because we were able to demonstrate, particularly with omicron, a number of outbreaks or ongoing transmission of cases in healthcare settings

Where it was the health care workers bringing the virus in

And transmitting and where we looked at that, we saw data and and there are several studies coming out very shortly looking at people who are hospitalized negative upon admission, not there for COVID who were there at least 10 days and then got infected and got seriously ill

Well they had to pick it up in the hospital and there were two sources

Somebody coming in from the outside, i.e., visitors who in most cases didn't exist, or healthcare workers or they got infected from other patients

Yeah, and when it's right and when it comes, yeah, when it well it's the outside inside kind of thing

Joe Rogan

That's three

Michael Osterholm

So when it comes to patients you know, we often these people were highly segregated

They were in totally different segments of the hospital

Health care workers had to play a role there, so our point in getting healthcare workers vaccinated is not just to help protect themselves, but it's also to help protect the

Patients, right?

Joe Rogan

But isn't isn't it been proven that people that are vaccinated also catch COVID and also spread COVID?

Michael Osterholm

They can absolutely, and we should, but but I'll tell you right now that if you were previously infected and had that

Those you're going to be much less likely to actually get infected yourself and spread the virus

So Yep, absolutely true

Joe Rogan

That's true, so it's not just that you're less likely to die, but you're also less likely to get it

And spread it

Yeah, so by how much what?

Michael Osterholm

Yes, exactly

Factor I can't give you the exact data, but it's it's substantial

I don't have it right in front of me

It's very substantial that you can get protected with that infection and dose with the debate has often been for health care workers, they feel like they didn't get

Credit for that previews

Don't that previous infection, right?

And I'm saying they

Joe Rogan

Should so you think that the healthcare workers have had a previous infection should get one dose of a vaccine, right?

Michael Osterholm

And I think we should look at that carefully, as considering that fully vaccinated

Joe Rogan

And do you think that it matters whether it's Pfizer or Moderna Moderna?

A stiffer version of the virus, correct?

Or excuse me vaccine and then Johnson and Johnson is different as well, right?

Michael Osterholm

Right, it is, and right now, clearly the evidence points to the fact that Moderna gives us a bit of a better

Take then we see with Pfizer

Joe Rogan

Because it's stronger

Michael Osterholm

And stronger now where J&J is interesting and and complicated is the fact that if you look at its response initially

It's not nearly as high so in

The 80 low

80% level where the M RNA vaccines are in the high. You know mid to high 90s. But if you look over time

The J&J levels don't decrease, they actually go up some and the

And the actual level of protection for the M RNA vaccines will decrease where we see that waning immunity at four to six months

Joe Rogan

Could you explain that to people that how the differences the J&J work, 'cause it?

Is an

M RNA best yeah?

Michael Osterholm

It's not, yeah, it's what we call an adeno virus platform

It uses that to basically get into the cell to have the cell make basically the spike protein that you then get your immune response for

But it looks like the the J&J vaccine may have more positive impact on the thing we call T cells a type of immune cell

Then we see

With the M RNA vaccines, again, all emerging new science we're learning about

I think if I had to make a prediction in the near term, meaning you know 6 to 12 months from now, we very well would likely talking about the preferred heterologous vaccine approach

Of using one dose, for example something like a J&J and then a dose of M RNA. I think that's really a possibility

Joe Rogan

Because this speculative

Michael Osterholm

This in speculative

This is based on on more and more data we're seeing accumulate that that may really be a possibility, and in fact it's also in this issue that I happen to have an intense personal issues because our center

The Cidrap Center for Infectious Disease Research and Policy

University of Minnesota is actually going to be leading and to be announced very shortly on what we call a PAN Coronavirus Vaccine road map process

We just completed a two year effort to come up with a detailed road map for how to get new and better flu vaccines

All the way from research and development to marketing, licensure, et cetera

And we're trying to get new and better flu vaccines and we're working on that

I think you're going to see version 2.03 point. Oh, and 4.0 of the vaccines in the next few years. The vaccines we have now, you know, are remarkable tools

But they're not perfect

And I think you're going to see an evolution just like with drug treatment, better and better vaccines coming out over the long term

Joe Rogan

One of the things that I read was that

One of the problems with

So accepting natural immunity due to previous infection is that different people had different levels of the disease and that some of those very mild infections did not impart enough

Of an antibody response and that these people were not as protected as maybe they thought they were 'cause, even though they had tested positive for COVID, they they really didn't have that much of an impact impact on their immune system, is that?

Michael Osterholm

Yeah, no, that's an important point

But let me just add a qualifier to that

When we talk about measuring antibody

I don't know what we're doing and what I mean by that is is that we don't really have a correlative protection today?

Those different kinds of antibodies

Neutralizing antibodies total antibody OK, all these different kinds of antibody there's there's the different kinds of T cells and what we're doing is taking one test and saying how high is this here?

Well, does it really correlate with protection?

And this is what we call a correlated protection

So for example, I can tell you if you get a measles vaccine and I do a blood sample and I can tell you likely if you have the immune response is going to protect you against measles

I don't know what a protective level is here, so when I talk about it, I know that that work is going on and I think you're going to hear a lot more about corolis and protection in the months ahead

But I'm looking at just from practical experience

If you've had COVID before, are you protected or not when you are exposed to go and compare those who were vaccinated after having had one episode?

Those who only had an episode and those who had nothing and then let's follow them forward

And that's where the real proof in the pudding is, is that

Do they get clinically ill or not?

Do they get infected?

And that's where we're showing right now that I can't distinguish people who've had a really severe case of COVID versus those who have had milder cases of COVID

Maybe over time that will emerge

Clearly the antibody levels are different as you pointed out they are, but I don't know how that responds to protection

Joe Rogan

Interesting, so just because antibody levels are high doesn't necessarily correlate with superior protection

Michael Osterholm

At this point, we can't say that what we can say is likely you have more, but it's a combination of all the parts of the immune system

You know the B cells and the T cells, and this is where I mean if I always jokingly say

You know, if you really want to talk about something complicated

It's immunology

You want to know science?

It's immunology OK, 'cause this whole immune system we have is so complicated and so to me the science you're going to see coming out of the immunity related to COVID is going to, I think


Michael Osterholm

Bring us some really exciting developments

HIV AIDS did that in the 80s and 90s

We learned a lot about the human immune system

I think this is the next best opportunity here

We're going to learn so much about human immunity from just trying to understand how to protect against COVID and how to respond to long COVID

Joe Rogan

So immunity as a whole

Is a very comprehensive and wide ranging thing, right?

'cause it's immunity to all sorts of different diseases and viruses and

It do you anticipate in the future that we can figure out how to boost overall immunity so it wouldn't just be immunity to COVID, but immunity to flu immunity to all these different things?

