Straight talk from an infectious disease expert on the coronavirus pandemic (updated)

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Michael T. Osterholm is Regents professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and coauthor of “Deadliest Enemy: Our War Against Killer Germs” (2017):

For decades, Osterholm has been in the business of telling people what they don’t necessarily want to hear: Pandemics are inevitable; outbreaks can be devastating; bioterrorism is a threat. Several real infectious disease threats exist that could stop the world in its tracks, and by and large government officials, industry professionals, and researchers are not acting together to stop them, he warns.

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In the new book, which he coauthors with Mark Olshaker, Osterholm said he’s trying to clearly sound the alarm on the real public health threats facing the world and explain the policy and research needed to tackle these threats head-on.

“I have the reputation as ‘Bad News Mike,'” said Osterholm. “But it’s not just bad news [in the book]. I’m also saying, ‘Wake up, there’s something you can do about it.’ I guess I’m at the age where I’m looking at what kind of world I’m leaving for my kids and grandkids, and I want to make sure we do what we can to stop disease.”

“Bad News Mike” Osterholm delivered a reality check to what we can expect in the coming weeks from the coronavirus pandemic in this interview with Steve Kornacki on MSNBC on Thursday. Dr. Osterholm contradicted the (unwarranted) optimism expressed by Congressman Adriano Espaillot (D-NY) and Washington Post health care reporter Yasmeen Abutaleb on the availability and ramping up of testing for the coronavirus in this interview … it’s not going to happen.

RawStory reports, It could be 18 months until we get back to normal if we don’t stop spreading coronavirus: Infectious disease chief:

President Donald Trump has tried to make Americans feel like it will take just 15 days to calm the spread of the coronavirus. If the country locked down for 15 days, it’s possible the spread could stop, or at the very least it would give hospitals the opportunity to tackle the problem [i.e., flatten the curve].

Research director Michael Osterholm from the University of Minnesota Center for Infectious Diseases warned that this could go on for as many as 18 months if we don’t lock down to contain the spread of the virus.

Steve Kornacki asked Dr. Osterholm about the new study from Imperial College in London. Mother Jones reports, A New Analysis Predicts 1.1 Million Coronavirus Deaths in a Medium Case Scenario:

If no control measures are put in place, the researchers estimate that we’ll exceed critical care capacity about 25 days from now and see a peak of about 50,000 deaths per day by early June.

CriticalCareBedCapacity

The Imperial College team concludes that suppression is the only “viable strategy,” but the “social and economic effects of the measures which are needed to achieve this policy goal will be profound.” Mitigation, conversely, is feasible only if our critical care bed capacity is increased by at least eight fold. And even at that, about 1.1 million people would die in the US.

“So, first of all, again just from a straight talk standpoint, let’s clear up a couple of things,” he began. “One, I think the imperial college report is right. It’s going to be 15 to 18 months and we’re going to have to decide how we’re going to live during that time, not just die from the virus. Second of all, let me just say, what the president did today in [invoking the Defense Production Act] is largely cosmetic. And I resent the fact we’re trying to sell to America we’re doing something we’re not.”

He explained that companies that make respirators and protective gear have been working full time and every machine has been running for weeks.

“There’s nothing new coming,” Osterholm explained. “You just don’t invent these overnight. so we are going to be very short on these issues.

As far as testing, I think we’re going to see an implosion of testing in three, four weeks. We’re running out of reagents. The world doesn’t have enough reagents right now.

Politico reported Exclusive: U.S. coronavirus testing threatened by shortage of critical lab materials:

CDC Director Robert Redfield told POLITICO on Tuesday that he is not confident that U.S. labs have an adequate stock of the supplies used to extract genetic material from any virus in a patient’s sample — a critical step in coronavirus testing.

“The availability of those reagents is obviously being looked at,” he said, referring to the chemicals used for preparing samples. “I’m confident of the actual test that we have, but as people begin to operationalize the test, they realize there’s other things they need to do the test.”

The coronavirus task force convened by the White House is also aware of the shortages, and one official said members are working on it.

