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Chapter 1: What is the main topic discussed in this episode?
Okay, well, I am really excited today. I get to talk to my favorite epidemiologist. And he has just launched a big book called The Big One. And it is an incredible book that I had a chance to review prior to its launch. And I just want to read what I said about it. And I'm a little guy compared to the other people that have reviewed the book.
Chapter 2: What is the main topic of 'The Big One' book?
I wrote, if it was one person to turn... For future pandemic readiness, it would be Michael Oster, one of the world's leading epidemiologists. In The Big One, a landmark book, he, along with Mark Olshaker, provide a remarkably clear-eyed, science-driven, and comprehensive preventive approach. So, Michael, welcome.
Thank you very much, Eric. It's a real honor to be with you.
Well, no, it's much more for me because this book is really the timing of it and the balance in it and the insight and wisdom from a person who's been doing it, what, for a decade and is the highest, as far as I know, the highest regarded person. American epidemiologists. That's all I can say.
Well, if I can add one addendum to this, okay, because it's in the book, so I surely don't want to disguise it. But what the audience may not realize is that you, along with several other colleagues and I, got together every Friday throughout the pandemic, what we call the party planning group to cover in our our calendars.
And what I learned from you during the pandemic, I felt like I could almost have gotten another PhD or, you know, at least another master's. And I just want to personally thank you. Your clarity of voice, your brilliant, brilliant assessment of what, you know, the various clinical and epidemiologic issues mean. has been just a gift.
And so when you started this Substack, obviously, as you know, I couldn't wait to subscribe. And I hope everyone who's listening today realizes just what a valuable tool you are to those of us.
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Chapter 3: How did the pandemic influence the writing of this book?
So it's an honor, a real honor for me to be here with you.
You're really kind, Michael. And You've been such a great support, and I've learned so much from you. And one of the things I learned from you, and it's throughout the book, is the importance of humility. Not only are you my favorite person for coming up with metaphors, you come up with country bumpkin metaphors, but you're really good at... having humility, saying, we don't know. I don't know.
We don't know. So let's get into something we don't know about, which is the last chapter of the book. We're going in reverse here. But the last chapter of the book is the big one. It's SARS-3. And it's about a virus that gets wings. and circles around the world in hours, I guess starting in Somalia and then getting into your neck of the woods in Minneapolis.
And it's obviously something that you imagined, but it's maybe not so far off from what could happen. So take us through the SARS-3 scenario that you envisioned.
Well, first of all, what we attempted to do with this book is provide basically a fictional outbreak that begins in the first chapter with the very first transmission in Somalia. And it points out just how quickly this virus would spread. And it's very realistic. I mean, we... Checked every figure with everyone in Somalia, Kenya, airports.
And what we try to do then is based on that, each chapter begins with that fictional scenario. And then we go into the nonfiction actual assessment of what should we or could we have learned. And as you know, we've learned a heck of a lot during this pandemic.
One of the things that was very challenging is that we never spent the time afterwards, either commitment-wise or just from a time standpoint, to assess what the heck happened. What did we go through? We needed a 9-11-like commission without finger-pointing, not partisan, just to say what are the lessons we could have and should have learned. And so, you know, we came up with this virus.
You know, at the time that we saw COVID take off, there were a lot of people skeptical that a coronavirus was going to do this. As we know, SARS and MERS were both two prototype coronaviruses that, in fact, were of great concern. But fortunately, as much as they could kill 15 to 35 percent of the people who got infected, they weren't that infectious.
There were rare instances where we did have some super spreaders, but basically we were able to stop that transmission.
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Chapter 4: What fictional outbreak scenario is presented in the book?
Early on in the pandemic, Eric, as you know, I took a lot of criticism from my colleagues for being sensationally crazy. And I was on Joe Rogan on March 10th of 2020. And I said at that time, I really honestly believe we could see 800,000 deaths in the next 18 months. And I'm telling you, you should have seen my inbox for, you know, why are you doing this, scaring people?
And it turned out that 18 months later, we were just short of 800,000 deaths. And that's what people didn't envision is this long term, not a hurricane, but we're talking about a really, you know, an infectious disease blizzard that lasted three years.
