Mar 15, 2020

Joe Rogan Michael Osterholm Podcast Transcript: Infectious Disease Expert Talks Coronavirus

Joe Rogan Michael Osterholm Coronavirus Podcast Transcript
RevBlogTranscriptsCOVID-19 Briefing & Press Conference TranscriptsJoe Rogan Michael Osterholm Podcast Transcript: Infectious Disease Expert Talks Coronavirus

Joe Rogan had infectious disease epidemiology expert Michael Osterholm on his podcast on March 10, where they discussed COVID-19 and other efforts to fight infectious diseases around the world. Read the full transcript of the podcast here.

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Joe Rogan: (00:02)
All right, here we go. So what you said when you sat down was absolutely perfect, that the timing could not have been better. Well tell everybody what you do Michael.

Michael Osterholm: (00:11)
Well thank you. I’m, for lack of a better term, a medical detective. I’ve spent my whole career tracking infectious diseases down, trying to stop them, trying to understand where they come from so we can make sure they don’t happen in the first place, but most of all trying to respond to situations just like this.

Joe Rogan: (00:27)
Just like this. And just off the bat, how serious is this? Is this something that we need to be terrified of or is this overblown or how do you stand on this?

Michael Osterholm: (00:37)
Well, first of all, you have to understand the timing of it in the sense that it’s just beginning. And so in terms of what hurt, pain, suffering, death has happened so far is really just beginning. This is going to unfold for months to come yet. And that’s, I think, what people don’t quite yet understand. What we saw in China, I’m convinced as are many of my colleagues, as soon as they release all of these social distancings, these mandated stay in homes, haven’t left her home in weeks and weeks kind of thing, when they go back to work, they’re on planes, trains, subways, buses, crowded spaces, manufacturing plants, even China is going to come back again. And so this really is acting like an influenza virus, something that transmits very, very easily through the air. We now have data to show that you’re infectious before you even get sick and in some cases quite highly infectious. Just breathing is all that you need to do.

Michael Osterholm: (01:28)
So from this perspective, I can understand why people would say, “Well, wait a minute. Flu kills a lot more itself every year than this does. And I’ll remind people that this is just the beginning. Probably the best guesstimate we have right now, on what limited data we have, this could to be at least 10 to 15 times worse than the worse seasonal flu year we see.

Joe Rogan: (01:46)
10 to 15 times worse in terms of fatalities?

Michael Osterholm: (01:48)
Yeah. Yeah, and just illness. In fact, I brought some numbers. We conservatively estimate that this could require 48 million hospitalizations, 96 million cases actually occurring, over 480000 deaths that can occur over the next three to seven months with this situation. So this is not one to take lightly. And I think that’s what I can understand if you say there’s only been 10 deaths or 20 deaths or 50 deaths, just remember two weeks ago we were talking about almost no cases in the United States and now that we’re testing for it and watching the spread as it’s unfolding, those numbers are going up astronomically.

Michael Osterholm: (02:26)
Three weeks ago, Italy was just living life just fine. Now they’re literally in a virtual shutdown in the Northern parts of Italy and that’s the challenge with an infectious disease like this. It can spread very quickly and it also can affect people. I think maybe to put this into modern terms, because this is something we think of often when we think of pre antibiotic days, the old time medicine, we have an employee at our center for infectious research and policy at the University of Minnesota and she has a dear friend who lives in Milan, Italy, and she works at a hospital there and she texted this to this employee of ours last night.

Michael Osterholm: (03:01)
And this was an email that came out yesterday from one of their physicians in Milan at the largest hospital there. And he said, “I just got a very disturbing message from a cardiologist at one of Milan’s largest hospitals. They’re deciding who they have to let die. They aren’t screening the staff anymore because they need all hands on deck and they have very small areas of the hospital dedicated to non-Covid patients where they still screen doctors. Everybody else is dedicated to Covid patients so even if they’re positive, meaning that they’re sick, but they don’t have a severe cough or fever, then they have to work.” He says that they’re seen an alarming number of cases in the 40 something age range and these are horrible cases. So we need to stop thinking that this isn’t only an old person’s disease. This is what’s going to unfold, not just in Wuhan, it’s unfolding in Milan, it’s unfolding here in Seattle and this is what’s going to continue to rollingly unfold throughout the world.

Joe Rogan: (03:59)
Yeah. Where did this rumor come from that it’s an old person’s disease? Is it just because the majority of the people that have died from it so far have been older?

Michael Osterholm: (04:07)
Yes. In fact, that’s the primary risk factor for dying is being old and then having certain underlying health problems. For example, in China, those men over the age of 70 who also smoked, eight to 10% of them died, 65% of older Chinese men smoke. The case fatality rate or the percentage of people who die in women in that same age group was only about 2%. In that case, very few women smoke. Now, the challenge we have is that that’s the Chinese data, but there are a series of risk factors that we worry about that if they overlay on this disease are going to cause bad outcomes and we happen to be right at ground zero for one of the major ones here in this country and that’s obesity.

Michael Osterholm: (04:49)
We know that obesity is just like smoking in terms of its ability to really cause severe life threatening disease and 45% of our population today over the age of 45 in this country are obese or severely obese and that’s men and women. So one of the concerns we have is we’re going to see more of these, what I guess I would call, very serious and life threatening cases occur in our country because of a different set of risk factors than we saw in China.

Joe Rogan: (05:16)
Now you mentioned that there’s some sort of incubation period before people become sick, they’re still contagious. What is this incubation period and how do we know about it?

Michael Osterholm: (05:27)
When we call something an incubation period, we’re talking about from the time you and I got exposed, meaning I was in a room breathing the air that somebody else who was infected with the virus was expelling out, I breathed it in. How long from that time period till the time period that you get sick and what is that? That’s what we call the incubation period. So that’s when case numbers can double or triple in every so many days. In this case it’s about four days and we actually have data there from people who were exposed one time or one time only and we when they were exposed where they were exposed and how soon do they get sick afterwards. So the chauffeur in the car where an individual was sick or showing symptoms then the chauffeur gets it four days later. They were there one time and one time only.

Joe Rogan: (06:10)
And if the chauffeur does not show any symptoms, he’s still contagious? He could still-

Michael Osterholm: (06:14)
He could also be contagious too and that’s one of the things that’s challenging here is, you and I might get exposed to somebody who is totally asymptomatic, no symptoms. That virus would appear, well that’s not a very strong virus, but in fact, when it infects us, it could kill us. So we’ve seen cases of fatal disease that we’re exposed to people that had minor symptoms themselves.

Joe Rogan: (06:34)

Michael Osterholm: (06:35)
This is what’s unfolding here and this is where I think is such an important, and I said why the timing is so important, because Joe, we really got to get information out to the public. There is so much misinformation right now and we’re going to be in this for a while. This is not going to happen overnight and I worry. I keep telling people we’re handling this like it’s a Corona blizzard, two or three days, and we’re back to normal. This is a coronavirus winter and we’re going to have the next three months or more, six months or more that are going to be like this. And so far this thing has been unfolding exactly as we predicted it. We, in our center, put out a piece on January 20th and said this is going to spread worldwide. At the time people said “Ah, no, it’s just China.”

Michael Osterholm: (07:14)
We put out a piece the first week of February and said this is going to pop probably the last week of February, first week of March because what happens is it has what’s called an R knot or a doubling time of these every four days, so increase is doubling every four days. So, if you go from two to four to eight to 16 it takes a while to build up, but when you start going from 500 to a thousand to 2000 to 4000, that’s what we’re seeing happen in places like Italy. We’re beginning to see it in some ways up in Seattle, it’s what happened in China. And when people are confronted with that, suddenly this low risk phenomena that everyone talks about isn’t so low anymore and that’s what you need to prepare people for.

Joe Rogan: (07:51)
Now, what can be done? What can the average person do? I see people walking around with masks on, wearing gloves. Is that nonsense?

Michael Osterholm: (07:59)
Largely, yes. First of all, let’s step back, the primary mechanism for transmission is just the respiratory route, it’s just breathing. In studies in Germany, which just have been published literally in the last 24 hours, they actually followed a group of people who had been exposed to somebody in an automobile manufacturing plant and then they had nine people that, with this exposure, he said, “if you have any symptoms at all, contact us we want to follow up with you.” And they all agreed.

Michael Osterholm: (08:25)
Well, they got infected. And so in the very first hours just feeling bad, sore throat, they went in and sampled the throats, their saliva, their nose for virus, they did blood, they did stool, they did urine. And they found that at that very moment when they first got sick, they had incredibly high levels of virus, sometimes 10000 times that we saw with SARS, in their throats. Meaning they were infectious at that point already and they hadn’t even had symptoms yet of really any nature, they weren’t coughing yet. And that’s where we’re concerned because that’s the kind of transmission… I always have said, “Trying to stop influenza virus transmission is like try to stop the wind.” We’ve never had anything successfully do that other than vaccine and we don’t have a vaccine here.

Michael Osterholm: (09:07)
So what’s happening is that people in public spaces are getting infected. And the way you need to address that is, unfortunately, if you’re older, over 55, you have some underlying health problems, which unfortunately a lot of Americans do, we have obesity, then right now you don’t want to be in large public spaces and trying to potentially get infected. So you can take care of that part. As far as what can public health do, we can talk about this, we’re not going to have a vaccine anytime soon, that’s happy talk. We can close schools. One of the big challenges we have right now, if we close schools, what do we accomplish? In influenza virus, we close schools during outbreaks, because it turns out kids get infected in school and they’re like little virus reactors. They come home and they transmit it to mom and dad and brothers and sisters and so we close schools sometimes. Christmas breaks are always great for putting a dampening effect on flu. In this case, kids are not getting sick very often at all, which is one of the really good news features of this disease. In China only 2.1% of the cases are under 19 years of age.

Joe Rogan: (10:12)
Why is that?

Michael Osterholm: (10:13)
We don’t completely know and I’m going to come to that in a second because they’re getting infected it turns out. One study showed that they still get infected with the virus, but they don’t get sick and we have that happen. There’s a disease called infectious hepatitis, hepatitis A, where we have outbreaks in daycares. And the way we know you have an outbreak is because it was transmitted through the stool, fecal oral. His mom and dad and the daycare providers all get sick and the kids, no symptoms. We go in and test the kids, they’re all positive. So some diseases will manifest primarily when you’re adult, but not as a child. This one appears to be the same.

Michael Osterholm: (10:46)
So do we close schools or not if we’re not really spreading the disease? Because it turns out that if we close schools, a recent study done showed that 38% of nurses today in this country who are working in the medical care area have kids in school, and if suddenly we’re closing schools for two or three months, who’s going to take care of those kids? One fourth of the American population has no sick leave. If we close schools, they don’t get paid if they have to stay home. So when you ask what can we do it, we have to really be thoughtful about what we do. Are we doing more harm than good by closing schools, for example, even though everybody will say, “Oh, we got to do everything we can,” or do we just tell people it’s going to be limiting your contact as much as you can and that’s really about what we can do.

Joe Rogan: (11:27)
And limiting the contact, is that really going to help?

Michael Osterholm: (11:29)
It does because it’s like putting rods in a reaction. If you don’t have as much close contact, you can not transmit as much. If I’m sitting in a room with a hundred people and we’re sharing air, the transmission’s remarkable. Right here, off the coast of California, you’ve got your cruise ship. Cruise ships are notorious for recirculating air inside the inner cabins. We’ve had a number of outbreaks.

Joe Rogan: (11:52)
That’s why they’re having these outbreaks on cruise ships?

Michael Osterholm: (11:55)
Yeah. And then you leave them on there. I think the cruelest human experiment we’ve done in a long time with humans is leave them on these ships. Get them off right away.

Joe Rogan: (12:01)
Should they get them off right away?

Michael Osterholm: (12:02)

Joe Rogan: (12:03)
And what should they do with them?

Michael Osterholm: (12:04)
Well, they can put them in quarantines of some kind, if they want and follow up on them, but you’re guaranteed they’re all going to keep getting infected day after day.

Joe Rogan: (12:10)
It seems like we’re not really prepared for something like this. Although the CDC has been telling us for a long time that we should be.

Michael Osterholm: (12:17)
We are not prepared at all in a sense. I wrote the book Deadliest Enemies that was published in 2017.

Joe Rogan: (12:25)
Right here ladies and gentlemen.

Michael Osterholm: (12:27)
Thank you.

Joe Rogan: (12:27)
Go get it. Read it. Panic.

Michael Osterholm: (12:30)
And in chapter 13, the title of the chapter was SARS and MERS, a Harbinger of Things to Come.

Joe Rogan: (12:35)
Oh, boy.