The growing scarcity of these “RNA extraction” kits is the latest trouble for U.S. labs, which have struggled to implement widespread coronavirus testing in the seven weeks since the country diagnosed its first case. Epidemiologists and public health officials say that the delayed rollout, caused in part by a botched CDC test, has masked the scope of the U.S. outbreak and hobbled efforts to limit it.

If enough processing kits aren’t available, the risk that testing will be disrupted is “huge,” said Michael Mina, associate medical director of molecular diagnostics at Brigham and Women’s Hospital in Boston.

“RNA extraction is the first step in being able to perform” a coronavirus test, he said. “If we cannot perform this step, the [coronavirus] test cannot be performed.”

Qiagen, a major supplier of the kits, confirmed that its product is backordered due to “the extraordinary pace” at which the world has increased coronavirus testing over the last few weeks.

“Increased demand for testing has the potential to exhaust supplies needed to perform the test itself,” said Robin Patel, president of the American Society for Microbiology. That would limit the testing capacity of public health, hospital and commercial labs alike, she added.

Dr. Osterholm said “We do not support drive-by testing right now” [something Rep. Espaillot and reporter Yasmeen Abutaleb both cited as a positive development in this interview]. We need to focus it in hospitals where it will have its most important good and we’re going to be rationing testing in a way that we haven’t even thought about just within a few weeks because we can’t” test everybody.

“Bad News Mike” Osterholm’s conclusions: we do not have the capacity to test everyone who needs testing, and we are soon going to be rationing testing. There are currently not enough respirators in supply and it is going to take time to manufacture enough respirators to meet a growing demand. Critical care hospital bed capacity is about to be overwhelmed, as it has in Italy. Italy’s coronavirus crisis could be America’s.

And this does not even begin to address the critical shortages in medical supplies and protective gear for doctors and nurses, Critical supplies shortage hampers hospitals, health providers, which leads to an inability to provide adequate care to all patients, as has already occurred in Italy. The Extraordinary Decisions Facing Italian Doctors:

Now the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines for the criteria that doctors and nurses should follow as these already extraordinary circumstances worsen. The document begins by likening the moral choices Italian doctors may face to the forms of wartime triage that are required in the field of “catastrophe medicine.” Instead of providing intensive care to all patients who need it, the authors suggest, it may become necessary to follow “the most widely shared criteria regarding distributive justice and the appropriate allocation of limited health resources.”

The principle they settle upon is utilitarian. “Informed by the principle of maximizing benefits for the largest number,” they suggest that “the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.”

In other words, Italian doctors are deciding who lives and who dies based upon rationing of the limited availability of medical supplies and hospital beds.

If you have not been taking this coronavirus pandemic seriously, in the next few weeks you will be. Follow the CDC guidelines and do your part to limit the transmission of this virus.

UPDATE: Laurie Garrett, a former senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer, has a sober warning at Foreign Policy, Sorry, America, the Full Lockdown Is Coming:

Whether you are reading this in your living room in Vancouver, office in London, or on a subway in New York City, you need to think hard, and fast, about two crucial questions: Where, and with whom, do you want to spend the next six to 12 weeks of your life, hunkered down for the epidemic duration? And what can you do to make that place as safe as possible for yourself and those around you?

Your time to answer those questions is very short—a few days, at most. Airports will close, trains will shut down, gasoline supplies may dwindle, and roadblocks may be set up. Nations are closing their borders, and as the numbers of sick rise, towns, suburbs, even entire counties will try to shut the virus out by blocking travel. Wherever you decide to settle down this week is likely to be the place in which you will be stuck for the duration of your epidemic.

To appreciate what lies ahead for the United States, Canada, Mexico, and the United Kingdom, pay heed to Italy, France, and Germany. The United States, for example, is currently tracking exactly where Italy was about 10 days ago. France and Germany, which track two to five days ahead of the United States, are now revving up measures akin to those taken by Italy, including lockdowns on movement and social activity. In a matter of days, the United States will follow suit.

If you live alone, have no family members or close friends who require your special attention, and have no alternative living space, you have no decision to make. You are where you will be for coming weeks.

Give this a read.




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