#102 - Michael Osterholm, Ph.D.: COVID-19—Lessons learned, challenges ahead, and reasons for optimism and concern

1. Remember the Human Cost

Despite the use of statistics and numbers, always remember that the pandemic’s impact is deeply personal, affecting loved ones and leading to serious illness or death for many.

2. Focus on Effective Solutions

Maintain hope that the crisis will be overcome, but critically focus on identifying and implementing the most effective approaches to navigate the challenges.

3. Seek In-Depth Information

Avoid relying on soundbites or short segments for complex topics like pandemics, as they fail to convey the necessary complexities and long-term views. Instead, seek venues that provide detailed, comprehensive discussions.

4. Understand Aerosol Transmission

Recognize that viruses can transmit via aerosols, which are small particles produced within the typical six-foot droplet zone, meaning protection beyond just droplet precautions is necessary.

5. Anticipate Future Challenges

Shift from a reactive ‘playing checkers’ approach to a proactive ‘playing chess’ strategy by anticipating where the pandemic is headed, rather than just reacting to its current state, to stay ahead of its rapid progression.

6. Interpret Models with Caution

Understand that all models are inherently wrong to some degree; while they can provide helpful information, their wide variability and potential for error mean their projections should be interpreted with significant caution.

7. Challenge Assumptions with ‘What You Have to Believe’

When analyzing complex situations, use the ‘What You Have to Believe’ game to probe the limits of current understanding by considering extreme scenarios and identifying the necessary conditions for them to be true.

8. View Crisis as a Long-Term Movie

Understand that the current situation is merely a snapshot, not the full movie; anticipate that the pandemic will unfold over years, revealing more similarities in outcomes across regions when viewed over the long term.

9. Adapt to Available Resources

When facing a crisis, understand that you must operate with the resources currently available, not with what you ideally wish for, and adapt strategies accordingly.

10. Assume COVID-19 for Flu-like Illness

If a patient presents with an influenza-like illness during the pandemic, assume they are COVID-19 infected, especially if influenza circulation is low, and proceed with appropriate isolation and care.

11. Prioritize COVID-19 Testing

In situations of reagent scarcity, prioritize COVID-19 testing for hospitalized sick individuals, symptomatic healthcare workers, and long-term care facility workers to manage the outbreak effectively.

12. Prioritize Healthcare Worker Serology

Implement widespread serology testing for healthcare workers to identify those with likely immunity, allowing them to safely return to work and be deployed to high-risk areas without fear of reinfection or infecting others.

13. Support Healthcare Worker Mental Health

Recognize and address the severe mental health toll on healthcare workers, providing support and care to help them cope with battlefield-like trauma during prolonged crisis periods.

14. Address All Crisis Fronts Simultaneously

Recognize that the crisis presents problems on multiple fronts (drugs, personnel, equipment), and an ‘all hands on deck’ approach is required for all of them, as bottlenecks will vary by location.

15. Strategically Relocate Healthcare Workers

Consider relocating healthcare workers to cities identified as current or imminent epicenters of the outbreak to address critical bottlenecks, provided they can be adequately protected with necessary PPE.

16. Demand Honesty and Accountability

Acknowledge the collective responsibility for being ill-prepared for the pandemic and demand honesty about the current situation and future challenges.

17. Utilize Syndromic Surveillance

Revert to syndromic surveillance methods, like monitoring influenza-like illness trends in physician offices, to detect community spread and determine when to implement aggressive public health measures, especially when testing reagents are limited.

18. Exercise Caution with Unproven Treatments

Be cautious about using unproven treatments, as some drugs, like chloroquine, may act as immunologic modulators and could potentially worsen certain conditions, highlighting the need for robust data.

19. Prioritize Rigorous Treatment Data

Support the rapid establishment of systems to collect meaningful data on potential therapies through randomized controlled trials, maintaining an open mind and letting the data guide conclusions on efficacy and safety.

20. Research Long-Term Survivor Health

Prioritize research into the long-term health outcomes of COVID-19 survivors to understand potential lingering issues like myocarditis, kidney disease, or lung fibrosis.

21. Investigate Comorbidity Mechanisms

Research the specific mechanisms by which underlying comorbidities, such as type 1 diabetes or obesity, predispose individuals to severe COVID-19 outcomes.

22. Identify Super Spreader Characteristics

Investigate the characteristics of individuals who become ‘super spreaders’ to better identify them a priori and implement more effective isolation strategies.

23. Improve Predictive Intelligence

Develop better predictive intelligence to anticipate future outbreak fronts and resource needs, addressing the current shortcoming in proactive planning and response.

24. Establish Global Resource Coordination

Advocate for global leadership and coordination to equitably allocate critical resources like tests and N95 masks, preventing a ‘haves and have-nots’ scenario where countries compete for essential tools.