Michael Osterholm: (12:36)
We predicted this. And then I wrote a chapter on there, what a flu pandemic would look like if it emerged in China. And if you read it, it’s exactly what’s happened. The supply chains went down, China locked down the country, it spread to other countries, people all pointed fingers and it’s the kind of thing where we hear it and hear it, but we don’t get prepared.

Michael Osterholm: (12:54)
Five years ago I gave a talk at the Mayo clinic. First time I talked about this, I talked many times afterwards, and I showed a slide of Puerto Rico, pictures of Puerto Rico. And then I showed the map and then I showed a picture of a building in Puerto Rico, a nondescript building and I said, “This is our next big disaster.” It turns out that 85% of all the world’s production of IV bags, saline that we need desperately, were made in these plants in Puerto Rico. And all we needed was one category five hurricane to come through and take it out. Maria came through a year and a half ago and the world went into a major crisis with a shortage of IV bags. Now, that was so obvious that was going to happen and yet we don’t prepare.

Joe Rogan: (13:32)
That’s so foolish.

Michael Osterholm: (13:33)
I know, I agree and hopefully this is a wake up call. The business community hopefully will wake up. One of the other things we’re doing right now, Joe, this is really one of the things that has me most concerned about this whole situation, is our group has been studying for the last year and a half with support from the Walton Family Foundation looking at critical drug shortages. It turns out that we identified 153 drugs in this country that people need right now or they die. It’s on the crash cart, it’s acute critical drugs. 100% of them are generic. All of them basically are made offshore of the United States and large part of them are in China and India. And at this point we have shortages anyway every day just before this crisis happened. Now these supply chains have gone down. Our group is actively helping the United States government try to figure out where they’re going to get these drugs.

Michael Osterholm: (14:23)
Now just think of this. If I came to you and said the defense department was going to outsource all this munitions production to China, you’d look at me and say, “Come on.” You know what? The US defense department has no more access to these drugs than anybody else. They are beholden to China for these drugs. 690000 Americans have end stage renal disease right now, most of their primary drugs are coming from China. And now with the shutdown and what’s happening with this, and this is what I talked about in the book, why I was so concerned, because we are at risk. So even the situation that’s unfold, it’s not just about what the virus does to you, it’s about what the entire system is rigged up to be and what this virus does once it gets into it.

Joe Rogan: (15:04)
Jesus, you’re making me nervous.

Michael Osterholm: (15:08)
Well, but before we get done here, we’re going to talk about what we can do to get people not nervous because this is-

Joe Rogan: (15:12)
What? It’s too late.

Michael Osterholm: (15:14)
No, no, no. What I mean is we’re going to bring you around to take… My job is not scary out of your wits, it’s to scare you into your wits. What can we do about it?

Joe Rogan: (15:21)
Sorry, let me ask you something about sauna use. One of the things that I read was that if you are in contact, that 20 minutes in a sauna, in a really hot sauna is a very good for killing some of the virus. Is that bullshit?

Michael Osterholm: (15:37)

Joe Rogan: (15:38)
Jesus Christ. These people. Yeah. There was a some sauna facts thing that was being pushed around, that it’s great for flu and all sorts of infectious diseases.

Michael Osterholm: (15:50)
Actually, it’s great for you. It makes you feel good, but we don’t have any evidence that it makes any difference in infectious disease.

Joe Rogan: (15:56)
So it doesn’t have any impact at all? The idea was that the breathing in of the very hot air, 180 degree air, for 20 minutes will kill some of the virus.

Michael Osterholm: (16:06)
See if that temperature of 180 degree air got really into your lungs, your lungs would be fried. You’d be dead.

Joe Rogan: (16:11)
Well where does it go?

Michael Osterholm: (16:12)
So what happens is, just from the time you breathe it in and what you mix with the air there, it’s kind of like taking a cup of hot water and putting it into a bathtub of cold water. And so what happens is by the time you get done, it’s not that hot. And so in this case, your lungs couldn’t stand even 110 to 20 degree heat without causing really severe damage. And so it doesn’t kill the virus at all.

Joe Rogan: (16:33)
So, the virus would have to be like just in your mouth or something like that. Even then?

Michael Osterholm: (16:38)
No. Nope, Nope.

Joe Rogan: (16:40)
Jesus, Michael. That’s unfortunate because that was exciting. I was reading that and I was like-

Michael Osterholm: (16:47)
Don’t stop using the sauna. It’s a good thing to use for your skin and everything else, but it’s not going to help you with this one.

Joe Rogan: (16:53)
So how does it cool the air down? What’s happening?

Michael Osterholm: (16:56)
In terms of-

Joe Rogan: (16:57)
It’s going right into your lungs, right?

Michael Osterholm: (16:58)
Yeah. Basically it’s a mixture of… When you breathe out you don’t breathe all the air out. Okay? You’d almost be dead. You couldn’t do the tidal volume. So what happens is every breath-

Joe Rogan: (17:10)
What? What’d you say?

Michael Osterholm: (17:10)
In other words, you have so much air in your lungs already, when you breathe out, you breathe just a little bit of it out and each time you can bring more in, out, in and out. And so when this mixes in, the hot air like that, or the very cold air, in Minnesota when you’re 45 below zero, we have the same problem we don’t freeze our lungs when we breathe in. May feel cold. And so it’s just there’s so much in there that it mixes with the other air and it ultimately, the temperature of your lungs don’t change.

Joe Rogan: (17:34)
Even if you’re doing like some crazy deep breathing exercises where you slowly exhale all the air out til there’s nothing left and then breathe it all the way?

Michael Osterholm: (17:42)
I’m giving you my best shot at it. It’s not going to make much difference. Sorry.

Joe Rogan: (17:46)
I’ve always wondered that about like people that are in like Alberta and it’s 50 degrees below zero. How do they do that?

Michael Osterholm: (17:52)
Yeah, well we do it all the time in Minnesota. Well we don’t anymore in Minnesota. It’s getting warmer there every winter.

Joe Rogan: (17:57)
Part of the problem, right?

Michael Osterholm: (17:59)
WE surely know what cold air is like.

Joe Rogan: (18:01)
All right, well so much for that myth. Myth number two. Well I won’t say myth, I should say rumor, was that this was something from some sort of a biological weapons thing that was leaked because Wuhan is some area, a part of China, that they actually do work on biological weapons.

Michael Osterholm: (18:21)
And we’ve heard that loud and clear. And let me just give a little bit background and more of my career. Back in the early 1990s I got very involved in the whole area of bio-defense and bio-terrorism, bio-warfare. It turned out I was involved with helping to interview and get information from some of the Russian bio-weaponeers. After the wall fell and Russia collapsed, we had all these experts coming out who’d been spending their whole lives making bio-weapons and it became very clear to me that this was really a serious challenge. And as part of my work, I spent a lot of time in this area and I actually, through a series of serendipitous events, became a personal advisor to his majesty, King Hussein of Jordan, before he died, on this topic. I got really into it.

Michael Osterholm: (19:06)
I wrote a book that was published on nine 11 of 2000 called Living Terrorist, What Our Country Needs to Survive the Coming Bio-terrorist Catastrophe. And I think I bought eight of the 12 copies that were sold in that year afterwards. And then when 9/11 happened, of course, then it became really prominent. And then I went on to serve on a group here in the United States that was basically the national science advisory board on bio-security, safety issues. So I’ve had a lot of experience in this area. And so I bring that to the table and I tell you there is no evidence whatsoever that this is a bio-weapon or that it was accidentally released from the Wuhan lab. Today, with the genetics we have on these viruses and how we can do testing, we can almost date them almost like carbon testing so radiocarbon and you want to know how old a block is or something like that.

Michael Osterholm: (19:51)
This thing clearly jumped from an animal species, probably the third week of November to humans. In Pangolins, these scaly anteater like animals are a very good source because we have Corona viruses just like those in these animals and it got into a human. So we surely had a lot of challenges with that, but I don’t believe that there’s any evidence linking this to one, an intentional release or an accidental release or that it’s an engineered bug. It’s not.

Joe Rogan: (20:18)
My friend Duncan and I did a show back in 2012-ish, somewhere around there, with Scifive where we went to the CDC in Galveston and we talked to them about that very thing and they said the real concern, the real concern is just actual diseases. It’s not manmade diseases. It’s naturally occurring disease.

Michael Osterholm: (20:37)
That’s exactly it. We could not have crafted a virus like this to do what it’s doing. We don’t have the creative imagination or the skill set. If somebody said, “Okay, I want to find a virus that’ll take out a lot of people.” Mother nature does it so much better than we could ever do it. And whether it was Ebola, whether it’s this one or it’s antibiotic resistance, any of these things. You and I were talking earlier about the [inaudible 00:21:01] chronic wasting disease to be a problem for humans. Mother nature is doing it pretty well on her own.

Joe Rogan: (21:05)
The chronic wasting one really scares me because there’s so many people that have a vested interest in dismissing it. I had our good friend Doug Durham on the podcast with, I don’t remember the gentleman that he brought with him-

Michael Osterholm: (21:18)
Brian Richards.

Joe Rogan: (21:19)
Thank you. Brian Richards, who explained the science behind it and there are so many people that are dismissing this because either they enjoyed deer hunting or they want captive cervids to be something that you can be released on private property because people grow and breed deer and then sell them to ranchers who want deer on their properties, particularly large deer. And guys that I have talked to that are dismissing it, I can see the chain of events that they want it to be not a concern, but if you see what it’s doing to deer, it’s terrifying. It’s a hundred percent fatal, the DNA exists on plants for years, they leak it out of their saliva, they leave traces of it everywhere and in Doug’s area there’s, somewhere near there, there’s a 50% infection rate.

Michael Osterholm: (22:11)
That’s right. Listen, I think this is really a significant challenge. I was involved back in the 1990s and into the 1980s when mad cow first emerged in England and at the time was asked to give an assessment when this was all this bovine spongiform encephalopathy and other prion, these prions are what causes disease, and people want to dismiss it that people aren’t going to get sick. Well, then we realize 10 years later all these human cases started to show up that were from those exposures 10 years before. And it took a while before those prions obviously changed in the cattle to get to the point where they’d infect humans. Well, the same thing is happening with deer. If you look back on the deer population that were infected 30 years ago and you look at it today, the prions are constantly changing.

Michael Osterholm: (22:58)
They’re mutating and there are new strains and they’re getting more human-like all the time. And one of the things our center is doing is we’re working on that very issue of trying to help people understand that the studies that were done 15 or 20 years ago looking at how infectious these might be for humans were really well done, they were good, but they had different strains and over time these strains are looking to be more and more like they could infect humans or they could even infect cattle, which would be another huge challenge if that happened. And so I think your point’s a really good one and we know today that there are probably at least 17000 deer that were consumed in the past year that were actually positive for this prion and people went ahead and ate it anyway. So I worry about that too.

Joe Rogan: (23:41)
That’s terrifying. So these people have these prions in their system now, but then currently they’re not making the jump to cause a… What is it? Jakob Creutzfeldts disease?

Michael Osterholm: (23:49)
Yeah, Creutfeldt Disease which is one… We don’t know that humans are getting infected. One of the challenges is we don’t have a test unless you die and then that’s a heck of a way to have to get a test for something. So one of the challenges, you don’t know this until you actually show up with the signs and symptoms. And so one of the things that we’re looking at carefully is doing surveillance or disease detection among people that might present with this. If it’s going to happen, I suspect the naturally occurring prion related diseases like Creutfeldt-Jakobs Disease you just mentioned, occurs typically in older people over 70. If you suddenly start seeing a 40 year old or a 50 year old or 60 year olds even, with this disease then you’ve got to start thinking what else is going on?

Michael Osterholm: (24:29)
And so that’ll help us detect it in cases, but then we’ve already failed. Then we’ve had 10 years worth of transmission or more potentially before we get the first human cases like we did with mad cow. And so our message has been right now hunting is really important, it is a very important part of our society. Frankly, it’s the way we managed deer herds, thank God. It’s a huge economic boon for running the kinds of DNRs as such we have. We balanced the back, as you know, from sportsman on these licenses. And so we don’t want to stop hunting, but we’ve got to make sure that we make sure that people aren’t getting infected. And one of the things that our group at the University of Minnesota is working on is tests now that are almost like point of detection tests. So if you shoot an animal, could you know very quickly that it’s positive or not? And then you’d know not to process that animal or eat it. And that’s what we need to get at.

Joe Rogan: (25:18)
Well, not only that, the prions, what’s terrifying is that how invulnerable they are, how ridiculously vigorous they are. When you can boil them at a thousand degree temperature for hours and hours and they’re fine.

Michael Osterholm: (25:32)
That’s right.