Common cold like that sometime we could get a grasp of the immune system to the point where we could

Elevate their levels of immunity for all infections well

Michael Osterholm

Let me just

That that's a really plus minus situation, and what I mean by that is, is that

There really isn't a term natural immunity

Everybody uses it, so you're a good company

OK, sorry, but no, you're in good company

But if you go to any textbook Aviv analogy or anything in update myologie, there's no term natural immunity immunity is immunity

It doesn't matter whether you get it from actually being exposed to the virus or you get it exposed to the vaccine

How your immune response happens is

It happens, but there is another kind of immunity called innate immunity

And that's where if today I get a sliver in my finger

OK, if there's bacteria all over that sliver and I'm starting to get an infection

There are cells in my body that don't recognize that anything other than this shouldn't be there and it responds

Now they're not very effective

Overall, what you want is the very effective specific

They recognize that bacteria, so you know if I get an infection with something, the immune response says I'm going after that specific

Part of that virus because I've been trained to do that

So when you say about boosting the whole immunity you got to be very careful because again, what we don't want to do is cause an immune related disease like the trigger that might be happening with COVID to up all the immune system in a way that causes you to have this over vigorous immune response

So I think you're going to always come back to the specific antigen or the specific piece of a virus or a bacteria that you're going to want to go after, and you're not going to have one kind of monolithic vaccine because that will elevate everything which could trigger these bad things, and it won't necessarily give you those specific

Lock and key with that fund virus

And so I I, I can't say I see the overall boost

What I do see though is more work on how do you handle so many different infectious agents?

Or for that matter, I think the one of the areas you're going to see a lot of work coming out in the near term is on cancer cancer vaccines, I think

Have a huge

Future because you can detect those cells that are just starting to emerge that are cancerous

Let your immune system clear amount

Joe Rogan

So what kind of work is being done right?

Now in cancer vaccine

Michael Osterholm

Oh, a lot

A lot of work

Joe Rogan

How does that?

How would was it an M RNA platform?

Michael Osterholm

Looking well, that's you know how M RNA is got all their initial research effort was for cancer vaccines?

Was that's how the first real efforts were put into place by the NIH on these vaccines, and I think that one of the things, particularly for people who have specific risk factors

You know, genetically, they're predisposed to breast cancer

They're predisposed these things

If you could pick up certain

Changes in the cells that indicate this is a precancerous cell or an early cancer cell

Imagine if you had a specific you know, kind of police officer in your body that could help identify that and take

Joe Rogan

It out so a general immune system response is not enough, it has to be a specific immune system response for something that

You're looking for like

Michael Osterholm

To make it most effective, right?

It most, yeah

Joe Rogan

Is there anything that's being developed that works as like a general immune system response that enhances general immune system?

Michael Osterholm

You know, I can't say other than just being healthy

I mean, if you malnutrition is a good example where basically you know you really have a major compromise on your immune system, you know that's a real challenge

You know, stress has been shown to challenge your immune system and and so I think it's general things like that

Again, I'm not immunologist, but I'm curious for my own self

If nothing else, you know what you can do that way, so I think those are the issues that that right now there's not one thing

Joe Rogan

When you look at these cancer vaccines, how far off are they from being deployed?

Michael Osterholm

Well, it's not somebody in the cancer area, but only familiar with the work is going on

You know from my colleagues in the cancer side of the House, they seem, you know, it's still early, but

It surely has a potential future

Joe Rogan

Now, when it comes to side effects and and adverse effects from vaccines, what is causing that?

Michael Osterholm

Well, again, we don't completely know, but for example, the myocarditis piece has come up over and over again is likely an immune response that's occurring OK, that itself is causing this immune response to attack part of your heart muscle that would cause that

Joe Rogan

And what?

Part of the vaccine is causing that immune response

Michael Osterholm

Well, that's what's not clear yet

Because it's when I say it's not clear, you know it it

It's not just the spike protein obviously, because that in fact is you know, a lot of people have that response to that, and so I can't say again not being a clinician immunologist, I can say though, that you know when you look at the seriousness right now of myocarditis

My job is to try to figure out

Well is this?

Is this really a deterrent to getting vaccinated?

And you know, we can show time and time again right now from study after study that in fact, the risk of myocarditis is greater in getting COVID by far than it is to getting the vaccine much greater

Joe Rogan

Isn't that different though with different ages and also with different vaccines like?

Hasn't it been shown that particularly for young boys, the Moderna vaccine is more problematic than the fire one?

Michael Osterholm

It absolutely

It has been

It's it has been absolutely

Joe Rogan

And isn't isn't it shown that with the Moderna in particular that there's more of a chance of myocarditis from the vaccine than it is from the virus?

No, actually

Michael Osterholm

Actually, at this point, that's where we were looking at the

You know, it's it's

It may be close to a tradeoff there, but you don't take into account pericarditis

You don't take into account a rythme as all the other things that the virus does to the heart, which we never talk about, and those are actually very substantial and are as much of a burden in many cases as myocarditis

So you have to factor in what does Cova do to your heart?

What does the vaccine do at your?

Joe Rogan

Heart and their vaccine

Cause any pericarditis or

Michael Osterholm

No, none we've seen 0

0 cases, 0 cases

Distance really

Michael Osterholm

Pericarditis very zero cases they rythmes

But the virus does it

Joe Rogan


That's wild, yeah, I have a friend who was a very healthy guy who wound up getting some strange heart condition from the virus and he was shocked and one of the reasons why he avoided the vaccine 'cause he's worried about a heart condition

Yeah, and then he wound up getting a heart condition from the virus itself

Now what?

What causes this response in the heart tissue?

'cause myocarditis is an inflammation of the muscle in the heart

What is causing that from the virus?

Michael Osterholm

I don't know really

I don't know

I mean, this is ongoing studies right now

Looking carefully at that, and it's surely a major area of study

Right now, but I don't know

You know, I I'm not aware of any nutrient issues, but I I want to point out just so people are aware

If you look at

The serious outcomes of particularly vaccines

There are only two cases of myocarditis that are currently under investigation that caused fatal outcomes. Out of all the millions of doses of vaccine, 193 million doses they've looked at in these age groups, and so there's only 222 under currently under investigation

Joe Rogan

But does that mean that there's only two instances?

Or is it mean only two that people?

Michael Osterholm

Two instances where people have died

Are studying well, studying in the sense that we know about when I say studying they haven't even yet confirmed that that really is caused by the vaccine

It's being looked at right now. We're more clear on the thrombosis from the J&J. The blood clot issue that clearly

Again, inflammation. Why how the inflammation occurred, why it occurred? I can't comment. We I don't know, but I can tell you that even there if you look at those, it's still from the J&J perspective, the risk of a bad outcome with your heart. Or if you're basically the thrombosis is still greater

Overall, from getting the disease now at this point, the J&J vaccine has had a warning put on it

A black label warning about the fact that thrombosis, which I think is important, but as we have shown over and over again, data wise, particularly in many parts of the world, the J&J vaccine is a real advantage vaccine because of the lower dosage, the more stability of it

And the fact that overall the health benefits going to be much greater than not having the vaccine

Joe Rogan

Didn't I read something that was pointing to the potential ceasing of the production of the J&J vaccine?

Michael Osterholm

Yeah they did, but it was in part and I don't have primary knowledge of this that they actually had enough inventory

That they didn't want to have outdating kinds of things happen, so my understanding is not permanently shut down

Joe Rogan

Oh, I see they have a surplus

Michael Osterholm

It's not a holiday, they have

Quite a surplus, and so they had more than enough, but they're putting the vaccine out and and they will continue to make it

It's not

Joe Rogan

There, down and it's they and they continue to distribute it. Is it still A1 dose or are they thinking of it?

As a 2 dose thing

Michael Osterholm

One dose with what they call a booster

Joe Rogan

Right, yeah, why do they call it?

