COVID-19 Fatalities, Healthcare Workers, & Vaccine Challenges | Michael Osterholm on The Drive with Peter Attia

Check out The Peter Attia Drive Episode Page & Show Notes

Due to the information contained within related to COVID-19, it’s important to note that this episode was recorded on Monday, March 30th, 2020.

Key Takeaways

  • Some good news: After you recover from COVID-19, you might be immune from getting or spreading it. 
    • A study showed that macaque monkeys could not get reinfected after they recovered from the virus
  • Factors that increase the chance of death from contracting the coronavirus: smoking, hypertension, renal disease, and obesity
    • Michael Osterholm believes the case fatality rate in the US will be 1-2.5% 
  • The virus found in a throat swab of people showing the very early signs of COVID-19 found that the virus level was 1000x what they see with SARS
    • So even if a person isn’t coughing or sneezing, the higher volume of the virus in the throat means that the virus could be spread just by breathing and pushing out aerosols
  • We need to protect health care workers, they need more n95 masks which work better than surgical masks–an n95 mask stops aerosols  
    • “We don’t send our soldiers into war without some kind of protective equipment or without bullets in their guns…We send healthcare workers into this viral battle and we’re going to be sending them in without bullets or without protective equipment.” – Michael Osterholm
  • Two things to remember:
    •  “This is real and more people are going to know somebody in the next couple of weeks that are going to be seriously ill or die” – Michael Osterholm
    • “We’re going to get through this”

Intro

COVID-19, SARS & MERS

  • COVID-19 first appeared in China in December 2019
    • It is different from SARS or MERS because the virus can be transmitted before symptoms occur–it takes about 5 days from getting the virus to start showing symptoms
  • We don’t know if this will be seasonal or not–SARS and MERS are not seasonal and MERS can be transmitted in 100-degree heat just fine
    • “It won’t stop transmitting in any meaningful way till we get 50 or 60 or 70% of the population infected” – Michael Osterholm
      • There is no easy way out, a vaccine will take roughly 18 months
  • Some good news: A study showed that macaque monkeys could not get reinfected after they recovered from the virus
    • This suggests that after you recover from COVID-19, you will be immune from getting or spreading it 
  • The virus found in a throat swab of people showing the very early signs of COVID-19 found that the virus level was 1000x what they see with SARS
    • So even if a person isn’t coughing or sneezing, the higher volume of virus in the throat means that the virus could be spread just by breathing and pushing out aerosols

Fatality Rates 

  • Factors that increase chance of death from contracting the coronavirus: Type 1 and 2 diabetes, smoking, hypertension, renal disease, and obesity
    • Michael believes the case fatality rate in the US will be 1-2.5% 
      • Why so high? The US has a large population over 65 and a lot of young people are obese
  • The data from China and Italy doesn’t show anything that would indicate that immunosuppression puts you at higher risk
  • On average, 100 people die in New York every day. Right now, the city is averaging 150 deaths every day just from COVID-19.
  • The US has 300 million people and about 60% will get infected or 180 million. About 20% of those will need hospitalization or 36 million, and about 1.5% of those infected will die or about 2.7 million deaths

What Needs To Be Done To Limit Deaths

  • To limit the number of people who will die from COVID-19, two things must be done:
    • 1) Suppress transmission as much as we can
      • We need a Wuhan like shutdown, but this would destroy the economy
      • We need to save lives but also save the economy
    • 2) Ensure the supply of critical care supplies and drugs 
      • About 85% of our generic drugs are made outside of the US
      • The problem is that China makes most of our generic drugs for hospitals and ICUs

We Need To Protect Healthcare Workers

  • We need to protect health care workers. They need more n95 masks which work better than surgical masks–an n95 mask stops aerosols  
    • “We don’t send our soldiers into war without some kind of protective equipment or without bullets in their guns…We send healthcare workers into this viral battle and we’re going to be sending them in without bullets or without protective equipment.” – Michael Osterholm
  • 3M is the largest manufacturer of n95 masks in the US and produce about 35 million masks a month, they’re trying to ramp up production by 7-8%
    • A single hospital in NYC used 2 million n95 masks last month
  • How do we get more out of the n95 masks we currently have?
    • Form wards with 18-20 patients and don’t leave the contaminated zone so you won’t have to throw away your mask
    • Michael and his team are working on techniques so that the masks can be reused
    • We need to test infected healthcare workers to see if they’re immune and if so, get them back to work ASAP

Testing for COVID-19

  • About 800,000 Americans have been tested for the virus so far
    • The whole world needs more test kits and that’s causing a shortage worldwide
      • Abbot is developing a new COVID-19 test
  • Michael is concerned that we will have a shortfall of reagent water
  • The first priority is testing sick individuals in hospitals, the second priority is testing healthcare workers, and the third priority is testing workers in long term care

Vaccines: Outlook & Challenges

  • It’s easy to create an effective vaccine, the issue is how safe it will be in the long run
    • Even if a vaccine is created, there will be a supply chain problem where demand will surpass supply
  • It took nearly 4 years to create and distribute the Ebola vaccine
    • Hopefully, we will have a vaccine for the COVID-19 in 18 months
  • Even more challenging than a vaccine might be creating an antiviral treatment
  • One type of drug being explored to treat COVID-19 are immunologic modulators (i.e., chloroquine)
    • “But if we have people dying from a myocarditis type picture, well that’s a whole different situation and we may actually cause problems using chloroquine.” Michael Osterholm
  • There was a study that was published from France that shows some positive effects using hydroxychloroquine  
  • However, studies like these don’t have the luxury of being randomly controlled so it’s hard to take much from them

Why We Can’t Forecast The Future

  • It’s difficult to forecast or model the impact of the coronavirus because of insufficient data 
    • In the 2014-2015 Ebola outbreak, the CDC model said the cases could reach 1 million, but it only ended up being 20,000
      • “All models are wrong. Some just provide helpful information.”  Michael Osterholm
  • Globally, information sharing has been lacking to this point
    • China hasn’t been transparent
      • For example, China isn’t saying it publicly but it appears that are closing movie theaters again and potential dealing with more spread since they removed their strict lockdown procedures

Additional Notes

  • We don’t know much lingering lung disease remains in terms of fibrosis or maybe even permanent destruction of a subset of the pneumocytes
    • The one good news is that humans do not get reinfected with MERS once they’ve had it even if they are re-exposed to it–perhaps the same will be true with COVID-19
  • Each country is fighting for the same supplies that are critical and in shortage so the lower-income countries will likely not be able to get the same stuff 
  • Two things to remember:
    •  “This is real and more people are going to know somebody in the next couple of weeks that are going to be seriously ill or die” – Michael Osterholm
    • “We’re going to get through this”

Drive with Dr. Peter Attia : , ,
Notes By Alex Wiec

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