Joe Rogan: (25:33)
When they’re sanitizing medical equipment that they’ve used on mad cow patients, whether it’s cows or humans with these prions, they’ve been able to do it three times, so try to sterilize these things… The sterilization process you were… What is the temperature that they do it for?

Michael Osterholm: (25:50)
Well they do it both temperature and pressure, but it’s in the hundreds of degrees and it’s under high pressure. And I’ve actually been involved with several cases where these very equipment you’re talking about were accidentally used on somebody who had Creutzfeldt-Jakob disease, they had to landfill it. They couldn’t even sterilize it.

Joe Rogan: (26:06)
That’s what’s insane. You can’t kill these things.

Michael Osterholm: (26:09)
It’s pretty hard. That’s why we want to make sure that if you’re eating deer, cervids, right now that we have to make sure they’re tested. And I think the other point you raised is a good one. We’ve been very concerned about the movement of this disease by cervid farming. We’ve had far too many examples, and Doug has shared that with you, just the extent to which we see state by state by state solely getting picked off because somebody moved a trophy deer from state A to state B and it was infected and it got out or others got out of the pens and then infects locals.

Joe Rogan: (26:42)
Yeah. Now has that the jump to bison or elk or any of those other animals yet?

Michael Osterholm: (26:47)
Not yet. It’s several kinds of deer, as you know, but not those.

Joe Rogan: (26:51)
It’s mule deer so far. There has been some cases in the West. It’s primarily Whitetails, right?

Michael Osterholm: (26:58)
Exactly. Yeah. And then there’s been a deer in Korea, a type of deer there and one in the Scandinavian countries.

Joe Rogan: (27:04)

Michael Osterholm: (27:05)
Yeah. The different kinds of deer types that are there. Yeah. Yeah. So the one we worry about right now is getting into the caribou in Northern Canada. Right now, the range of the deer that are infected in the provinces of Canada is right budding up next to caribou. And of course, if you’re not a hunter, you would know this, but caribou, obviously the herds are remarkable unlike white tails or for that matter elk. If you got it into caribou, it would likely spread very quickly and as you know, the native populations, caribou are key. They’re key to their livelihood. So you wouldn’t want to see it getting the caribou.

Joe Rogan: (27:40)
Now I didn’t even know that it was in Canada. What parts of Canada has it been?

Michael Osterholm: (27:46)
Throughout a number of provinces, I think there’s four provinces now it’s in. And it’s spreading. It’s the same phenomena that a combination of a deer movement with cervid farming and then once it’s in an area, it’ll keep migrating a bit and a bit as these animals move somewhere. But, as we know, deer don’t fly 4000 miles every season so it’s not that kind of movement of humans. If we’re going to see a big movement, it’s humans are doing it.

Joe Rogan: (28:13)
As our good friend Doug Duren has been doing all this work to try to alert people about it and also they’re putting up these testing places where hunters can bring in a deer and have the deer tested. How much of that is available to people around the country though?

Michael Osterholm: (28:30)
Not nearly enough. And that’s what we need to work on, is if you don’t make it easy and convenient, as you know, it’s not going to get done. And so it’s hard enough to convince people that there’s really a problem because people don’t want to believe it even if they know that there’s CWD in deer in the area and we have some like that. But I think the tide is changing. More and more people are sensitive to it. They want to have access to testing quickly. But if it’s going to take you a month and a half to get the test back, you know what it is by-

Joe Rogan: (28:56)
Does it take that long?

Michael Osterholm: (28:56)
Well, in some cases they get so busy because unlike laboratory testing for an entire year, where I do one 12th and January one 12th and February, et cetera, et cetera, deer season typically is very concentrated in just a couple of weeks to a month in the fall. And so the problem is all the animals come in at that time so your lab capacity has to handle that huge surge all at one time. And so sometimes it takes a while to get it back.

Joe Rogan: (29:20)
So these hunters just hope they don’t take a bite during that time.

Michael Osterholm: (29:25)
Yeah, and we hope that these prions don’t ultimately infect people.

Joe Rogan: (29:30)
And jump.

Michael Osterholm: (29:30)
And jump. But if they do, I worry what will happen to deer hunting as we know it because probably a lot of people will not continue and we need that desperately for herd management. That’s the way we do it.

Joe Rogan: (29:43)
Well, what they’re doing in Doug’s areas is they’re actively trying to eliminate a lot of deer and try to lower, drastically lower the numbers, particularly of bucks, which I guess they wander more.

Michael Osterholm: (29:55)
Yep. They do. Yep. Yeah. Yeah.

Joe Rogan: (29:57)
It’s all really scary stuff because if they do make the jump to humans… It has made the jump to I believe mice. Is that the case?

Michael Osterholm: (30:04)
Well, what happened was originally it didn’t, and so that was some of the data that was used to support, “Ah, it’s not a problem.” Now these, what we call humanized mice or mice that are basically much more like a human, we’re now seeing that jump occurring in these new strains. See, the strains that again, were around 20 years ago are not the same ones today because as these prions continue to pass from animal to animal to animal, they go through these little minor mutations and they’re getting more and more and more like what a human transmissible prion might look like. So in these mice studies now that are really made to mimic a human, we’re starting to see that jump.

Joe Rogan: (30:41)
Yeah. And folks, if you’ve never seen a deer with CWD, you should go and Google it because it’s terrifying. The idea that could make that jump to human beings and people pouring saliva out of their mouths and their whole body just wasted away to skin and bones. That’s what we’re looking at. That’s why it’s called Chronic Wasting Disease because the animals literally waste away.

Michael Osterholm: (31:02)
We actually have a major resource center on our website. Free of charge, open, and it’s all on Chronic Wasting Disease. So if people want to go there, it’s www.CIDRAP, C-I-D-R-A-P and you can go there and all these pictures, all the kinds of-

Joe Rogan: (31:16)
Can you repeat that? What is it again?

Michael Osterholm: (31:17)

Joe Rogan: (31:21)

Michael Osterholm: (31:22)
Yep. Just center for infectious disease research and poly,

Joe Rogan: (31:27)

Michael Osterholm: (31:29)
And we have a lot of information-

Joe Rogan: (31:29)
There it is. Danny’s got it.

Michael Osterholm: (31:29)
There it is. That’s it. You got it right there.

Joe Rogan: (31:33)
Chronic diseases resource center.

Michael Osterholm: (31:33)
Yep. And we’ve got a lot of information on there also about corona viruses. We have a whole resource center just for the corona viruses too.

Joe Rogan: (31:39)
Novel Corona virus.

Michael Osterholm: (31:41)
There you go.

Joe Rogan: (31:45)
So, for the average person that is sitting around reading these articles that say don’t worry or readings these articles that say this is the end of humanity. What could these people do? What could they do and what do they do if they get infected?

Michael Osterholm: (32:02)
Well, first of all.

Joe Rogan: (32:03)
… They do, and what do they do if they get infected?

Michael Osterholm: (32:03)
Well, first of all, neither of those kind of articles are correct. We have to make sure that we get that message out to people. We need straight talk right now. Part of it is, it’s so hard to … You hear from people as well as experts, “Well, is this going to happen or not happen?” Let me just give you an example, because we’ve heard a lot about, “Well, it’s going to go away, the Coronavirus, with the seasons. When it warms up, it’ll go away.”

Michael Osterholm: (32:28)
Well, the other Coronaviruses that we have that we’ve had to worry about was SARS, which appeared in 2003 in China. When that came out of China in February 2003, it took us a little while to figure out that these people aren’t really that infectious until day five or six of their illness. Then they really crash and burn, and many of them would die. What we did was, basically, by knowing that, identify these cases and their context quickly, so if they had symptoms, brought them in, put them in these isolation rooms so they wouldn’t infect anybody else. It took until June to bring it under control. That had nothing to do with the seasons.

Michael Osterholm: (33:06)
MERS, which is another Coronavirus that’s in the Middle East. It’s in the Arabian Peninsula. The natural reservoir for that is camels. By the way, SARS it was palm civets, a type of animal food that we got out of the markets there.

Michael Osterholm: (33:22)
In the Arabian Peninsula, we’re not going to euphemize 1.7 camels to try to get rid of MERS. There, it’s 110 degrees out, and this virus is transmitted fine, thank you. I mean, it goes from animals to people, it goes in the hospitals. There’s no evidence it’s seasonal there.

Joe Rogan: (33:39)
That’s a good myth to expose right away. This is not something that’s going to cure-up when it gets warm.

Michael Osterholm: (33:44)
If it does, it won’t be because there’s a model for it.

Joe Rogan: (33:48)
What will it be? Because how does something like SARS run through a population and then stop being around anymore?

Michael Osterholm: (33:54)
Well, it wouldn’t have, but had we had good public health, had we had the same kind of transmission we’re seeing with this Coronavirus, where you’re infectious before you even get sick, where you’re highly infections. Remember with SARS now, you didn’t really get infectious until you were six days of illness and you knew that you were in trouble, and then you could isolate you. We didn’t understand that at first, and the virus transmitted, so that’s why SARS stopped.

Michael Osterholm: (34:18)
MERS stopped because we don’t get rid of the camel, so it keeps hitting humans day after day, but then when we go to the hospital, we no longer allow those individuals to transmit to others in the hospital, because we do what we call good infection control. As soon as they get there, they’re in special rooms with special masks, and all this kind of thing.

Michael Osterholm: (34:36)
In that regard, these Coronaviruses can be stopped. This one’s not. As I said at the top of the program, this is like trying to stop the wind. Influenza transmission, you never hear anybody say in a bad seasonal flu year, “We’re going to stop this one.” If you don’t a vaccine that works, you don’t. It’s just breathing, that’s all it is.

Joe Rogan: (34:55)
What’s the best case scenario here?

Michael Osterholm: (34:57)
Well, I think, as I laid out to you before, this could be 10 times worse than a really bad seasonal flu year. I’ll grant you, it will hit primarily the older population and those with underlying health problems. As I mentioned also, we have a lot of people who have other risk factors. Obesity, high blood pressure is another risk factor where you could have a really bad outcome with this. We don’t quite know what it’s going to do yet.

Michael Osterholm: (35:19)
I think, we’ve been right on the mark predicting where it’s going to be to today. I think from here on out, I can tell you it’s going to stay around for months. It’s not going to go away tomorrow. We got to stop thinking about, “If we just get through tomorrow, that’s it.” If we’re going to close schools, we’re going to tell people not to go into public or we’re going to cancel big events, how long are we prepared to do that? What are we going to do? We have to ask ourselves that.

Michael Osterholm: (35:40)
I think the big thing is, if eventually enough people get infected, where it will be like putting reactors in the rods … Rods in the reaction, I should say. Then that stops it by itself.

Joe Rogan: (35:49)
How so?

Michael Osterholm: (35:52)
Because if two of the three of us in this room were immune right now to it because we’d had it, and recovered, and had protection, because of natural protection, then I couldn’t transmit it to anybody. That’s what’s going to happen. If you get enough people who get infected, ultimately, then it’ll slow down and stop transmission that way, but that’s a heck of a price to pay to get there.

Joe Rogan: (36:11)
Is it safe to say that we’re fairly fortunate that this isn’t something like the Spanish Flu, or something that’s really ruthlessly deadly?

Michael Osterholm: (36:19)
Well, that’s where I think we have to be really careful. Just to back up, about .1% of people who get seasonal flu die. Grant you, it’s mostly older or younger people. That’s one out of a thousand. With this one, right now in China, we’re seeing between 2 and 3% of the people die, and some say, “Well, that’s way too high. It’s not going to be that high. It’s going to be lower.” Again, and they say that because we didn’t pick up all the milder illnesses.

Michael Osterholm: (36:46)
On the other hand, we have a lot of additional people in countries like ours that have even more risk factors for having bad outcomes than China. Spanish Flu, the one you mentioned, 1918, that was about a 3 to 3.2% case mortality rate. Now, it did preferentially impact 18 to 25-year-olds. They were the hardest hit group.

Joe Rogan: (37:07)
Why was that?

Michael Osterholm: (37:09)
Well, it has to do with your immune response, again. We think that what happened is, when this virus got into you, it created what we call a cytokine storm, which is an antibody response in your body that’s out of control and, basically, you destroy yourself, and it sets this thing up to trigger it off.

Joe Rogan: (37:25)
The healthier people had the more adverse reaction to it?

Michael Osterholm: (37:28)
Exactly. Or the other group that has had a real challenge with that are pregnant women. Pregnant women have a very unique issue. One is, of course, they have some constriction in their lungs just by the very physical mass.