A boost, I mean if it's if it's just

Michael Osterholm

Well, I I hate I don't like that or yeah, I've been really opposed to that from the get go

You know, in August of last year I was one of several people who came forward and said, look at the waning immunity data

It's clear that at five to six months out, we're seeing an increase in number of people who previously before seemed protected, who are now getting infected who are getting

Seriously ill and hospitalized, and it's because it tends to wane at four to six months, so I very strongly urge that in fact, everyone get at that time

They called it the booster dose. I think CDC should change the definition of fully vaccinated for the RM RNA vaccines to three doses. Skip the booster concept

For for the J&J 2 doses and then for those who are immune compromised, they surely should get a fourth dose

Absolutely, they should get a fourth dose

The data we have says that that does boost even better

You know it successfully there, but I think that right now we should be labeling people with three doses and don't call it a booster

Joe Rogan

What do you think is going on with Israel?

Michael Osterholm

Well, Israel actually is a very interesting situation in that it is both the best of science and the worst of times, and what I mean by that is they only have a segment of their population vaccinated

They have a relatively high percentage not vaccinated

Joe Rogan

I thought they were one of the most vaccinated countries

Michael Osterholm

In the world, they are among the vaccinated

That's the whole point

They are actually where they're now doing 4th doses among many people

But if you look at the recent big uptick in cases they had was almost all in unvaccinated people

Joe Rogan

I don't, that's not what I read

Michael Osterholm

It is, it is

Joe Rogan

I read this whole thing about vaccinated people in Israel

Like that, there was a giant surge of vaccinated people catches COVID

Michael Osterholm

The surge, now the surge and primarily and and I don't have the numbers in front of me, but the surge is primarily an unvaccinated people

They're surely was an increase in cases in in vaccinated people who had had three doses

That's why they went to four doses for older populations, etc

But the real burden the the major thrust in this surge

In Israel was in fact unvaccinated people

Joe Rogan

That's confusing to me, 'cause I'm almost positive that I read something that was talking about the confusion that they're having, because the amount of vaccinated people that have been infected with COVID and that it's a giant percentage of the cases

I didn't read anything about it being primarily unvaccinated people

Michael Osterholm

I just did that on

Joe Rogan

We see if we can find

Something on

Michael Osterholm

Yeah, go ahead

Joe Rogan

That because that's fascinating

Michael Osterholm

I just did that in my own podcast

By the way, OK, I just did a cover

I covered that about two weeks ago and I actually had the numbers in front of me and I actually went through what percentage were unvaccinated

What percentage were vaccinated?

Clearly, the unvaccinated, the vaccinated did see increased numbers of cases, but the surge was really

Joe Rogan

Covered by the unvaccinated so there's an enormous surge, but it's because of unvaccinated people, yes

Michael Osterholm

We can look it up

Joe Rogan

See that is so confusing to me because I was almost positive that read that, uh, an enormous percentage like a very high percentage of the people that were new cases that were infected with COVID were vaccinated

Michael Osterholm

They were increased, but again, the big surge itself, in particular in hospitalizations and deaths were unvaccinated people

We can get it here

Looked up here, yeah, we're going

Joe Rogan

Good, see whatever you can find Jamie

You got anything?

Speaker 3

Sorta sorta

Speaker 3

I mean a good thing it gets

Speaker 3

Here's the first thing I found which I don't know, like the efficacy of this information

Joe Rogan

Analysis of COVID vaccine, breakthrough infections and highly vaccinated Israel, OK

A recent study published in what does that say Med RX Ivy?

Preprint server research is evaluated

Modelage structured cases of severe acute respiratory syndrome coronavirus 2 vaccination coverage and breakthrough infections

To do this, the researchers data Ministry of Health

Speaker 3

I know, so I don't know if

Michael Osterholm

This is an older piece

Yeah, this doesn't give it to you

This is, yeah

Joe Rogan

January 13

Michael Osterholm

Yeah, but I mean it's in terms of the omicron surgeries

More data that's come out on

That issue, but this is

Joe Rogan

Only a month old?

Yeah, I know, but uh

Michael Osterholm

If you look here

Speaker 3

Well then

Michael Osterholm

Unfortunately, my research assistant's outside the door. He actually has the papers in hand

Well, let's see

Well, we'll get you

Joe Rogan

We can find on here anyway

Michael Osterholm

We'll get you the data and show you that

OK, and that you can take a look at that

That's an old one

That's an old one

Speaker 3


Michael Osterholm

That's an old one

Yeah, yeah you gotta have a late January

Joe Rogan

See what's in that?

First, let's go to that January 1 and see what it says though

Yeah, like it's it is an analysis and we only looked

At the top

About the study. Yeah, the following data sources received OK March 21st to November 6th, 2021

The proportions of various types of variants and concerns were also confirmed throughout the course of the study

The vaccinated class divided into 5 stages to mimic the diminishing of immunity

Michael Osterholm

See these are all vaccinated people

Joe Rogan

Go back

Michael Osterholm

This is not the unvaccinated so you have what we're looking for

Data that will actually talk about the number of unvaccinated

So what this study is doing is an important study

Joe Rogan


Michael Osterholm

What it's looking at is among the vaccinated who had breakthroughs

Joe Rogan

I see what?

You're saying right? OK, so

Maybe we can Google what percentage of people that have COVID in Israel are vaccinated?


So Omicron, which is the

How much more infectious is omicron than than the the alpha variant or the delta?

Michael Osterholm

Variant, well, it's estimated to be at least two to three times more infectious than Delta, and Delta was two to three times more infectious than alpha

Joe Rogan

I I had heard it

Was way more infectious than that

Michael Osterholm

That's roughly what we've got

Joe Rogan

Is it just just guesswork?

Michael Osterholm

About two to three is a

Joe Rogan

How do they catch that is like is it dependent on it's a scale based on?

Have you?

Joe Rogan

Say if you're infected how many people you'll infect?

Michael Osterholm

Yeah, how many look look

Look at households and drug contacts that look at that, and that's really the primary way to

Joe Rogan

Get it, there's not a way you can like

Look at the actual virus itself and

Say oh this is like measurably more infectious, so it's basically in how many people it

Infects Yep, that's it

Michael Osterholm

It's a real experience, So what happens with it?

And in the same setting between the different variants, what does it mean?

Joe Rogan

Got anything?

Speaker 3

The first thing I found it was blocked, but it said before blocked it said that 40% of the population Israel is under is unvaccinated

Joe Rogan

But 40%, why did I see like I?

Speaker 3

Again, it's

Let me see if

Joe Rogan

Read that it was 80% that were vaccinated

Speaker 3

I can find it

Joe Rogan

Is that true?

Michael Osterholm

No, that's right, that's

Percent they what that's exactly, and that's the group that really had contributed, yeah?

Speaker 3

If I click on this, it's going to disappear real quick

Michael Osterholm

See it's edit

Sorry you have the right stuff

Speaker 3

I've gotta find it

Michael Osterholm

There that is the right piece

Yeah, yeah

So, but anyway, I think the message I think the message

Joe Rogan

It's so that means Israel's only got 60% of their population vaccinated. I thought it

Was way higher

Michael Osterholm

Than that, so I think the message though

Joe Rogan

Lags behind on COVID. 40% of Israelis have no protection against COVID

But isn't that?

Speaker 3

So Mark on variant it says

Joe Rogan

Is right, but how does that work then?

Is that because Omicron evades the protection of the original vaccine?

Michael Osterholm

It does and it also evades the protection of vast infection

Joe Rogan

So, but his previous

But is that like?

Put that article up again?

The way they're phrasing that is that a manipulation of language because it's saying 40% of Israelis have no protection against COVID Omicron variant. But are they vaccinated from the original variant?

'cause if they're saying that they don't have any protection, are they saying that because?