Yeah, I mean, I think, and Christian, you know, you called it. I think a lot of people didn't appreciate and, you know, labeled you as a scaremonger, which couldn't have been the truth. But here you are, you know, you're now trying to take all that wisdom, not just from SARS-CoV-2, but, you know, all the other things, influenza and everything else.
And you're trying to project, you know, what do we have to do? And this transcends many different areas about universal vaccines, which many academic labs have been coming up with, not just for coronavirus, but also for influenza and other leading potential viruses that could cause a pandemic.
Surveillance systems, the critical aspect of public trust that you emphasize that we've got to reestablish, getting the right funding. Now, as I look down the list of all the things you brought up, I'm saying we're not doing any of this stuff. Is that the right call on that?
Unfortunately, you're right. And let me just add one little piece to my last answer because you asked me and I didn't answer it. It was about kids. Yeah. Oh, yeah. And, you know, what people didn't realize is the variants made all the difference between night and day with kids. You know, there were in the first three years of the pandemic, we had roughly 1,559 kids die in this country.
If you look at the first year, it was only 199, and I'd say only, and it's still a tragedy, but 87% of the deaths in kids occurred in year two and year three. And what happened was, as alpha gave way to beta, beta gave way to delta and the variants, and then we got to Omicron, we saw a very different impact on kids.
But people had published these papers in the first year saying it's not a big risk for kids, that I don't get seriously ill. And we missed totally what was changing with the epidemiology and pediatric COVID per the different variants. And so the fact that, you know, 87% of the deaths occurred in year two and three, We totally missed that.
We were having all the arguments about school being open or closed or what we did based on what was from year one data. And I think this was one of the lessons that taught us is you got to constantly be evaluating the data, whether it be for transmission purposes, for disease severity, et cetera. And I think that's one of the lessons we should learn with these variants.
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Chapter 5: What lessons from COVID-19 are highlighted for future preparedness?
And so when we recently saw this administration withdraw any support for mRNA and basically almost cast it aside as evil, that's been really unfortunate because that was our best get out of jail card right now. And so in that sense, that's an example. But otherwise, you know, all the other things we have going for us at best can limit a bit of what happens with the pandemic.
But we really need to have these vaccines.
You know, I could agree with you more there. You really highlight this in the book. And the point here is that, you know, we haven't done anything to improve the mRNA nanoparticle package since day one. It was, of course, a miracle. that we had it in 10 months from the time of sequence to the first vaccine being able to be given to people.
But we know, like, for example, in Japan, there's self-amplifying mRNA at tiny doses, much less potential for side effects. And the nanoparticles can be tweaked. And we're still now, you know, five years later or four years plus later from the vaccines being available. And, you know, the companies are doing nothing. And of course, as you point out, Mike,
The abandonment of HHS, of mRNA, perhaps not just even for infectious diseases, but for cancer, autoimmune diseases, gene editing, and all sorts of other things. This is really a tragedy, I think, because as you just pointed out, a lot of people don't realize it, you can make an enormous amount of mRNA vaccines quickly.
And of course, we could stockpile, ideally, universal flu, universal coronavirus, and pick a couple more leading culprits and have, you know, like you said, billions of doses ready. And you really spotlighted this in the book. The investment in stockpiling universal vaccines, mRNA vaccines, that would offset the tragedy and the loss of lives, the economic impact, on and on and on, right?
If we had that, Eric, we wouldn't have the big one. It's that simple. That's the difference, okay? And so that's what we need to get across to people. You know, when you think about defense spending, people say, well, they spent too much money on it. We don't spend enough on it. I don't know. I don't understand that. But I do understand.
If you're going to build a new aircraft carrier, they budget that for 15 years of construction. So it starts today, and you don't have to go in every year to get refunded or hoping that you're going to continue to get funding. It's planned that way. We should be doing this with our vaccines.
And the private sector is not going to pick this up because already, look what's happening once the mRNA fell out of favor with this administration. Everybody, investment-wise, is getting out of it because they're fairly going to lose their shirts. Who pays for manufacturing capacity that you don't keep warm, basically, day to day?
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