Michael Osterholm: (37:41)
Also, their immune system is really at a heightened state at that point. There’s a part of that immune system in that woman that says, “This is all not me. Get rid of this.” It’s like a rejection of a graft. The other part’s saying, “This is the most precious cargo I’ll ever carry. I got to make sure I don’t lose it.” When that virus got in-between those two, it started, again, that same kind of cytokine storm.

Michael Osterholm: (38:02)
Now, the thing that concerns us about this, what we saw in 1918, I mentioned this three-plus percent, this one could be as high as 2%. It’s somewhere between a really bad flu year at .1%, and it could be as high up here, getting closer to 1918-like. That’s the numbers I just gave you a few minutes ago from the American Hospital Association, of 480,000 deaths here in this country over the next 6 to 12 months.

Joe Rogan: (38:31)
What can someone do to shore-up their immune system while this is all going on?

Michael Osterholm: (38:37)
Well, a couple of things. First of all, just being as healthy as you can be. Weight, weight. I’m getting up there right now where it becomes more and more of a challenge to stay in good shape. The more you can do to do that, something you know all about, is keeping in shape is really important.

Michael Osterholm: (38:55)
A second thing is, if you’re on medications, like for high blood pressure, don’t miss them. Take those drugs, because they’re really important. Even though they may not appear … You don’t have any symptoms of high blood pressure, or something like that. Then, I think just getting sleep and eating a healthy diet. That’s about what we can do today to help get you prepared for this.

Joe Rogan: (39:18)
Is there anything else one could do? Like maybe IV vitamin drips or anything that’s going to really boost your system?

Michael Osterholm: (39:28)
When you look at all the things that might be there, and I’m happy and willing to accept any and all that might help, but we don’t really have any data that those substantially impact on your immune system to make it that much better.

Joe Rogan: (39:40)
Is that the case because not that many people do it though?

Michael Osterholm: (39:43)
No, actually there’s been studies-

Joe Rogan: (39:45)
It’s been studied?

Michael Osterholm: (39:46)
It has been studied. It’s been studied. I mean, a good example is, and I was one of those people who thought, “Boy, this is a great thing.” Probiotics, things. It turns out that we’ve studied this with regard to antibiotic resistance and does it help your gut? Et cetera. It turns out that the probiotic users were no different than the non-probiotic users.

Joe Rogan: (40:04)
In terms of recovery from antibiotics?

Michael Osterholm: (40:06)
No. The issue of if you’re going to kind of compete out the bad bugs so by getting the good, healthy gut flora, the bugs there, you would actually reduce the chance of picking up a bad bug. It turned out there was no difference. That people-

Joe Rogan: (40:19)
How would they do a study like that? The only way I think they would do a study like that accurately is infect someone that is the same person. Like have the same person with no probiotics, and then have them with probiotics.

Michael Osterholm: (40:33)
The studies that have been done are very close to that, but what they did is they used two different groups of people. These people used probiotics, this group did not. Then they looked at all their illnesses, and they got stool samples on everybody, and they got samples-

Joe Rogan: (40:43)
How large is the group?

Michael Osterholm: (40:45)
I don’t have the numbers in front of me. They’re pretty sizeable. Because I was disappointed. I was taking some myself. I think the key message here is, is that we’re going to get through this but right now, we do have some real challenges before us. What we can’t tell people is, “It’s all safe.”

Michael Osterholm: (41:04)
Every time I hear people say, “The risk is low right now,” it reminds me of what would happen if there was this huge low pressure system five days off the coast of the Gulf, and there was 90 degree water between that system and the beach, and there was no wind sheers in the Northern Hemisphere that was likely going to knock it off, but we tell the people standing on the beach that we have low risk of anything. Well, we know five days from now it’s coming.

Michael Osterholm: (41:26)
What we need to do is help the American population, or the world for that matter, understand we’re going be in some hurt for the next few months, and we have got to get better prepared. How are we going to work? Where are we going to work? We can’t stop working. We need our lights on, we need healthcare, we need food.

Joe Rogan: (41:45)
A bunch of things people should do that’s going to boost their immune system that we know of, right? Like get sleep.

Michael Osterholm: (41:51)
Mm-hmm (affirmative).

Joe Rogan: (41:53)
Drastically lower your alcohol intake. Drink a lot of water.

Michael Osterholm: (41:56)
Mm-hmm (affirmative).

Joe Rogan: (41:57)
Take vitamins.

Michael Osterholm: (41:57)
Mm-hmm (affirmative).

Joe Rogan: (41:58)
Those kind of things. Things that are going to keep your body healthy.

Michael Osterholm: (42:00)
Yup, that’s … You nailed it. That’s it.

Joe Rogan: (42:02)
In that sense, a sauna will help you a little bit because it does …

Michael Osterholm: (42:06)
Well, it relaxes you.

Joe Rogan: (42:07)
Relaxes you. It also boosts up your heat shock proteins.

Michael Osterholm: (42:11)
Now, if you’re in Minnesota, we’d say there’s a two-part requirement to that. You got to go from the sauna to the ice water, back to the sauna. You got to do both.

Joe Rogan: (42:17)
Yeah. People love that, right?

Michael Osterholm: (42:19)
We do it all the time.

Joe Rogan: (42:20)
Well, the Russians invented that, right? [Banya 00:42:22], yeah.

Michael Osterholm: (42:23)
Yeah, yeah.

Joe Rogan: (42:25)
Have you ever done that?

Michael Osterholm: (42:26)
I have. My son and daughter have a beautiful lake place up in Northern Wisconsin. They got a sauna, like literally 12 feet from the lake. There’s a spring right there, so in the wintertime, the lake actually stays open so we go right from the sauna and the hot tub, right to the water, and back.

Joe Rogan: (42:43)
Oh, wow. Even when it’s frozen?

Michael Osterholm: (42:45)
Oh, yeah. Well, because it’s not frozen right there where the spring is, so you literally can go right into it. Then you run right back into the hot tub. That’s when you sleep well. When you’ve done a couple of those rounds, you sleep really well.

Joe Rogan: (42:55)
Yeah, yeah. I would imagine. Your body’s freaking out. I love the sauna but I haven’t had any opportunity to jump into a lake right afterwards.

Michael Osterholm: (43:03)
Okay, well, we’ll have to … Not just any lake. You got to have an ice covered lake.

Joe Rogan: (43:07)
Yes, yeah. Real cold.

Michael Osterholm: (43:08)
Then you get it, yeah.

Joe Rogan: (43:10)
That’s the real feeling.

Michael Osterholm: (43:11)

Joe Rogan: (43:13)
What else can people do in terms of all this hand sanitizer jazz and masks? Is that all-

Michael Osterholm: (43:20)
The hand sanitizers actually are a great thing for stopping a lot of infectious diseases. They actually are really good. They’re good for your hands, in terms of the skin. They kill the bad bugs. The whole issue of using your hands, touching your face that people all concentrate on, the data’s actually very weak that this kind of virus is going to be transmitted that way. I wouldn’t tell you to stop using hand sanitizer, but don’t think it’s going to have a big impact on this bug.

Joe Rogan: (43:46)
Did you see that viral video that’s going around with that woman who was giving the address at the Bethesda, the White House? She tells people not to touch their face, and then immediately licks her finger and turns the page.

Michael Osterholm: (43:59)
I did. I saw that. Yeah, I saw that. I saw that, yeah.

Joe Rogan: (44:00)
Well, why is she telling people not to touch their faces?

Michael Osterholm: (44:02)
Because the thought was is that there are receptors around your eye right here that actually for this virus could get in and then get into your body. The data we have on this is to sparse to say that that’s the case. I think the primary thing about hand washing is legitimate.

Michael Osterholm: (44:20)
One of the things, people want to do something. They want to feel like they’re doing something, and so we tell them, “Wash your hands often to prevent this disease.” I feel like we’re not being really honest with the people. That the data, and we’ve looked at this very carefully, really is about just breathing air, and that’s a hard thing to stop. Keep doing the hand washing, but don’t think that that’s going to stop the disease. You asked about the masks-

Joe Rogan: (44:44)
It’s going to stop other stuff. Yes, the masks.

Michael Osterholm: (44:46)
Well, there’s two kinds. Basically, the surgical mask, which just fits over. The reason it’s called a surgical mask is because it’s loose fitting, just fits, kind of ties behind you. It was worn by surgeons so that they don’t cough or drip into your wound. It was never made to protect you from bugs coming in, so those little spaces on the sides, that’s not a problem if I’m breathing into the cloth right in front of my nose, but in terms of the air coming in on the side, they’re not effective at all. People wear them, they look like they’re doing something, they’re not.

Michael Osterholm: (45:18)
Now, if you are sick, they may help a little bit from you transmitting because if you cough, then you cough right into that cloth, and some of it will embed in there and not get out around. The other one though is called an N95 respirator, but for all intents and purposes it looks like a mask. It’s just tight face- fitting and it has a seal at the nose, et cetera.

Joe Rogan: (45:36)
That’s an apocalypse mask.

Michael Osterholm: (45:38)
It could be. I don’t know what those are, but that could be.

Joe Rogan: (45:41)
I’m just saying that that’s how I look at it.

Michael Osterholm: (45:43)
Okay, okay. Well, actually, we use them in healthcare all the time, all the time. They use them, actually, about 90% of them are used in industry, so when they’re grinding things or asbestos, et cetera, they don’t breathe in all these parts.

Joe Rogan: (45:55)
If we have one of those, that’ll do something.

Michael Osterholm: (45:57)
They’re very effective, they’re very effective. The problem is, we have a big shortage. Right now, we have hospitals that are down to just a couple days worth of these masks, the respirators. It’s because we don’t stockpile anything in this country. Hospitals don’t have the money to do that.

Joe Rogan: (46:13)
Those preppers right now are so excited. All the preppers across the … “I knew it. I knew the day would come. I got my bottled peaches.”

Michael Osterholm: (46:19)
Yeah, well, they are. They are, but this is really important because how healthcare workers go is how the country, I think, will see we’re going. There have been over 4,000 healthcare workers in China who were infected, many of them on their job, and a number of them died.

Michael Osterholm: (46:36)
If in this country, we have a real challenge delivering healthcare because we’re overwhelmed, and then we have healthcare workers picking up the infection, like we talked about the group in Milan, and we don’t have the protection for them, I really believe that’s when the public will say, “Wait a minute. What’s going on here?” That’s where I think the challenge …

Michael Osterholm: (46:57)
We really have to protect our healthcare workers. They are the frontline people. The biggest problem we have is a lot of these cases need intensive care medicine, which we only have a limited number of beds for. This is really sophisticated medicine, so when one of those people get infected, a doctor or nurse working in intensive care, it’s not like you just took out another solider. You took out a Special Forces person. You can’t just bring somebody in from family practice or wherever and put them in there, and so we’ve got to protect these workers.

Michael Osterholm: (47:26)
I’m really concerned that that’s one of the areas we’ve not done. Nobody stockpiles. We have no capacity to make lots of them all of a sudden. Prior to this event, the hospital purchasing agent would go online, click a button, “Send me 5,000 of these,” and they would be there the next morning.

Joe Rogan: (47:42)
Has anyone contacted you, before this or since in particular, and asked for your advice as to how they can better prepare? Like in terms of like the President?

Michael Osterholm: (47:55)
The President hasn’t, but I know a number of the people who are working in the White House-

Joe Rogan: (47:59)
They’ve contacted you?

Michael Osterholm: (48:00)
Oh, yeah. Well, I’ve served roles in the last five Presidents’ administrations. I worked for two Republican governors, a Democratic governor. You’ll appreciate, one independent wrestler I worked for too, when he was governor, Jesse.

Joe Rogan: (48:13)
Oh, that’s right.

Michael Osterholm: (48:15)
Yeah. I’ve never had a partisan … I’m just a private in the public health arena, and so I actually served as a science envoy for this administration in the State Department last year, still, and my full-time job at the University. I’ve never been … I mean, I’m there to give the best advice I can. I’ve talked to a lot of these people there at the CDC, at Health and Human Services, et cetera. Yeah, we’ve given a lot of advice.

Joe Rogan: (48:42)
Do you think there’s anything that you could now that could help them make sure that we don’t have these shortages of masks, and shortages of medicine, and IV bags? Something that could be done to … I mean, obviously, you’ve laid out all these problems and you laid it out in your book here that people can buy right now. Go pick it up on Amazon, right? Is there an audio version of it as well?

Michael Osterholm: (49:08)
There is.

Joe Rogan: (49:09)
All right. Do you read it?

Michael Osterholm: (49:10)
The book?

Joe Rogan: (49:11)
Yes, the audio version. You know what I’m saying? Do you … Like, “My voice”?

Michael Osterholm: (49:13)
I have. I don’t read it myself. No, there’s actually a really good voice, it’s not mine.