Michael Osterholm

They they they

Joe Rogan

They don't have protection because they've not

They don't have antibodies for it

Are they saying they haven't been vaccinated?

Michael Osterholm

I can't tell you what that headline is saying there

All I can say

Joe Rogan

It's weird though, right?

The way they're phrasing it

Michael Osterholm

All I'm telling you is, is that if you look at the proportion had no vaccine, those that had full vaccination but no booster

That's what they were trying to compare there

Joe Rogan

So this is what that is what they're saying, so look it says 1,000,000 refuse the booster while just 110,000 out of 1.2 million young kids got the that's a lot of language there

Speaker 3

Yeah, I recently found something while I was looking. That said that this is back in the end of the summer that 90 not enough doses had been administered in Israel to get 99.3% of the population vaccinated

Speaker 3

Yeah, that was enough to, but doesn't mean that they were

Michael Osterholm

No see the thing

It's also because they also counted a dose to person, and if you get 2IN

This is 100 million people. Doesn't mean you have a

100 million people

Joe Rogan

Vaccinated well, they also don't count you being vaccinated if you're not boosted

Michael Osterholm

Well they do, but they don't count it as fully vaccinated

Joe Rogan

Right, yeah, but you have

They have a green card situation or whatever they what is it?

Michael Osterholm

Yeah, yeah

Joe Rogan

What's their term that they?

Use I don't know

What it is so with them you have, you must be boosted to be termed fully vaccinated, correct, right?

When looking, this is what pops up

For what percentage is vaccinated but like this is?

It's enough to have vaccinated 99% of the country's population, but it doesn't mean that they

Did it exactly

OK, so you said that Omicron, so part of the thing

The reason why that article was phrased that way is because Omicron evades the protection

Of the vaccine

Michael Osterholm

It does evade protection of vaccine, and it evades the protection from previous infection at a level that the other variants hasn't done

Joe Rogan

If that's the case, then what is the benefit of getting vaccinated now?

Michael Osterholm

There's still very substantial protection, but it's what I mean by evades

Joe Rogan

But if you if

If it's evading the protection of the vaccine, what is the protection it gives?

Michael Osterholm

You well again, let me point out these are numbers I said before

If you just look in this country for the issue of

With this is during Omicron

If you look at deaths again, the point I made earlier. If you're unvaccinated, your rate is about 9.74 per 100,000 population, 9.74 if you're fully vaccinated is .71, but if you're fully enacted with a booster, it's .01 per 100,000

Joe Rogan

But how is that possible if it evades?

Protection of the vaccine. Have you said 100% of all the cases that nearly 100% are now Omicron, but Omicron evades the protection of the vaccine?

Michael Osterholm

But not for everyone

It reduces it

So what we're talking about?

Joe Rogan

Reduces the production of the vaccine

Michael Osterholm

Reaction yeah yeah

So for example with the booster you can boost it back up if you look at for example, fully vaccinated 2 doses or you look at it versus 2 doses

Plus what some would call the booster

You had eight times as much protection with full vaccine

And that booster then you did just full vaccine

Joe Rogan

From omicron

Michael Osterholm

Yep, Yep for 8

Joe Rogan

So then how is it not protecting you from the vet then?

How is it evading the the the vaccine it?

Michael Osterholm

Well, the evasion is not complete, it's it is limited it. So if you take something from 95% protection to 78% protection

We call that evading immune protection, but you're still getting substantial protection for most people

So when that's a term that is not very artful to say the main effusion

Immune evasion doesn't mean that it's yes or no

It's it's like a real stat, and So what we're concerned about is that goes on over time, that immunity may actually continue to lower and lower and lower, and that's what we're trying to study right now is we can't boost our way out of this pandemic

Are we going to need vaccines every six to seven months?

We don't know

But that's when I talked about by waning immunity

Joe Rogan

So the booster helps something from Omicron

It helps you avoid severe illness

Michael Osterholm

That's why I just gave you just now, weirdest. But if you look at hospitalizations the same thing. OK, if you look at these are data from December 25th for the United States for hospitalizations

Joe Rogan

And this is gauging, like how many people who are admitted were boosted versus how many people only had two shots versus how many people were unvaccinated


Michael Osterholm

Right, and I don't have the data on the boosters for those data here, but if you look at for unvaccinated people for hospitalization it was about 79 point

Six per 100,000. During Omicron, if you were fully vaccinated, it was only 4.4 per 100,000. So 79.6 versus 4.4

If you're boosted, it even takes it down lower

Joe Rogan

And does this factor in comorbidities?

Is this factor in all the things we talked about, like low vitamin D, obesity?

Michael Osterholm

It's all of it there

There's not a distinction made

I haven't seen any breakouts

The best breakouts we get are largely those with age and some of the major comorbidities, but that's a previous infection

Joe Rogan

And what about?

How does that factor in with Omicron?

Michael Osterholm

In previous infection again also gives you more protection, like a dose of vaccine, but it's not yes or no

Yes, think of it like a dose of vaccine and that's what it

Joe Rogan

Does now?

Is there a possibility of an attenuated COVID vaccine?

Michael Osterholm

It's possible, and in fact I think many of the vaccine researchers are thinking

What can we get to really cause the upper respiratory protection?

Localized protection in your upper respiratory tract

Because if you can stop the virus there, you can stop it from going deep into your lungs and then going into the rest of your body

Clearly people are looking at what vaccines would work and you know our previous experience would suggest that live attenuated as you called it, which is something that actually grows

Causes an immune response, but doesn't cause illness

Could be one way to go

Can't say it's going to be the way, but it surely is something that everybody is looking

At right now is that in develop

I can't say it's in in development in the sense there are several labs working on it research wise, but development might say a little further along, but I think it's going to be the future

But I think

I think it surely could be a big

Joe Rogan

Part of the future and when these labs that are working on it, have you seen promising data?

Have you seen trials have?

Michael Osterholm

I haven't not all it's fart

You seen anything far?

Michael Osterholm

Early for that yet

I mean, I think part of the challenge we had was in January and February of last year

We kind of jumped on the M RNA bandwagon to the extent of saying this was going to be the answer

And some people will say, well, you know, we, we didn't say that would protect against infection, but there was a sense it was going to really protect against infection

At 95%, I think it was only really by this summer that people begin to realize that they're still very, very important and remarkable tools. But they're not perfect. You know, these aren't going to necessarily be

The final vaccines we need, and so it's really only this summer that you started to see more interest in

Well, what other vaccines can we look at? What is going to be 2.0? What's going to be 3 point?

Oh, and at this point you know that really is now

People are realizing we do need much more in the way of vaccine research

That's why I mentioned ur group is actually developing a road map for how do we get these new and better vaccines?

Joe Rogan

Now what are your thoughts on the monoclonal antibodies?

Michael Osterholm

Well, I think it's a very powerful tool

I think my concern and we had an article in the Cidrap news this week and I covered it in my podcast is very weak

The one that was

Ostrom update

Joe Rogan

What's the name of your podcast?

Michael Osterholm

It's comes out every Thursday morning and I actually covered the issue that our big challenge right now is we're seeing it not being used

You know, even though they were down to one monoclonal is, you know, the other two, basically because of Omicron and the mutations challenging how well they worked

But we're sitting in a number of states right now where we have PX loathed and monoclonal antibody

It's not being used

Joe Rogan

Why is that?

Michael Osterholm

Well, that's the challenge, is it?

Because people aren't aware it's because people can't get tested in time, and so therefore you know you have to have it within that five day period

People actually get sick enough that they move into the hospital quickly and then therefore they're not eligible for it

Is it because they don't have access in their communities?

I mean, if you don't have a health care provider, how the hell do you get tested and get the result back and take it to somebody that will issue a prescription for that drug?

Joe Rogan

It seems like if you're trying to reduce deaths

And severe illness that monoclonal antibodies would be an important part of that strategy

Michael Osterholm

Should be absolutely

I couldn't agree more

Joe Rogan

Now, why did they eliminate the first versions of monoclonal antibodies?

Michael Osterholm

Well, the first two actually, which were quite effective

It turned out that actually the mutations and Omicron basically

Cancelled out their effect on us because the mutations were where those two monoclonals really attack the virus

Joe Rogan

Was it reduction of protection or elimination of protection?

Michael Osterholm

Well, in the laboratory setting it was largely almost elimination of protection and the challenge we have is is we went through a period where Omicron

It wasn't everywhere all at once, and some people were concerned about the fact that, well, you know we should have taken off the market right away

Joe Rogan

Because there's still delta cases

Michael Osterholm

Because there are still delta cases and the problem we had is we just didn't have an adequate way to test people to say you have delta or you have omicron because either one would have made a decision

Easier to say

Oh, go with this one or go with these two

Joe Rogan

Yet so that becomes a problem again with testing

And that in in particular testing for which variant people are sick with

Michael Osterholm

Yep, and and how fast could we get those who?

Even if you can't get it for a patient, can you have a running average of what's happening in your community?

So if you suddenly see that only you know 4% are you know all Micron and 96% are delta. You're probably going to air on going with the monoclonal, but it's from for delta

If you see the reverse, you're going to say, well, it doesn't matter to use those other two, they're going to be ineffective

I'm going to use this one and we don't even have those kind of data at a timely way, which is part of what I was talking about earlier

We need this national testing prioritization

We need to really put this in there and that should be part of it for purposes

Joe Rogan

Of treatment in which monoclonal antibody

Is most effective for Omicron?

Michael Osterholm

Well, it's one that actually is made in England

It's not very common here

Trova Mab is the name of it that most people would recognize the name, but it's one that basically it attacks the virus at a different location to the other two, and that still has been shown to be quite

Joe Rogan

Effective is that one effective on delta as well?

Michael Osterholm

Yes it is

Joe Rogan

So yeah

Michael Osterholm

It is true, yeah, interesting yeah

Joe Rogan

So that would be like an almost

Universal monoclonal antibody

Michael Osterholm

Right now, but tomorrow another variant could show up, and it'd be all

Joe Rogan

Done, and that's how it works with this stuff, right?

Yeah, what was what?

Was unusual about this in terms of early treatment

This this this disease is so unique and so different like what do you think could be learned from the way the early treatment of the virus, particularly before the vaccines were administered?

Yeah, yeah

Michael Osterholm

You know, a lot was learned and you know I looked to our colleagues in Italy to New York, a number of places that

The kind of care that they provided, whether it was ventilators, how they approached it, what they did in terms of oxygen

How they helped basically try to regulate what the immune response was or wasn't, and frankly, the survivorship of patients with similar conditions between those early surges in 2020 and even six to 10 months later was substantially better. The intensive care community

I get so much so much to try to understand what should be the best methods

You know what?

What should be our standards of care are our best practices, and so we've have seen a substantial increase in in outcomes for patients just based on the early research

Joe Rogan

Do you think that because of our?

Having gone through this pandemic that we are better prepared for another pandemic like say if COVID was to die off, you don't

Think so we're

In West worse shape, why is that?

Michael Osterholm

500,000 healthcare workers have quit their jobs in the last two years

I have seen

Fatigued soldiers who are friends of mine come back from war

With less post traumatic stress syndrome that you see in the healthcare workers

There we don't ever really have a good sense of just how fragile our healthcare system is right now

Joe Rogan

If they're not the case, why would they fire so many unvaccinated workers?

Michael Osterholm

Well, you know they didn't fire so many there was 1 to 2% at most 1%. Mayo Clinic, Mayo, Mayo Clinic fired. You know 700 people out of 70

Joe Rogan

That's really all it was

Michael Osterholm

Or excuse me, yeah, 700 people out of 77,000 OK and again you have to look at where their jobs were, where they in intensive care or not, where they up front you know where they

People that were at admitting as such

Joe Rogan

So you think that's a false narrative that they fired?

Michael Osterholm

I think it's absolutely a false negative, absolutely excited healthcare workers

Joe Rogan

Unvaccinated health

Michael Osterholm

Very few

Very few of the doctors and nurses who work in intensive care were unvaccinated

They want to be vaccinated, protect themselves

I mean, we've lost 300 health or excuse me. 3000 health care workers have died of COVID since the beginning of the pandemic

And so

They want to be vaccinated largely, and as I said, 99% of doctors got vaccinated quickly

I think the challenges we don't understand yet is how fragile our healthcare system is

So when you ask me, are we better prepared right now?

The Department of Labor has just surveyed health care workers and think that we're going to see a number of them quitting in the next three to six months just out of their burnt out

Joe Rogan

What could be done to?

To strengthen and enlarge the health care system to make it better prepared for some new pandemic and what what could be done in terms of having treatment protocols prepared in advance

Michael Osterholm

We have to be better prepared to handle surge capacity

We just weren't

Joe Rogan

And this is a term is this hospital beds is this staffing?

Michael Osterholm

It's no, it's people

It's staffing and training and the problem is Joe that we've lost so many senior doctors and nurses who are just burnt out

That even though we have the pipeline coming in from medical school, we've had more applications in medical school in the last year than we've had in many years

But the problem is it takes time to educate them to get them to be in a more senior status, learned status, and so for this period of time

Right now we're going to have real troubles if we have another big surge because

It was, it was almost like a a vicious cycle

The more people that were infected meant more cases in the hospitals, the more care needed, the more care needed, the more people were stretched, the more people got stretched working, the more quit, the more they quit meant that the fewer people had that much more work to do again again and again

And that's why Casca and you know, I thought I'd never see this in my lifetime, but

Joe Rogan

Cascading effect

Michael Osterholm

All eight of the major health care systems in the state of Minnesota, including the Mayo Clinic

We took a full page out at AD out in papers around Minnesota back during the Omak Ron Surge begging people

Please don't get infected

We can't take care of you

We we don't have the quality of care has dropped

You know when you during this recent Omicron surge, you did not want to have a heart attack

You did not want to have an automobile accident or a stroke because of the challenge we saw people literally waiting two days in emergency rooms

Really, oh it's crazy

And it was just a shortage of staff, so equipment wasn't the problem

Beds weren't the problem, it's people

And so I think that that's one of the things we have to really invest in right now

If we're going to be prepared for any future search and what we have to understand is how many health care workers now, not just the stress of what they did

But how many times that they're vilified in the community because they people say you, you know you didn't do it

You should have done to save my loved ones, life et cetera

And they're doing everything

Joe Rogan

They can, do you think masks work?

Michael Osterholm

I'll answer that if you can tell

Me what's what's, what's?