Joe Rogan: (49:17)
Oh, it should be you, man. It drives me crazy when someone else does it.

Michael Osterholm: (49:23)
This is the challenge we have is today, in this environment, everything’s just in time delivery. I mean, you go online and whatever place you’re ordering from, Amazon or whatever, you expect it there the next day. People forget that we don’t have that capacity today to suddenly make lots of things.

Michael Osterholm: (49:39)
Right now, all the mask manufacturers in North America are working 110% time, but if they were trying to fill all the orders they’ve gotten in just the last few weeks, it would take them years and years with the capacity they have. You can’t go build these new machines to make masks overnight.

Joe Rogan: (49:57)
This is something that should be set in advance of anything like this, any pandemic happening, like long in advance, we should be prepared.

Michael Osterholm: (50:04)
Think about the issue with defense. We prepare all the time well in advance. We don’t build an aircraft carrier at the moment we think we’re going to go into battle. We look at, “What all do we need?” We don’t do that in public health. We’ve tried, and so you know what? Stockpiling 500 million of these N95s would have been the difference between night and day. When you look at the price of one of those versus one airplane, not even close.

Michael Osterholm: (50:29)
If you look at the things like that, it’s like these medications … Think about our own Defense Department employees are at risk of running out of the critical drugs because they get them from China. I mean, what a vulnerability.

Michael Osterholm: (50:41)
What we need to do is take a step back after … We can start now, but we’re not going to fix it now, is to say, “What are the key things that we should do?” Vaccines. If we had been serious about this, we might very well have had a Coronavirus vaccine that whether it worked specifically for this strain, whether it worked for SARS or MERS. Right after SARS happened in 2003, everybody was hot on a new vaccine. Then when it went away, the interested waned.

Joe Rogan: (51:08)
Isn’t it something like the flu, where sometimes when they come up with a flu vaccine, it doesn’t necessarily address the current strain?

Michael Osterholm: (51:16)
Yeah, it could be. That’s where a Coronavirus family vaccine might not matchup right here now, but it could. The flu one, you really hit on an important point. There’s one where we do have an imperfect vaccine, but it still does a lot of good. If 50% of the people are protected, that’s a heck of a lot better than zero. If we had a vaccine right now that 50% of the people could be protected against this virus, man, think of all the lives we’d save.

Michael Osterholm: (51:41)
The bottom line message is, we can’t wait until the crisis to fix these things. You know what? We spend about .0001% on public health compared to our Defense Department and yet, look how vulnerable … The bugs. It’s not a war, it’s not a missile that’s bringing down the world economy right now. It’s a darn virus, and so this is where I think …

Michael Osterholm: (52:02)
That’s what I tried to say in my book was all about that. I went into what we needed to do. In fact, I hate it when people come up and say, “We’re screwed.” My whole bottom line is, “Well, what are you going to do about it then?” That’s what, I lay out a whole plan in here, like these vaccines, like the stockpiles of masks. We should have a plan in place already. What are we going to do with our schools when they close? Are we really going to close schools? Let’s not try to make this on the fly.

Michael Osterholm: (52:27)
I just mentioned, if we close schools, we are really going to hurt some people. People may die in healthcare facilities, hospitals, because we don’t have enough nurses or healthcare workers. Why do we have to make that decision all of a sudden? We could have planned for that a long time ago. I think, hopefully, this is a wake up call because nobody, I think, really believed this.

Michael Osterholm: (52:45)
I got to tell you, the market today, as you know, on this particular day, crashed badly. I think that up until 10 days ago, the market didn’t even think this was a possibility, if you look at it flying high. On Friday, I did a briefing for over 400 major financial investors around the world, how I’m talking to you right now. I’m not trying to be scary. I’m just trying to tell the facts, and make sure people understand it. The questions I got from these people almost reminded me of a six-year-old who was afraid to have to go down a dark hallway.

Michael Osterholm: (53:24)
I thought, I actually said to friends and colleagues Friday night, I said, “You know what? Monday’s market is not going to look good.” Because I could hear the fear in these people. Well, we shouldn’t be there. We should be, “We have a problem.” It’s like a forest fire, whatever. “We got a problem. What are we going to do about it? Financially, how are we going to get through this? Where are we going to go with it?” No plans again. It’s caught everybody by surprise.

Michael Osterholm: (53:49)
I mean, you were one of the few people that wanted to deal with this issue. We set this up several weeks ago. You guys saw it coming. I think that’s where the country hasn’t seen it. Now they’re getting it.

Joe Rogan: (54:00)
Well, I’m paranoid. Well, I seek the advice of experts whenever possible. What I was seeing was that there was a lot of weird misinformation-

Michael Osterholm: (54:12)
A lot.

Joe Rogan: (54:12)
… and conflicting information. A lot of people saying, “Don’t worry,” and a lot of people that were terrified. I’m like, “Okay. I got to talk to an expert,” and lucky you were willing to sit down with us and help us out.

Michael Osterholm: (54:23)
Well, and the other thing, I think that maybe it’s a function of age, but straight talk is so important today. I’m so tired of having people say to me, “Oh, if you tell them this stuff, they’re going to panic.” I say, “Well, what’s panic? Have you seen anybody rioting in the streets yet? Have you seen cars turned over, smashed? Have you seen people hurting themselves over this issue?”

Michael Osterholm: (54:42)
They’re concerned, but they want legitimate information, and so what you need to do is just tell them the truth. We have many experiences like that. A few years ago when I was at the State Health Department in Minnesota, we had a big outbreak of meningitis, a type of brain infection, bacterial brain infection. A number of high school students were very sick. All of a sudden, in one day, they were in the hospital.

Michael Osterholm: (55:02)
This community of 20-some thousand people were on edge, and so we head a big town meeting. Several thousand people showed up, and I addressed them and gave them everything I knew about meningitis, what we’re going to do about it, et cetera. Then towards the end of the talk, I said, “I just need to let you know. About one out every seven cases of this dies.” People looked at me and said, “Why did you tell them that?” I said, “Because they needed to know it.” Two days later, one of them died.

Joe Rogan: (55:27)

Michael Osterholm: (55:27)
You know what? Everybody in town was terribly sad, very emotional, but they all said, “We knew it, we knew it. You told us. We knew it.” Then they got on with dealing with it. We vaccinated the whole town. 20,000 people we vaccinated in one weekend for this bacterial meningitis, but it was because they had faith in us because we told them the truth, and we said what we know and what we didn’t know.

Michael Osterholm: (55:48)
That’s what we need to do here. We need to just have straight talk. Don’t tell them it’s low risk. That’s like the hurricane, okay? I would be really mad at you if I thought you were a hurricane forecaster and you knew this was coming, but you kept telling me, “Oh, it’s low risk. Don’t worry about it.”

Joe Rogan: (56:01)
Right, yeah. Once it hit.

Michael Osterholm: (56:04)
Yeah, so that’s what we need to do today is just say, “This is going to be challenging, and we’re going to get through it though, we are going to get through it.”

Joe Rogan: (56:10)
I hope this wakes people up to the value of vaccines too. There’s so many wackos out there that think that vaccines are a scam, or they’re dangerous. There are so many people out there that won’t vaccinate their children.

Michael Osterholm: (56:24)
I know. One of your best shows you ever did was Peter Hotez. He’s a dear friend of mine.

Joe Rogan: (56:28)
Yeah, I love that guy.

Michael Osterholm: (56:28)
I do too. He’s a dear friend of mine, as you. He is one of the champions out there on this very issue. I couldn’t agree with you more. I think that’s really an important point, that we got to get this idea, these vaccines can be life-saving. If we had one right now, think how different this situation would be that we’re in right now.

Joe Rogan: (56:45)
It would be radically different. You see the measles making a comeback, directly attributed to a lack of vaccines.

Michael Osterholm: (56:54)
You know what? It’s not only the vaccines themselves, but it’s the prioritization of vaccines. I mean, one of the real tragic stories right now in Africa is we are just finally bringing to a close this outbreak of Ebola in the Democratic Republic of the Congo, far northeast part of the Congo. 2,800 people have died from this, okay? Bad. Been going on for almost two years.

Michael Osterholm: (57:19)
Everybody talks about that, and I understand why. Ebola is a challenge. Do you know that during that same time period, over 7,000 kids in that same area have died from measles? Because everybody was preoccupied trying to deal with Ebola. Those deaths were totally preventable-

Joe Rogan: (57:34)

Michael Osterholm: (57:34)
… Totally preventable. I mean, I think that’s a … I have to say, and I’m already on this show so I’m not trying to … Thank you for what you do say about vaccines, because people listen to you, and we need every positive voice because we have so many crazy voices out there right now, and there’s so-

Joe Rogan: (57:49)
So many people are paranoid and delusional. They want it all to be a conspiracy. There’s been an amazing medical innovation in human culture, and that’s vaccines. It’s amazing what it’s done. Have there been adverse affects on people? Of course. Everything that people do, there’s some people that are going to react in a bad way. It doesn’t mean it’s not a positive thing. There’s a reason why the cases of polio are so tiny. There’s a reason why smallpox went away. It’s because of vaccines.

Michael Osterholm: (58:21)
Absolutely. That’s one of the challenges you know today between the anti-science misinformation that’s out there, but then when they don’t see it. The reason they don’t see it is because we did vaccinate, until we get enough people not vaccinated, and then look what happened.

Joe Rogan: (58:37)
There’s a famous photo of two twins from the early 20th century. One of them has smallpox, and one of them was vaccinated. Have you seen that photo?

Michael Osterholm: (58:47)
I have, I have, I have, yes.

Joe Rogan: (58:47)
It’s a black and white photo.

Michael Osterholm: (58:49)
It’s a very telling-

Joe Rogan: (58:50)
Jamie will find it, because people need to see it. That is the difference.

Michael Osterholm: (58:54)
There it is. Yep, yep, yep. There it is, right there. That’s it right there. That’s the one, yeah.

Joe Rogan: (58:58)
One kid whose body is just devastated by what looks like pebbles glued to his skin, all over his body, his face, his hands. Then his brother, right next to him, with nothing.

Michael Osterholm: (59:10)
You know what’s really important to note here is that in that body, all those things are very painful but what’s going on inside the body is equally bad. You’re exactly right. I couldn’t agree with you more that this is really an important point.

Joe Rogan: (59:25)
The diseases are terrifying, they’re really terrifying.

Michael Osterholm: (59:28)

Joe Rogan: (59:29)
When something like this can be prevented, and the reason why people don’t do it is because they’re paranoid of vaccines, and they get that information from some wacko website, or from some person who really has no business talking about it, whether it’s the people out there that think that it causes diseases or it’s a government plot, or that it’s a medical scam because it’s just trying to raise money. It’s just, all of it’s very, very disturbing but it’s a part of people.

Joe Rogan: (59:56)
Human beings, for whatever reason, there’s a percentage of us that lean towards conspiratorial thinking. They lean towards thinking that there’s some sort of a plot against them, or the government’s against them. It’s just, you got to listen to the medical experts.

Michael Osterholm: (01:00:15)
You know what? I hope that if there’s any good to come out of this terrible Coronavirus situation, is that there’s a wake up call. If we’d had a vaccine for this, or one that even worked partially, think how different we’d be. You know what? We’ve got other ones coming like this. We have to use our creative imagination.

Michael Osterholm: (01:00:32)
As I said in the book, the chapter on Coronavirus, the title is SARS and MERS, a Harbinger of Things to Come. I mean, we can use our creative imagination to say we should be funding these things, almost like we pay for our Fire Department. Imagine if we had to go out and buy a firetruck when the 911 call came in.

Joe Rogan: (01:00:49)

Michael Osterholm: (01:00:50)
We need to do it now.

Joe Rogan: (01:00:52)
It’s kind of disturbing that it’s chapter 13 though.

Michael Osterholm: (01:00:54)
I know, it was. Well, actually, would you do me a favor? You’re going to really like this. Open up to chapter 13, okay?

Joe Rogan: (01:01:00)

Michael Osterholm: (01:01:01)
When you look at … It’s towards the end there.

Joe Rogan: (01:01:04)
I’m just trying to find the-

Michael Osterholm: (01:01:06)
Read the quote that goes with it.

Joe Rogan: (01:01:08)
Okay. 125 …

Michael Osterholm: (01:01:11)
Okay. Every chapter’s started not with just a title, but a quote, and I think you’ll find this one quite interesting.

Joe Rogan: (01:01:23)
“Bio Terror: Opening Pandora’s Box.”

Michael Osterholm: (01:01:26)
That’s not it. That’s not the chapter.

Joe Rogan: (01:01:27)
That’s not it?

Michael Osterholm: (01:01:28)
It’s chapter 13. You’re close.