Similar between a 747 and A and a

Joe Rogan

Car, what's similar, they both hold people

Michael Osterholm

They both have tires

Let's see it

Well, master like tires, you know it's it's, they're different, they're totally different

And so whether you had the N 95 on that thing that I wore into this studio, which is a high level protection, or you are a face cloth covering totally different between night and day, how well they work. You know shortly I was after I I when I was on here in 2020

Out of peace in April 2020 saying this is aerosol transmitted. It's like a perfume. It's like smoke

And basically you have to have high level respiratory protection to really protect yourself

And what we get is we got into people saying, well, anything works and some studies were done, which frankly, if one of my graduate students had done those studies, I would have failed him

Because they were so badly done in terms of trying to understand, did face cloth coverings work well?

They don't

They're much more of a clothing declaration than they are anything about really working, and so when you ask me

Do in 90 fives in KN 95's work I'd say yes

If I say a face cloth covering surgical mask no

Joe Rogan

And that's a big problem

A lot of people are wearing those surgical masks, which are to stop droplets when you're doing surgery, right?

Michael Osterholm

Yeah, and and and

Joe Rogan

That's what the

Michael Osterholm

Not only that, but you know, just on my trip down here, which this is only my second trip in two years

So if you used to fly 150,000 air miles a year, I can't tell you how many people

We're not wearing masks at all, even though it was mandated or they warm on their chin

They were chin diapers

That was it

You know, we've been doing a study where we freeze frame news media reports and just look at the people in the frame

Weather indoors or outdoors, we have consistently seen since the beginning of the pandemic. 1/4 of the people are under their nose

That's like fixing three of the five screen doors in your

Submarine, you know?

Joe Rogan


Michael Osterholm

It doesn't matter

You know what good does it do?

Joe Rogan

So explain to me how N 95 masks work. If you can breathe out of them. If you can breathe into and breathe out of them, what are they doing to protect you from infection and what are they doing to protect other people from being infected?

Michael Osterholm

And that is the key issue, right?

Joe Rogan

How are you?

Michael Osterholm

There are people to understand the difference

There are two issues that are critically important to protecting you and protecting others from you that is fit and filtration

Think about swim goggles

I mean you know it's all about fit

You know if they don't seal completely, they leak

Joe Rogan


Michael Osterholm

OK, so you got to have something that's a very tight fit

That means also by the way, you can't wear a beard if you wear a beard you invalidate anything you put in front of your face 'cause it all

Leaks right through OK

One of the problems we have with kids is we don't have good sizes because in 95 as basically over the oversight regulation of those comes from the occupational world is largely for professional use and we've never really looked at for personal use, so I will have to safe. It is a challenge. OK, it absolutely is

But filtration is what's critical and people don't get this. The material in an N 95 is a milk blowing material. It's actually a milk blowing. It's like a foam that hardens, OK

Joe Rogan

It's a what?

Michael Osterholm

And it has

Joe Rogan

Saying milk

Michael Osterholm

Milk, yeah, that's what they call it

Yep, just like that, yeah, and it is basically one that has large enough spaces in it

That allows air to move through it regularly

OK, but like a good electronic filter you might put in a room

It has an electrostatic charge in it, so as the viruses come through they get grabbed quickly

So this works really well

Joe Rogan

The virus clings to the outside of the mask, actually

Michael Osterholm

No, it's it actually has

It comes in, it's outside, but it's on the inside too, as the mask

That's why it's like it

Is and so this special material is what gives you both the breathability but also the protection

So when you wear a cloth, even if you can breathe, you have no protection

The virus will come right through

In and out

Joe Rogan

OK, so when you see I'm, I'm sure you're probably seeing these

There's a Doctor Who uses a vape pen and he blows through various masks to show you the the poorest nature of them

And he uses a surgical mask and a cloth mask, but he also uses an N 95. So you think that that is disingenuous because he's not taking into account the electrical charge of this mask that actually

Michael Osterholm

Exactly you want you want to have it breathable

You want to be able to make certain you have to

Joe Rogan

Otherwise you'll die

Michael Osterholm

Yeah, I mean that's right

Yeah, yeah, I jokingly said I could stop all transmission

Let me put cellophane over peoples faces but that wouldn't last very long and so that's what makes these so really important

Joe Rogan


Michael Osterholm

And So what we need though is we need a major initiative to basically develop

A personal N 95 like material that's comfortable that people can wear with good fit

And that people can actually breathe through in a way that they'll use them

Joe Rogan

So the N 95 material and you said it's a milk. What is this milk fallone?

Michael Osterholm

Milk borne blowing

It's basically a it's a type of industrial process where they basically put this material down and it has the electrostatic charge and it has the poorest nature that lets air move in and

Joe Rogan

Out now, should they be replaced on a regular basis, and if so, like how regular?

Michael Osterholm

Fitting tight in your face you can actually wear them for quite some time

I wear my where my N 95

Joe Rogan

Like what is?

For days days yeah days, you should probably have a new one once a week or something

Michael Osterholm

If you can, that's great

You know they run a little over a buck buck 50 some places and I think the most important thing about them is right now

They're readily available early on in the pandemic. You know, all of us said don't use them because health care workers need them and we had a major short supply, but by the summer of 2020, all of the manufacturers had so boost production

That we have more than enough right now so the public can use them

They can be very helpful, but you gotta use them and you know, wearing it under your nose or not wearing it

I mean, I, I find for example in schools

The great debate right now is, you know, what do we do with masks in schools so kids go to class all day?

They wear their whatever they're supposed to be wearing

Then they go to the lunch room for half an hour

They take it off while they eat with all their friends

I'm sitting there going now

The virus doesn't take a vacation, just when

You're in lunch

OK, So what?

Should they do not eat?

No, but I think you have to at that point

Then figure out do you need to space people

Joe Rogan

And just does that work?

Michael Osterholm

Well, basically it's one other option

Joe Rogan

Blend or setting?

Yeah, can you really space people out to the point where you can have sick people in the same room and not infect?

Michael Osterholm

Can't sick, affected but then that's where ventilation comes in

Ventilation is huge and what we can do for example, in fact you can actually develop and build and put into schools

Things called Corsi boxes

Corsi boxes named after the the Air Arrows

Biologist specialist who devised these

Are basically taking a regular old fan

And putting in a MERV filter, a high level furnace like filter on one side of it

And basically attaching it to the fan and then letting the air blow through the filter

Put one of those or two in a room

You can do a great deal of eliminate virus

Thank you

Michael Osterholm

Things like that that we haven't thought about things that we need to

We should be investing in in our ventilation systems in so many buildings and we're not

Joe Rogan

Interesting, so the ventilation systems that they have on airplanes

They've been touted as being very highly effective

Michael Osterholm

Right, they can be more effective, but you know, I sat next to a guy yesterday in the plane that took his mask off

Most of the time and it was a surgical mask to begin with

OK, and so I mean, if you have enough infected people on a plane, I do believe you get transmission on planes

I don't think you can say that they are absolutely perfectly safe

They are safer, clearly by the air filtration

How it goes through the filters that they have and move it around

Joe Rogan

But isn't it kind of nonsense if you're sitting right next to a person and they're allowed to take their mask off to eat?

And what is the point of a mask mandate?

Thank you

Michael Osterholm

I agree

Joe Rogan

So what it should you be doing? You think everybody should be not eating on a plane and just keep up a 95 tight to your face?