Joe Rogan: (01:01:35)
There it is.

Michael Osterholm: (01:01:35)
Okay. Read the-

Joe Rogan: (01:01:36)
“SARS and MERS, a Harbinger of Things to Come.”

Michael Osterholm: (01:01:39)
Get the quote underneath it.

Joe Rogan: (01:01:39)
I need glasses. These make me look smarter. Rudyard Kipling, “And the dawn comes up like thunder, water, China cross the bay.” China.

Michael Osterholm: (01:02:00)
China. We said-

Joe Rogan: (01:02:02)
Did you put that in there because you really thought that a lot of this stuff was going to come out of China?

Michael Osterholm: (01:02:06)

Joe Rogan: (01:02:06)
Or because it’s a great quote?

Michael Osterholm: (01:02:07)
No. This is exactly what we’re talking about.

Joe Rogan: (01:02:09)
Why China?

Michael Osterholm: (01:02:10)
Because they have this incredibly large population, two billion. They’ve got this food supply that is largely wildlife that comes into these markets, where there’s incredible contact between people and these animals. The crowded nature of that society … I mean, I think one of the things that surprises people when they go to China, 15 million population cities are common over there.

Michael Osterholm: (01:02:35)
I mean, we think of the United States, we think of LA and New York, and that’s big. Over there, in Wuhan, a city of 15 million, the entire Metropolitan area is 60 million, and so you have people crowded so closely together that if you add in the bugs coming from these animals, and then the potential for this kind of contact where it spreads quickly, China’s been a bacterial and viral soup festival for a long time. That’s, again, why we have to protect ourselves here, because a bug anywhere in the world today can be a bug everywhere tomorrow.

Joe Rogan: (01:03:11)
Particularly when you’re dealing with a massive number like these kind of cities.

Michael Osterholm: (01:03:15)

Joe Rogan: (01:03:16)
They call them wet markets. Is that what they call them?

Michael Osterholm: (01:03:18)
Yep. Wet markets, yep.

Joe Rogan: (01:03:19)
That’s what it is, a lot of it is wildlife?

Michael Osterholm: (01:03:21)
Oh, it’s incredible. I’ve hunted, my life, I’ve always, I love to fly fish. I love the outdoors. I could never have imagined the animals. I’ve spent time in these markets. I remember one day, spending a day in the Bangkok, Thailand market, and it was about a mile by a mile and a half big, in these tight aisles. Every animal imaginable to humans, and I swear to god, there were some out of the movies, I think, that were in there, and they’re all just right on top of each other.

Michael Osterholm: (01:03:51)
I actually have a picture that I show in some of my lectures. There was a situation where there were all these chickens in a cage. I don’t know, 15 or 20 of them in a big wire cage, and it sat on top of a …

Michael Osterholm: (01:04:03)
15 or 20 of them, okay? And a big wire cage. And it sat on top of a wire cage full of ferrets. And ferrets are actually an animal model from flu standpoint that they do really well and getting infected with flu viruses. If you wanted to create the perfect experiment that no university, research group would let you do is you’d put birds and ferrets like that together. And that is just common. That’s just common. That’s common.

Joe Rogan: (01:04:23)
And so birds and ferrets together, the something that’s infecting the birds could jump to the ferrets or vice versa?

Michael Osterholm: (01:04:29)
The ferrets could breathe it out and we can get infected.

Joe Rogan: (01:04:31)
Oh Christ.

Michael Osterholm: (01:04:31)
And so these markets, and I don’t know what’s going to happen here, but for the first time we really saw the Chinese after this outbreak in Wuhan really start to put down some markers on what they’re going to do to supervise these markets. I mean, they still have to eat, but I think this is a dangerous practice where we see it, but you know, it happens. Look at Africa with Ebola, right? You know, bushmeat is still very important and there’s so much of the world that that’s their primary foods.

Joe Rogan: (01:04:56)
And when they say bushmeat, it’s basically everything.

Michael Osterholm: (01:04:59)
Everything from bats, we think bat was the primary source of this outbreak in West Africa was a human bat that was consumed. They eat them all the time.

Joe Rogan: (01:05:08)
Do they really?

Michael Osterholm: (01:05:09)
Yeah. Yeah. So you know… And some of them were pretty big bats, there are literally three feet wingspans are, they’re big. And so, that’s one of the challenges we have with China. We know that this is going to happen. It’s going to occur. We think of the flu virus is the same way and that’s why we knew doing better flu vaccines. This could just as easily be a flu pandemic. The same thing like 1918.

Joe Rogan: (01:05:32)
So these wet markets, they just have all these animals hanging out and some of them are still alive. Is that what it is?

Michael Osterholm: (01:05:39)
Many of them are alive and then they’ll actually prepare them for you right there. They basically kill them and gut them and so forth. You got some pictures up there.

Joe Rogan: (01:05:49)
The bazaar, Wuhan West-

Michael Osterholm: (01:05:50)
There you go.

Joe Rogan: (01:05:51)
… Market menu shows over a hundred wild animals sold as food link with virus unclear.

Michael Osterholm: (01:05:57)

Michael Osterholm: (01:05:58)
This is what it looks like. And here I’ll show you the list so you can read it.

Michael Osterholm: (01:06:00)
It’s pretty amazing. Yeah.

Joe Rogan: (01:06:01)
Let’s see some images. Whoa, Whoa. Look at that [writ 00:01:06:05]. Look at that list.

Michael Osterholm: (01:06:06)
I know-

Joe Rogan: (01:06:07)
… peacocks. People are eating peacocks?

Michael Osterholm: (01:06:09)
Oh yeah, absolutely.

Joe Rogan: (01:06:10)
Deer, crocodiles, turkey, swan. They’re eating swans. How dare you. Kangaroos, squirrels, snails, foxes. Foxes?

Michael Osterholm: (01:06:17)
And civic cats were the cause of the SARS outbreak.

Joe Rogan: (01:06:21)
Ostriches. I’ve had that. Pretty delicious. Yep. I’m a hypocrite. Look at me eating ostriches. Centipedes, geese, hedgehogs, goats. Jesus.

Michael Osterholm: (01:06:32)
So yeah, it’s a challenge.

Joe Rogan: (01:06:33)
That’s pheasant, right? That’s normal.

Michael Osterholm: (01:06:35)
Yeah, it’s just a picture of it.

Joe Rogan: (01:06:36)
So do we have a video of the market? I want to see what… Whoa. Look at that freaky looking-

Michael Osterholm: (01:06:40)

Joe Rogan: (01:06:40)
… Salamander. The size of that sucker.

Michael Osterholm: (01:06:43)
Big. Yep.

Joe Rogan: (01:06:44)
That’s a huge salamander.

Michael Osterholm: (01:06:45)
I went light for you first. The pictures I was finding… Were dark.

Joe Rogan: (01:06:50)

Michael Osterholm: (01:06:51)

Joe Rogan: (01:06:51)
Come on. What do you got?

Michael Osterholm: (01:06:53)
Cages of turtles and cages of bunnies. [crosstalk 00:01:06:55].

Michael Osterholm: (01:06:59)
Oh yeah.

Joe Rogan: (01:06:59)
Let’s see it.

Michael Osterholm: (01:06:59)
All right. Bam.

Joe Rogan: (01:06:59)
Wow. This wet market is very, very strange. So, and these are enormous markets. Right?

Michael Osterholm: (01:07:03)
OH, they’re huge. And the number of people in them is incredible. I mean, they’re-

Joe Rogan: (01:07:07)
Where are they getting the animals from? They’re getting them from the wild?

Michael Osterholm: (01:07:10)
Rural area, from rural areas. Yeah.

Joe Rogan: (01:07:11)
And are they growing these things and farming them or are they just catching-

Michael Osterholm: (01:07:15)
Some cases both. Some cases both. Like a lot of the seafood today is actually being farmed.

Joe Rogan: (01:07:20)
So this is really like a giant Petri dish.

Michael Osterholm: (01:07:23)
Yeah. Yeah.

Joe Rogan: (01:07:24)
I mean it’s almost… Wow-

Michael Osterholm: (01:07:26)

Joe Rogan: (01:07:26)
Weird looking fish. That fish looks not that fresh. Whoa. What’s all that stuff? Rabbits and-

Michael Osterholm: (01:07:32)

Michael Osterholm: (01:07:33)
I couldn’t tell you what all that is but…

Joe Rogan: (01:07:34)

Michael Osterholm: (01:07:34)
But you’re getting an idea-

Joe Rogan: (01:07:37)
They’re just laying them on the ground.

Michael Osterholm: (01:07:37)
… of why? If we can’t stop that, we surely can try. But if we can’t stop that, we need to stop the infectious diseases coming from those animals to us.

Joe Rogan: (01:07:45)
Look at them all wearing masks. That’s hilarious.

Michael Osterholm: (01:07:47)
That was, I think with the outbreak. Was that… That might’ve been since the-

Michael Osterholm: (01:07:51)
Yeah, a lot of these pictures are-

Joe Rogan: (01:07:51)
Are those gigantic things a mollusk? What is that? What are those things?

Michael Osterholm: (01:07:57)
Can’t tell.

Joe Rogan: (01:07:58)
Those look like giant mollusks.

Michael Osterholm: (01:08:00)
… They’re also like flat turtle shapes or something.

Joe Rogan: (01:08:00)
Yeah, they are. Right?

Michael Osterholm: (01:08:01)
I can’t tell the difference.

Joe Rogan: (01:08:01)
Because look… No, because look at the ones behind.

Michael Osterholm: (01:08:03)
I think you’re right. I think you’re right.

Joe Rogan: (01:08:05)
They look like huge muscles.

Michael Osterholm: (01:08:06)

Joe Rogan: (01:08:07)
Wow. Look at those suckers behind them. Wow. Yeah. There’s a lot of people in China. They’ve got to eat. That’s where it gets weird, right? This is like, how do you tell them that they’ve been doing this for who knows how long, how do you tell them to stop doing it? Or is, is that impossible and is it more possible to just accelerate our vaccine program and try to preemptively create something to address coronaviruses to address various different ones. What other viruses are we concerned about other than Corona viruses?

Michael Osterholm: (01:08:40)
I think it’s both. I think the next most… Not even next. It’s still, it’s a co-virus, you might call it influenza. I mean, there have been 10 influenza pandemics in the last 250 years and each one of them was a little different, but some of them had been horribly bad. You know, back in the 1500s even, there was a major pandemic that occurred where Spanish cities were described as normally almost totally depopulated. And so these viruses pop out and that’s why we need new and better flu vaccines and we’re actually working on one now, but it’s still a ways off. But having those would really prevent the big calamities, meaning you know some of the things are going to happen. They’re not good, but they’re not going to bring down supply chains and threaten governments and so forth. And so I think the priority vaccines we need to get are for those diseases that we know could.

Joe Rogan: (01:09:29)
Is the flu injection the most effective way or is a mist as effective? Like I know they do the mist up the nose.

Michael Osterholm: (01:09:36)
Yeah. Turns out that what research we have and our group was involved with some of it, the flu mist in the nose works really well in children mostly because they haven’t been infected yet themselves. They don’t have any protection and so that virus really multiplies in the nose. Remember this virus is adapted not to multiply in your lungs because the nose is colder than the lung, and so it’ll grow here. It won’t… If you swallow it, it won’t grow in your lungs. If you’ve already been infected once, then you actually have some interference in your nose. There’s a little bit of protection there. So it works well in kids who haven’t been infected before. Adults not so well. For us, the injection works best, and I’m happy to report that although I’m not happy to report being an old man now I can even get the high dose vaccine over age 60. They are actually the best we have.

Joe Rogan: (01:10:23)
The high dose vaccine is better?

Michael Osterholm: (01:10:24)
Yeah. It’s better than the regular vaccine in terms of protecting-

Joe Rogan: (01:10:27)
When you hit a certain age?

Michael Osterholm: (01:10:28)
Yeah. When you get a little older you need the higher dose cause your immune system is starting to wane, just naturally having a less… But what we need-

Joe Rogan: (01:10:35)
I wasn’t aware that there was a low dose or high dose-

Michael Osterholm: (01:10:38)
Yeah, there’s a high dose. There’s a high dose. Yeah, there’s a higher dose vaccine. So…

Joe Rogan: (01:10:40)
Where do you get it? If a person’s listening to this and they are like, I’ve never had flu vaccine-

Michael Osterholm: (01:10:44)
Any doctor’s office. Any doctor’s office. And they will usually say that to you if you’re over 60, you can get those vaccines. So they’ll actually do that for you. So yeah.