Michael Osterholm

Well, you know

I think I, I think

Well, first of all, I use again not long after I was on here where I didn't support general lockdowns

I said you know what, when you have a surge, apply the brakes and what you're applying the brakes for is trying to keep people from overwhelming the health care system

And of course you want people not to become seriously ill and die

But that if you maintain lockdowns as they call them

When you don't have high activity and we had many parts of Minnesota that

Didn't know of anybody that got infected in Greater Minnesota and yet they went into that

That's the challenge, but when you do see the transmission, then you want to have that limited time period

Well, I'm the same way with mask mandates

Two things

One, there's a time and a place if you want to try to stop or eliminate transmission as much as you can, but then also don't make a mandate around somebody wearing a face cloth covering

Joe Rogan

You know 'cause it doesn't work

It doesn't work for a surgical mask, yeah

And so that is what you see though when you have a mask mandate you see people wearing what you think are

Very ineffective mask

Michael Osterholm

I continue to come home and say, you know, please wear high quality restaurant protection

Then I could support more mandates for a limited period of time

When you have that surge capacity, I mean what we just went through for the last 10 weeks was an example where if the more we could do to slow down transmission like that ad in the in the papers in Minnesota from the health care systems we're asking people to do

Just give us a break

I think that's fair

I think you're going to see a period coming up in the next weeks where you know whether the public health thinks you should be wearing a mask or not

The governors have already read the tea leaves and

Said no, we're not

And I don't think that's a wrong thing

Joe Rogan

When you saw the residual effects of lockdowns like particularly high suicide rate, depression, drug addiction, there's a lot of businesses went under a lot of restaurants, went under

What do you think could have been done to manage that differently, and do you think that that?

That residual effect is just a function of not being prepared and not not anticipating anything like this ever happening and not having the steps in place to handle it

Michael Osterholm

You know, I don't think

It's a straightforward issue

What I mean by that is I just saw a recent research effort that just showed that the number one reason for depression during the pandemic

Was not about losing a job or work

It was losing a loved one

And you know, when you have 900,000 people die

And it's among the top ten causes of death for all age groups

When you have 3000 kids or maybe 300,000 kids in this country, 300,000 kids

Who have lost a parent?

Or a guardian who took care of them

You know it's that adds to the challenge, so I think that we clearly had an impact by the negative things you just talked about

But how much was actually caused by quote UN quote these mandates? And how much was caused by just going through a pandemic is hell. It's not. It's it's tough

Joe Rogan

Right, it was both though

Michael Osterholm

Right, it was both

I'm actually acknowledging what I'm saying though is trying to understand that isn't a self important for going forward because we as I shared earlier in this session, we could see another surge again

So what are we going to do next time?

How are we going to be prepared for that?

How are we going to communicate to the public?

What are we going to tell them we need to do and why?

And you know, right now, I think they tune us out quite a bit because they feel like we don't get it

We're not going to you

Joe Rogan

Know why do you think that is?

Michael Osterholm

One is there for fatigued and tired. I mean think about Ebola. Back in 2014. Fifteen it lasted for about four months

Worldwide it was over with. If you look at the 2009 H1N1 pandemic, it's really about 6 1/2 to 9 months and it was over with

We're now into our third year

Fatigue is setting in

I mean, if I get asked to run a marathon once, that's tough, but if I get asked to do it day after day after day, for months and months

You know I give up

And so I think that part of the challenge we have with this virus, which has made it so difficult

Is the long term nature of what's happening and I'm not saying that that

Excuses any mistakes that have been made about how to approach it, but it's just human nature right now we're challenged

We're tired, we want it done

And so I think that's one thing I think the second thing though, is is that we didn't communicate clearly

What we know and don't know

I started out the program by saying

Joe Rogan

That what do you think was was done incorrectly by what we by not communicating what we know or don't know?

Michael Osterholm

I think we had

We gave the public expectations that they felt like they

When things change quickly that we were not credible

You know?

Joe Rogan

Like what for example?

Michael Osterholm

Well, you know, a year ago, right now, yeah, you know, and I'm not taking a great credit, but you know, I made public statements and I thought the darkest days of the pandemic were still ahead of us

And it was because of these variants

I didn't understand

Wow, how could they affect things you know and look what happened, but we had many

Of the talking heads out there, I wish I include myself as a talking head who are saying to the public

You know it's over with now

Summer is going to become quiet and calm

The peak is come down, vaccine is flowing maybe with a little bit of activity next winter

And then Delta came along

Joe Rogan

Why do you think that they made those declarations?

Michael Osterholm

I think

There was a situation where we lacked humility in saying what we know and don't know

I mean when I leave here today, I hope everyone says, Osterholm says maybe it'll be OK

But maybe it could be another bad one and we got to be prepared for it

You know, it's it's that willingness to say I don't know

I mean, I think probably the three most important words I've said to you all this entire session is I don't know

Yeah, and and I think that that's what we haven't done enough of and then we have to tell people

So what are we going to do to find out what do we need to know?

You know, to basically answer the question?

Well, many of the questions you asked me already

And I think that message is one that we have not done a good job getting out of

Just being humble and saying I don't know

But this is what?

Might happen, this is what could happen

Joe Rogan

Speaking of, I don't know did you did?

Was there any more definitive data on Israel or was it too confusing?

I, I think that the confusion came with that 'cause I kept seeing that 4 doses for some people

The confusion meaning what they determine is to being vaccinated

Right, yeah, what?

Yeah, what the definition of that word becomes?

Michael Osterholm

So when we walk out of here

My researchers, this is going to tell you exactly the answer

OK, he's got

Joe Rogan

Well, why not bring him?

In here, go get him if

Michael Osterholm

You want

Joe Rogan

We could take a 10 second break I guess

Yeah, we'll take a 10 second break and go

I see

Joe Rogan

Get the data

That'll help everybody

Michael Osterholm

I like that. Thank you

Joe Rogan

OK, so to wrap it up, what's your assessment of what we just looked at in terms of like the the Israeli data?

Michael Osterholm

I think the really important message here

If you look at the countries

What happens to them in terms of cases, severe illnesses, hospitalizations, deaths, its vaccine vaccine vaccine?

Good example, but it's

Joe Rogan

Is it?

True is 90% of the population of Israel have at least two doses of the vaccine

Michael Osterholm

Yes, the data we have shows that but

The point of

Michael Osterholm

Right now it is

Joe Rogan

That that was what we talked about earlier

Michael Osterholm

No, but I'm talking about the fact if you look at the surge is being contributed by those people who are unvaccinated or partially vaccinated, unvaccinated and and well

Joe Rogan

Completely or two shots

Michael Osterholm

We have a number of that have

One shot which

It is not nearly enough adequate protection to stop it

Joe Rogan

Unless it's the J&J

Michael Osterholm

No, that's even people who have gotten M RNA but just got one shot

We still see that in the here in

The United States, for whatever reason

Joe Rogan

Right, But I'm saying it's the J&J count as like a one shot because one shot is fully vaccinated with the J&J until you get a second

Michael Osterholm

I can't, I don't know, and Israel how much change it was used

Joe Rogan

I don't know, so your thought is the reason why everything is going sideways in Israel is not the failing of the protection of the vaccine, but rather the fact that there is a substantial portion of the population that's unvaccinated

Michael Osterholm

It's both, but what I'm saying is what really brought that Sir John was in terms of hospitalizations, severe illness and death was largely of that surge piece was among unvaccinated or one with one dose

Joe Rogan

OK, so it's one dose or 0 doses

It's not two doses, so when you hear about vaccinated people catching COVID in Israel

Michael Osterholm

Not two doses, right?

Joe Rogan

It's a small percentage

Michael Osterholm

Small percentage of what?

Joe Rogan

Of their population that has COVID

Michael Osterholm

No, actually it

Well, I shouldn't say small

Yeah it is relative, but if you look at the total numbers we also did see infections among people who were fully vaccinated

Yeah, what we're talking about

And I talked about that surge

I'm talking about it in terms of severe illness, hospitalizations and deaths, and that was being driven largely by those

Who were unvaccinated or who had just a single dose?

And that's what those data show that hurt

Joe Rogan

What is going on in Africa and why did they have such low rates of infection and and death?

Michael Osterholm

Well, first of all we have to be

Really cautious about saying how many cases they've had because the house testing

Because there's a lot of surveillance, surveillance and testing

And I mean if you look, for example at South Africa where we have better testing, we have better follow up

You did see increased number of cases

If you look at some Bob way you look at countries like that and so part of it is that surely it's not

The same as the US. We're not seeing the hospitalizations the same way, but then we have a much younger age population

You know any of those conditions that could predispose if you know your median age is 20 or 30 years younger than it is in a high income country right there, you have an advantage in terms of likelihood of having severe illness, but I think at the same time we're we're trying to study that to understand how many cases did we miss

Did we miss?

What are the impacts?

And it's been particularly important in Africa for a separate reason is because public health services have been so disrupted there because of COVID

Levels of vaccination

Malaria control maternal and child health

All these other issues are taking a huge toll right now, and I mean we're really going to have to reinvest back into that area just because we've lost a lot of footing in our control from a public health standpoint of many infectious diseases

Joe Rogan

Is there any other factors that could be?

Of consideration in terms of like the low rates of infection, do you think that it's just a lack of reporting and testing, or is it possible that there's other medications that they've been taking that could have contributed to their low numbers of infections?

Michael Osterholm

Well again I come back and say that it's not just the fact of underreporting

As I pointed out, you know if you have a much younger age population, you can see big differences in the rate of serious illness, hospitalizations, etc just by that alone in terms of any of the factors such as has been suggested, could certain drugs that they may take, or how often do they take those drugs, could play a role

I you know, I'm at this point again, open to the data

You know, we just have seen so little come out of Africa and we need more

We need much more information to understand that

I think the South African experience was helpful in allowing us to see what Omicron was going to do now

However, we're in a place where even looking at South Africa, that big burst of cases has come down, but it's not

Going away, it's there's a tail here

That's pretty substantial

Why is that?

What's going on in South Africa?

So I think the African continent has been largely neglected relative to many other parts of the world

To better understanding what COVID has done both directly and indirectly to the society

Joe Rogan

Were there any?

Countries, do you think that were a model of how to handle the pandemic correctly?

You know, I

Michael Osterholm

Think trying to make the very best out of a horrible situation

I think Australia New Zealand have probably done as well as any two countries and you can say whether islands, but you know they they pursued this zero COVID policy to the extent that they could, and when it became impossible with Omicron

They graduated their response in a way you know that I think is really helpful

I mean, just take for example New Zealand

Here's a country that with you know 5.2 million people. Here's Minnesota State I'm from, you know, with 5.65 point 7,000,000

You know when you look at our desks, you know we've had, you know, 12,000 almost

Look at their desks. They've had 52 as of two weeks ago

What's different?

Well, I think in part it's because they did try early on to really have major control and then allow things to be relaxed when you know the numbers didn't appear to be increasing or you know the follow up

And so I think there's lessons here for us to learn across the board

All countries need to go back and look carefully at it

A very interesting

Peace and the Financial Times

A couple of weeks ago, David Byrne Murdoch, who I think is one of the most wonderful journalists today in this topical area, did an analysis looking at what we had, what happened during the Omicron surge in the United States

If in fact we had the same immunization rates for COVID as Denmark

And he estimated that about half of all the hospitalizations would have been limited half

And I think that's probably true. That's why if you see now, you see lots of cases in Denmark occurring as they've opened up everything but the number of hospitalizations and people in ICU's have gone down

Because again, they're actually providing protection against serious illness, hospitalizations, and deaths with their immunization programs, and I think that's a lesson for us going forward

How do we make that work so that we can do?

More of the

Joe Rogan

Same now what is your take on doctors like the FLCC that had this early treatment protocol for COVID?

That is been widely disparaged by other people like you know that I've remarked in hydroxychloroquine, zithromax in all that stuff together, like what do you?

What do you think about these doctors that had put out these protocols for early treatment?

Michael Osterholm

Well, I don't have an opinion on the doctors, you know

Joe Rogan

Do you have opinion on the protocols?

Michael Osterholm

Well, I'm going to say yes, I

I think again it has to be science driven, you know

And as I just said earlier in our discussion, I think the data coming out on these five trials with Ivar Mac is going to be very interesting

I am eyes wide open, you know, I'm ready to see them

These double blind, placebo controlled trials

Joe Rogan

Have you looked at any of the randomized controlled trials that have been done previously?

Michael Osterholm

You know they were none that were really randomized controlled trials

I could tell you I look at it the studies carefully

There were so many problems the one in Brazil was really a challenge

I mean it it again going back to my previous statement of one of my graduate students had done that kind of a study out of flunked him

So I think we need really much more comprehensive data and we should be collecting data on these kinds of treatments, so I'm I hope everyone can agree

If you do a double blind placebo controlled trial, that means that neither the patient nor the investigator knows who got the drug and who didn't

Everybody is otherwise the same, they're equal

It's only when the code is broken

By the monitoring Board, does anybody know what the results were?

Then we can feel confident that we have a study that is objective that is based on the data and you know if I ever met and comes out working, you'll hear me say it

If it doesn't, I'll explain what I think the study said and what it meant

So I'm I'm wide open on all of these things

I just

If I had to say anything that I wished we learned from, this is some of these things have to be done much sooner and agreed

I think a year ago people thought we were done

I wish we had started some of these trials

I wish we had done some randomized controlled trials on masking

And how does it make it work?

You know what can you do?

Maybe you can't, what can?

You do and maybe inform

Joe Rogan

Be informed people about what you were saying about N 95

Michael Osterholm

Exactly and then and then share that information as quickly as possible

Tell the story you know

I you know you you understand this, but you know

If people really respond to when you tell them a

Story, you know

I learned a long time ago as a kid growing up in rural Iowa

That if I wanted to try to make a point or to try to put forward a position, if I couldn't get it to sell

At the 10:00 O'clock Coffee Group at the S&D Cafe in my little hometown in Iowa

You know I needed to go back home and rethink it

How do you get that to sell?

And you don't do it by being a salesman

You do it by just being a good storyteller, telling the truth, telling what you know and don't know, and I think that's what we need to do

A better job of in public health

Right now

We need to be that we need to code it all all

Of it in a

Of humility, say what do I know and don't know?

I mean, you know what this interval probably remembered for how many times I told you that I don't know?

Joe Rogan

Well, that, and I mean I think he gave a a great analysis of things that went wrong and things that we could have done better

And also the burden on the health care providers

I think that's something that people need to be really reminded of

Thank you OK, your podcast is the Oelstrom update podcast

Michael Osterholm

Every Thursday every Thursday morning it drops and it's on our website

It's on apple

It's on Spotify

It's on all of the services out there and welcome it

I try, it's again my attempt just to be unvarnished, to be humble, and just to tell you what I know

Joe Rogan

And don't know well, thank you very much for that

And I appreciate you coming back again, and hopefully we won't have to do this again

In two years, well, if we do it

Won't be on those topic

Yeah, hopefully yeah

Well hopefully it won't be a new one, right?

Alright thanks

Michael Osterholm

Thank you very much, thanks a lot, thank you, thank you everybody