Joe Rogan: (01:10:53)
So run out, get a vaccine because-

Michael Osterholm: (01:10:55)
To now is pretty much over. The flu season’s waning. I mean if you hadn’t gotten it, you should’ve had it a couple of months ago. Okay, this one’s waning now. We’ve had a bad flu season, a really bad one, but for the last couple of weeks, the numbers are coming way down.

Joe Rogan: (01:11:07)
So what can a person do other than the vaccine to prevent getting the flu?

Michael Osterholm: (01:11:13)
That’s primarily it. Again, it’s a issue of who you’re around.

Joe Rogan: (01:11:17)
And your body’s overall health.

Michael Osterholm: (01:11:20)
Yep. And just keep healthy as you can. And then I think the other key piece though is if you do get the flu and you have really bad muscle aches, one of the things about real influenza is it’s not just sniffles. You feel like you got hit by a Mack truck. If after several days you still are really feeling bad, really bad and you haven’t seen a physician by then, you should because that’s when you get the complications occurring. The bacterial pneumonias that occur subsequent. And if you get those treated earlier than later, you can actually do a lot to keep somebody from dying. So you know, if you don’t feel a lot better in two days… I mean if you, if you catch it really early, you can get a medication for flu.

Michael Osterholm: (01:11:58)
There’s actually a medication that will reduce your illness a bit. But if you’re sick for more than a couple of days, not better, you absolutely should see a doctor so you don’t have these other complications.

Joe Rogan: (01:12:08)
And what can a doctor do once you…

Michael Osterholm: (01:12:11)
Any family practitioner would know what to look for and whether or not your lungs are starting to fill up. They’ll listen to your lungs to make sure you’re not developing pneumonia.

Joe Rogan: (01:12:18)
And what would they do for you?

Michael Osterholm: (01:12:20)
They would likely give you an antibiotic based on what you had because you are then this… The problem with flu, it’s not just the flu virus, but then you get secondary bacterial pneumonia from the damage in the lungs and so they can prevent that. A lot of older people in particular will die from actually what we call secondary pneumonia to having had influenza. They wouldn’t have gotten the pneumonia if they had not had flu, but then they do.

Joe Rogan: (01:12:42)
Now we were talking earlier about probiotics. Is there a benefit of probiotics once you’ve taken antibiotics to re-flourish your gut flora?

Michael Osterholm: (01:12:52)
You know, that’s where the studies really at this point demonstrated that it’s very temporary. In other words, if you’re taking probiotics, you can get a boost initially, but it doesn’t sustain itself over time and then the natural flora comes back. I mean the gut microbes will come back as they’ve been reduced.

Joe Rogan: (01:13:11)
But what I’m saying is, is it beneficial to people if they do take a probiotic after antibiotics because antibiotics do have a devastating effect on your flora.

Michael Osterholm: (01:13:21)
They do, yeah.

Joe Rogan: (01:13:22)
Kills the bad stuff, but it also kills a lot of the good stuff, right? So is it beneficial for people once they have taken an antibiotic to take probiotics to sort of re-flourish at least temporary?

Michael Osterholm: (01:13:32)
Yeah, and that’s what I’m saying is that it doesn’t… The data don’t support that it stays. In other words, you get a short term boost and it gives you some other new good bacteria, but they don’t stay around.

Joe Rogan: (01:13:43)
And what if you just keep taking it?

Michael Osterholm: (01:13:45)
Even then, they just don’t stay around. Your normal gut flora will come back and take over. So the probiotics and of themselves are not giving you that longterm boost that-

Joe Rogan: (01:13:55)
So you don’t think there’s any benefit to having even a short term boost?

Michael Osterholm: (01:13:58)
Well, you know it’s again a,.. I surely am not going to profess to be the expert on probiotics, but I’ll tell you that the data we have doesn’t show that they have a big boost and that they actually help you long term or short term, meaning that it makes any difference. Now there’s one exception to that where I would say, and this is a very different thing than probiotics, but we actually have a disease called Clostridium difficile, which is a bad bacteria that happens when you’ve taken way too many antibiotics and it colonizes your gut because you don’t have competing organisms there and then you can die from this. There are treatments for that called actually fecal transplants.

Joe Rogan: (01:14:37)
Yeah, I’ve heard of that.

Michael Osterholm: (01:14:38)
And that’s where actually there you take it a little capsules, but it’s actually-

Joe Rogan: (01:14:42)
You’re drinking poop, swallowing poop.

Michael Osterholm: (01:14:44)
Well, purified purified bugs from the poop. You’re right. But you take that and then that kind of is what you’re talking about. That does have a real benefit. And there is clear evidence that if you take those, those fecal transplants as opposed to just probiotics and such, that that can have a major positive impact on your recovery from things like Clostridium difficile infection. And so more and more institutions now actually are doing fecal transplants, which you’d never thought that that would be one thing you do one day. But for those who’ve had this problem, they’re lifesaving. They’re amazing.

Joe Rogan: (01:15:15)
Maybe we should change the name.

Michael Osterholm: (01:15:16)
That would, although on the other hand, you don’t forget it if you-

Joe Rogan: (01:15:21)
Right. That’s true.

Michael Osterholm: (01:15:21)
You don’t forget it.

Joe Rogan: (01:15:22)
Yeah, that’s true. you don’t forget if it’s a fecal transplant, but that’s what’s going to be, nerve wracking to people. Right?

Michael Osterholm: (01:15:28)
Yeah. Yeah. You know, once you’re that sick, boy it feels good to take it. It does, you know…

Joe Rogan: (01:15:32)
Have you done it?

Michael Osterholm: (01:15:33)
I’ve never done it. I’ve never had a problem where I’ve had to, but for the… I know people who have been desperately sick who have taken them and have really done much better, much, much better.

Joe Rogan: (01:15:42)
I want to ask you about Lyme disease.

Michael Osterholm: (01:15:43)

Joe Rogan: (01:15:44)
Lyme disease is a scary one. Right? And I mean, so many of my friends in the East coast habit, it’s really terrifying that that part of the country in particular seems to be like really badly infected with these ticks that carry this disease. What can people do to prevent that and what can we… There’s no vaccine for Lyme disease. And I know there was at one point in time, but people were having an issue with… I mean a good friend of mine, her dad actually got Lyme disease from the vaccine before they discontinued it. What can someone do to sort of protect themselves?

Michael Osterholm: (01:16:23)
Yeah, well Lyme disease in of itself is a fascinating story. I’ve actually been involved with it since its early discovery in the 1980s and Minnesota, Wisconsin was a big focus of the upper Midwest. This is a story that I think you’ll find interesting is is that even though it was discovered primarily in the Eastern part of the United States named after Lyme, Connecticut, it’s a disease that actually probably originated in the upper Midwest and I tell you that because it turns out that there is a focus in Northern Wisconsin and in east central Minnesota where there’s Lyme disease, there’s another disease called anaplasmosis, there’s another disease, Babesia, et cetera. That all seemed to have a similar kind of tick human deer kind of component. And back in the CCC days of the 1930s, the white tail deer population had been virtually totally depopulated from the Northeast. And so they actually trapped deer in Northern Wisconsin and took them out and deposited them in the New York and Connecticut and so forth.

Michael Osterholm: (01:17:28)
And most of those deer are actually deer that today their great, great, great, great, great grandfather came from Wisconsin.

Joe Rogan: (01:17:36)

Michael Osterholm: (01:17:36)
And guess what, when you moved deer, you moved ticks. In fact, I was involved with the study that the Wisconsin division of health did and a colleague of mine, the late Jeff Davis where up in Northern Wisconsin, as deer would come into the check station, they would actually measure the number of ticks that were attached to the nape of the neck. Okay? And they had a thing drawn. And they asked hunters who are driving back to Madison and Milwaukee if they would be willing to check in at a station down there for just a second and then they’re going to count the ticks again. And it turned out that as the vehicles come rolling down from highway 51 from Northern Wisconsin get on the interstate 90-94 and go to Milwaukee or Madison, the ticks just kept falling off. By the time they get to Madison or Milwaukee, the ticks were almost all gone.

Michael Osterholm: (01:18:25)
Well guess, lo and behold, where all the Lyme disease and so forth started to show up. Right along the interstate corridor. Because the ticks were coming off and then they were getting into the local deer in that population and so it’s exactly what you said. The ticks are moving, they’re moving, okay. They’ve moved and they’re now infected. So I think that that this Lyme disease issue is a key one. Lyme disease is really an important disease. It’s real, no question about it. The challenge we have is is that there’s a lot of people that assume that they have chronic Lyme infection and you know, the data on that is just really, really not there to support that these people are chronically infected, but they do have an immune response likely that occurs where it sets up this trigger and so they’re sick.

Michael Osterholm: (01:19:09)
They actually have something, but it’s not treating it again for the bacteria infection. It’s the fact that your own body’s immune system as we’ve talked about several times today, it starts attacking you. I think it’s a similar picture we see with chronic fatigue syndrome, same kind of thing. These people really are sick. They really do have problems, but it’s not something you can treat. So when people… I have a challenge because when people take IV antibiotics at extended periods of time for Lyme disease, you know the data… There’s four different studies that have been done where people have had what we call a double blind placebo controlled trial where half got the drug, half got of a IV but no drug. And it turned out all four of these studies in Lyme disease, the people who got the just the placebo did just the same as the people who got the drug. And I worry that we’re using antibiotics a lot there. And this is where I just mentioned earlier about Claustrum difficile. We actually had a patient, Minnesota, that died from the IV treatment for what was chronic Lyme disease. And wouldn’t have been helpful. And so we need a lot more research in this area to figure out what are these people getting? What is it that we can shut off so that they don’t have this chronic Lyme disease picture knowing that it’s not actually just you got to treat it more. Treatment’s not going to help him with the antibiotics anymore. And so I think that that’s an area that we just need a lot more work in and numbers are growing, as you know.

Joe Rogan: (01:20:36)
So we don’t know what’s happening?

Michael Osterholm: (01:20:39)
Well there’s a… We have enough data to say your immune system is really cranked up. Your immune system is, you know, it’s like-

Joe Rogan: (01:20:46)
Reacting to something.

Michael Osterholm: (01:20:46)
… It’s like rheumatoid arthritis, a lot of things where we… You know, thank God for our immune system. It’s what fights off all the bad things we have. But sometimes that immune system gets turned on too much and then it takes on us. Okay. And goes back to the coronavirus. That’s why a lot of these people are dying right now. Is this over vigorous immune response and Lyme disease is kind of that same inciting event where we have evidence now that you could be infected with the bacteria, but if we treat you, it’s like every other bacteria you can really get rid of it, but you still have this chronic illness that’s occurring.

Michael Osterholm: (01:21:22)
And what I think is hard is, is that we see people who have this who are desperate to have somebody understand what they have and they end up going to people who take real advantage of them. Clinicians who charge them an arm and a leg for things that are not going to help them. And what we need is a lot more research on what is actually going on and what kind of drugs can we use to reverse this immune system disorder.

Joe Rogan: (01:21:46)
I have a friend of mine who’s a UFC fighter, Jim Miller, and he’s, he’s got Lyme disease and it’s pretty bad. He takes a stack of pills. I don’t know what he takes every day. What do you think someone is taking and what benefit would they get from that?

Michael Osterholm: (01:22:03)
I couldn’t tell. I mean I’m not… Without knowing what it’s there. But again, more often than not, if he’s been adequately treated, it’s not that the bacteria is still growing in him. Like it might be for a lot of disease, but-

Joe Rogan: (01:22:14)
It’s an autoimmune response…

Michael Osterholm: (01:22:15)
It’s autoimmune type, which is real. I mean that’s the other thing is I think these people just want to be legitimized and said, you know, I’m really sick and I’m not, it’s not something I’m mentally ill about, whatever. But then we’ve got to figure out what it is that you have. And I-

Joe Rogan: (01:22:28)
So we really don’t know.

Michael Osterholm: (01:22:29)
We don’t know yet. We don’t know.

Joe Rogan: (01:22:30)
Wow. But it’s been around for so long.

Michael Osterholm: (01:22:32)
I know. But this is where we need a lot more research about this in terms of what is it that’s making these people like this and this is really important.

Joe Rogan: (01:22:40)
And is there anything they can do to eradicate the ticks?

Michael Osterholm: (01:22:43)
You know, this is another thing you’ll find interesting. In Minnesota, prior to the arrival of the first white men, the native Americans burnt much of our state all the time. The prairies for much of the territory. And even in Northern Wisconsin, Northern Minnesota, we had the classic pine forests, fire would wipe through and with that it would open up so much of the forest that, that you’d have a very different kind of mammals, population, deer, et cetera, et cetera. And with the suppression of fire, what’s happened is we’ve now have, instead of having these old growth forests, we have all this younger non pine or any kind of… Like the Oak trees of the upper Midwest are all disappearing because Oak trees need sunlight and fires. What kept, they were very resistant to fire.

Michael Osterholm: (01:23:34)
And so the old Oak forest and so forth would survive because of fire. Whereas today with no fire, the Elms and the Maples and everything else comes in and the Buckthorn and all that kind of stuff and takes over. So what’s happening is in our state of Minnesota is we have a really good example of this is, we’re losing our moose. And the big primary reason is brain worm.

Joe Rogan: (01:23:57)
Brain worm.

Michael Osterholm: (01:23:58)
Brain worm. It’s a type of parasite that’s common in white tail deer but causes no problems. In moose, it actually causes a brain infection and it kills them. And guess why it’s happening? Because the deer range has moved farther and farther north in Minnesota.

Joe Rogan: (01:24:13)
Try to keep this close to [crosstalk 01:24:15]-

Michael Osterholm: (01:24:14)
I’m sorry. Yep. Yep. That has moved farther in Northern Minnesota because of lack of fire because the forest is changing. So now where there only used to be moose, we’re seeing deer and moose and where that intersection is, we’re starting to see moose develop this brain worm infection because it’s from the deer. So the tick population has changed too. And it’s largely due to the fire, lack of fire in many places. In the Northeast, never used to be like it was. We had fire all the time that would clear out these areas and it was just a part of natural everything. So one of the challenges we have with ticks is they’re here, we’re not going to change how we live. Suburbs and trees and all of that.

Joe Rogan: (01:24:51)
Could controlled burns eliminate a lot of them?

Michael Osterholm: (01:24:54)
They do because what they do is they just don’t eliminate the ticks. But what they do is they eliminate, for example, the Whitefield mice or in all of these different species that are important to the ticks and then they bring in different species that will be there. So I mean this is a big debate in Minnesota right now. I mean we’re losing all these moose to brain worm. Ironically, the moose for population is expanding dramatically in Isle Royal. Why? Because there’s no deer out there and so they’re not getting brain worm out there. So people have said, we’re going to lose our moose. Well it’s the deer. So fire actually has helped the most in areas in Northern Minnesota where there’s been a lot of fire, the moose population is growing because the deer are not there because exactly those mammals, those rodents and so forth are very different in burnt out areas. And they are in non-burnt out areas.

Joe Rogan: (01:25:44)
Well they do control burns in some States. I got, I had a friend who was hunting in Washington state a couple of years ago and he said it was really weird because there’s these massive fires in the distance that were actually being controlled. They do it on purpose.

Michael Osterholm: (01:25:55)
Yeah. Which is a lot better than having the out of control fires where you have so much fuel. And you know, if you haven’t had a porous fire in 85, 100 years in an area, the fuel in there is huge. And so actually they do that in Northern Minnesota too. They’re doing controlled burns, and the prairies of course we do a controlled burns all the time. So…

Joe Rogan: (01:26:12)
But the problem with the East coast is you’re dealing with a lot of these sort of, almost residential areas that have all these ticks.

Michael Osterholm: (01:26:18)
Yeah. You can’t. There, you can’t. There we have to find ways… That’s where we really have to have vaccines and treatments for these diseases. We’re not going to get rid of the ticks. So we have to do is figure out a… I mean, wouldn’t it be incredible if we have a cocktail vaccine for Babesia, for Lyme disease, for… that’s what we need.

Joe Rogan: (01:26:37)
Is there any kind of an animal that eats ticks?

Michael Osterholm: (01:26:40)
Birds? Yeah. Birds will eat them.

Joe Rogan: (01:26:42)
But not enough.

Michael Osterholm: (01:26:43)
Not enough. No, no.

Joe Rogan: (01:26:44)
They’re not doing their job.

Michael Osterholm: (01:26:44)
No, they’re doing very well. Thank you. Ticks do very well. And that’s another issue, you know, for some of the larger mammals, as you know, tick predation can get so heavy, particularly in certain times of the year that really, literally, it takes a lot of blood out of these large animals even though they’re so big. That’s a lot of blood.

Joe Rogan: (01:27:01)
Yeah. I went down a rabbit hole the other day online, and I saw this one deer that was covered in these Frisbee size patches of ticks.

Michael Osterholm: (01:27:07)
That’s exactly it.

Joe Rogan: (01:27:08)
That were all swollen.

Michael Osterholm: (01:27:09)
And they’re full of blood.

Joe Rogan: (01:27:10)
Oh, so disgusting.

Michael Osterholm: (01:27:11)
And it happens day after day. So that is a hit on him. It’s a real hit on them.

Joe Rogan: (01:27:15)
You should pull up a picture of that just to freak people out that are watching online, just they need to see this.

Michael Osterholm: (01:27:21)
Yeah, yeah. It’s pretty amazing.

Joe Rogan: (01:27:22)
I mean, it’s one of those things that when you talk about ticks and you talk about Lyme disease, most people, their eyes glaze over. They don’t even care. It’s not affecting me until someone in your family has it. There’s a guy that I know who was a former UFC fighter, Marcus Davis, who he put… His wife got Lyme disease and he’s spent hundreds of thousands of dollars trying to help her and do something about and treatments and all these different things for it.

Michael Osterholm: (01:27:48)
Yeah, it’s a real challenge. It’s a challenge. And this is another area again, when you think of the amount of money we lose in just lost time, let alone pain and suffering. What an investment to make in this. I mean this is the kind of thing, and this is where infectious diseases really need to a renaissance. I mean, we can do a lot here.

Joe Rogan: (01:28:06)
We pulled up a chart of the United States where they showed the areas that are affected by these ticks and what percentage of ticks carry Lyme disease they’ve tested. And some places in the Northeast, it’s in the 60%.

Michael Osterholm: (01:28:20)
Oh, exactly. Yeah, it is. It’s huge.

Joe Rogan: (01:28:22)
It’s so scary.

Michael Osterholm: (01:28:23)
It’s growing and it’s growing. I mean, when you understand how wildlife has changed, I mean, look at to think that we have all these wild coyote populations in New York city now. I mean it’s amazing-

Joe Rogan: (01:28:33)
Every single city in the country.

Michael Osterholm: (01:28:35)
Yeah. What the rats aren’t doing, the coyotes are taking over and it’s a challenge. I mean, these are infectious disease issues too. They’re very real.

Joe Rogan: (01:28:44)
Yeah. They have coyotes in central park.

Michael Osterholm: (01:28:45)
They do. Yeah, absolutely.

Joe Rogan: (01:28:47)
They have them in the Bronx, they have them in… I mean, it’s weird. It’s weird to see because this is something that just didn’t exist before. Look at this.

Michael Osterholm: (01:28:54)
Oh there it is.

Michael Osterholm: (01:28:54)
I mean, I’m looking for a good one, but-

Joe Rogan: (01:28:57)
That’s okay. That’s okay. That’s not that’s not the best I’ve seen, but it’s gross enough.

Michael Osterholm: (01:29:02)
Yeah, it is. It gives you a good sense of it though. Yeah.

Joe Rogan: (01:29:05)
Dan Flores, who has been a guest on the podcast before has a great book called Coyote America that sort of details how this came to be and how these coyotes have a… Oh, look at that all over that poor deer’s face.

Michael Osterholm: (01:29:17)
Look at the eye in the phone.

Joe Rogan: (01:29:18)
Yeah. They’re disgusting.

Michael Osterholm: (01:29:21)
Yeah, they are.

Joe Rogan: (01:29:21)
But coyotes. About how when they got rid of the wolves and they tried to do the same to the coyote, they just actually expanded their territory. They’re sneaky. Very clever little animals.

Michael Osterholm: (01:29:35)
Adaption. Just like microbes. Adaption.

Joe Rogan: (01:29:38)
Yeah. Is there anything else that we should cover?

Michael Osterholm: (01:29:41)
No, I mean I think I’ve… Thank you for covering this issue on infectious diseases.

Joe Rogan: (01:29:45)
Thank you.

Michael Osterholm: (01:29:46)
We can use all the help we can to get people to be aware of what’s out there and what’s coming and just keeping the message straight and we’re going to get through this, but at the same time it’s going to be a challenge. You know, today you have an underlying health problem and you’re particularly over age 50, 55 I’d say avoid big crowds if you can, and that’s going to be really important and know that we’re going to work on the critical drug supply to make sure that people aren’t without drugs that save their lives every day. That’s going to be a big challenge.

Joe Rogan: (01:30:14)
One more question. How long does it take to develop a vaccine for this coronavirus?

Michael Osterholm: (01:30:19)
Well, you know when I’m asked that question I don’t mean to sound glib again, but I can make a vaccine for it overnight. The question is, is it safe and effective? And that’s the challenge we have right now. Questions about how do you make immunity to a coronavirus and what kind of vaccine do you have to have that brings in all the different parts of the immune system. So we don’t know that yet. So some of this research is going to have to be basic to that. The second thing we have to worry about is safety. There’s a condition in humans called antibody dependent enhancement, ADE. And it turns out that if you have no antibody or an immune response, you’ll get the disease. If you have a lot, you’re protected. But if you have this in between level and then you get the disease, it actually enhances the disease.

Michael Osterholm: (01:31:04)
Immune response is really destructive. And in fact, there was just a couple of years ago, a major recall of Dengue vaccine, type of vaccine we use from mosquito infection in the Philippines where kids who got the vaccine actually made just a little bit of antibody. And when they got the real disease it made them a lot sicker. And so we found with the 2003 SARS vaccine that there was an ADE component to it when we made it in animals. And so we’re going to have to really study this to be sure it’s safe. And as you said earlier, we can surely make mistakes. We need to do everything we can not to. And so I think between getting the effectiveness and the safety data together, we’re years out. I mean, maybe two years. Yeah. This is not going to happen soon.

Michael Osterholm: (01:31:48)
It’s wishful thinking. You know, every time… I mean, I go back to SARS in 2003 and look at every event, Zika 2015, and we said, “Oh, we’ll have a vaccine for no time.” Here we are five years later, we have no vaccine. And so this is one of the challenges we have. We have to complete the job. You know, it’s like we start on something and then we forget that it’s important because it kind of goes away for a while but only to come back. And so this is part of that picture we talked about and this is what Peter Hotez talks a lot about. You know, we got to finish the job on these things. You know, I worry that we’ll get through this situation and then people say, “Oh, we’re done.” And then we’ll forget until the next one comes along. And so, this is where vaccine research and development is really important.

Joe Rogan: (01:32:30)
How do they test for safety? So once they come up with a potential vaccine, how do they make sure that it’s safe?

Michael Osterholm: (01:32:37)
What you do it gradually. First of all, you put it into animals to see and you know enough about them, how their immune responses, what do they do? Then you put it into a few humans, 30 humans. They volunteer willingly knowing to see what kind of reactions they have.

Joe Rogan: (01:32:51)
Why don’t we just take really bad people that are in jail and practice on them?

Michael Osterholm: (01:32:55)
Well, I don’t know if that’s doable here in this country without their informed consent. So I’ll just-

Joe Rogan: (01:33:00)
I think Trump can fix that. If anybody, if we have a shot at doing that with any president, it’s Trump. Just start with rapists.

Michael Osterholm: (01:33:07)
Yeah. So anyway, the bottom line though is that then they gradually work their way up to larger studies where you know, if something happens, one every 1000 people. You have to study a lot of people before you know that the chance that you might find that. You can’t do it in 30 people. So that’s why it’s going to take awhile. And you know, they’ll test it on more and more people and they’re going as fast as they can. It’s not like there’s anybody dragging their feet. It’s just that… I jokingly say it’s like if the Iowa farmer wanted to harvest his corn in half the time, it doesn’t mean by planting twice as many acres, he can do that. You know, planting in April, you still can’t harvest until October.

Joe Rogan: (01:33:40)
That’s a good point.

Michael Osterholm: (01:33:41)
That’s what this is. It’s going to take us as long to get this vaccine.

Joe Rogan: (01:33:44)
Well, Michael, I appreciate you and I appreciate your time and your book, Deadliest Enemy. People go out and buy it and thank you for informing us.

Michael Osterholm: (01:33:52)
Thank you.

Joe Rogan: (01:33:52)
And thanks for being here. It means a lot to us. Thank you very much.

Michael Osterholm: (01:33:55)
Thanks. Take care.

Joe Rogan: (01:33:56)
Appreciate you. Thank you.

Michael Osterholm: (01:33:56)
Thank you. Bye.

Joe Rogan: (01:33:56)

Michael Osterholm: (01:33:56)
Can I get a picture with you holding this book?

Michael Osterholm: (01:34:01)
Oh, I’d love to. I’d love to get a picture with you.

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