Mike Osterholm's Last Stand

Minnesota’s homegrown epidemiologist has spent a lifetime preparing for this pandemic. Can he rise above the chaos to be heard?

by

This spring, like seemingly every other human in the COVID era, Dr. Michael Osterholm, the University of Minnesota’s superstar epidemiologist, decided he needed to improve his livestream backdrop. Maintaining his isolation under the cover of darkness, he went into his office at the Center for Infectious Disease Research and Policy (CIDRAP)—the center he founded in 2001—to borrow a green screen. He needed something that looked better on national media appearances. For several weeks during those early days of the pandemic, he broadcasted from his St. Louis Park home as if he were levitating in front of the 3rd Avenue Bridge with the Minneapolis skyline behind him.

The uncanny valley of the Zoom façade may be an ambiguous look for a scientist, and is even a little weirder when held in relief by Osterholm’s folksy directness, but he’s game to play the part. And technology has its benefits. “I found out if I get up and walk back into the screen behind my computer, I disappear.” This delighted his grandkids. He said they started squealing, “Grandpa! Grandpa! Do it again.” 

Osterholm built his career playing a less powerful but more heroic part, as an epidemiological Indiana Jones, logging up to 200,000 airline miles a year for his work, which includes investigating deadly diseases in Minnesota and the rest of the world, trying to share what he had learned as widely as possible. He developed a reputation as a dogged truth teller, to some an alarmist, but clearly a man out to save the world from itself. 

When he founded CIDRAP in 2001, his ambition was to expand his purview to big, global threats, studying phenomena that could result in pandemics like Zika, Ebola, and influenza, with the intent of informing policy that could prevent them from ever gaining a foothold. In the last 20 years, as an advisor to presidential administrations of both parties, he’s sounded the alarm about our domestic health system’s woeful underpreparedness. And in early January, his longtime fears were realized, when CIDRAP was among the first to recognize that SARS-CoV-2 had made the leap from animal to human in Wuhan, China. COVID-19 would become the most threatening global pandemic on his four-decade professional watch. 

Osterholm believes the U.S. is looking at between 800,000 and 1.6 million dead by the time this is all over. “Those are the numbers I generated three months ago,” he says. “And right now, unfortunately, they’re right on the mark.”

He has been preparing to lead the public through a pandemic for 40 years, but the information age has complicated the mission. Deep political polarization has undermined our ability to trust in the voice of any one expert or institution, while the mysterious nature of this novel coronavirus has launched a torrent of academic and governmental research that’s barely filtered by an anxious, too-fast-for-nuance, conspiracy-theory-prone social media. And then, the most intense civil unrest over racial inequality since the 1960s pushed all of it just out of frame. Osterholm himself went from ubiquitous to invisible. 

COVID-19 isn’t going anywhere, and he isn’t shrinking from a challenge. But six months into the scariest pandemic since 1918, Mike Osterholm—he insists on being called “Mike”—remains on the horns of a dilemma: how to tailor and present a message for 2020, lest he recede into the void, like a grandfather fading into his green screen. 

*****

It is the time of the epidemiologist, but it’s also a time of panic and blame. We want to be reassured so badly we lionize them, and we’re so wary and cynical we eventually can’t help turning on them. Dr. Anthony Fauci gets played by Brad Pitt on SNL, and then he gets attacked by the president on Twitter. Hipsters in Sweden get tattoos of Anders Tegnell, and then the press excoriates him for the country’s skyrocketing nursing home death rate. So how should we feel about our guy? Why exactly should we trust this oracle from Iowa again? 

Mike Osterholm’s biography is well known, but when revisiting it, two things stand out: his precocious and abiding passion for scientific curiosity and his desire to help people he cares about avoid pain. 

For more than 40 years, first as the Minnesota Department of Health’s state epidemiologist, and then at the U’s CIDRAP, Osterholm has been saving lives. He’s famous for protecting us from killer tampons (1979’s toxic shock syndrome) and deadly ice cream (1994’s salmonella outbreak at Schwan’s). In 1995, his team inoculated 30,000 people over three days in Mankato, containing a deadly meningitis outbreak. And in the early ’80s, he was the first state epidemiologist to take on the initial AIDS outbreak. 

Osterholm grew up the oldest of six children in Waukon, Iowa, a small town in the rolling northeastern part of the state. His father was a violent alcoholic who worked as a photographer for the small town’s newspaper. As Osterholm put it in his recent commencement address to Des Moines University: his father “had a primary way of expressing his internal anger with the world—it was through his fists and mental intimidation without regard to your age or gender.” 

But it was the local newspaper publisher’s wife, whom he refers to as “Nana,” who “adopted him spiritually.” Nana was a renaissance woman with a journalism degree, and she gave him her copies of The New Yorker—hard to find in the Driftless region of Iowa—and it was within those pages that a teenage Osterholm fell in love with Berton Roueché’s investigative Annals of Medicine column. His curiosity about public health grew when he landed a summer job in high school for the Iowa State Hygienic Laboratory as a mosquito researcher specifically looking for Aedes triseriatus mosquitoes carrying La Crosse encephalitis and continued to be stoked while he studied at Luther College. 

After graduating from Luther in 1975 with a double major in political science and biology, he came north to Minnesota for grad school at the U’s School of Public Health, landing a job at the Minnesota Department of Health five days after enrolling. He graduated with two masters and a PhD, and by 1979 was investigating toxic shock syndrome as an epidemiologist at the department. In his 2017 book, Deadliest Enemy, Osterholm describes one of the lowest moments in his career: standing by helplessly as he watched a 16-year-old girl, her body horrifically swollen by edema, dying from organ failure from toxic shock. He consoled her parents afterward and vowed to get to the bottom of the mystery, which he did, but not in time to save their daughter. 

Then in 1996, a week after he and his son Ryan had done some yard work outside the house Osterholm built on Lake Minnetonka, his son became violently ill. After a stay in the Minneapolis Children’s ICU, it was determined Ryan had contracted La Crosse encephalitis, the mosquito-borne virus that Osterholm had battled more than two decades earlier, while a high school summer research assistant. “Here I am, supposedly an expert on the topic,” he says. “And I was just a scared parent. I watched the medical staff provide the most amazing care to my son.” The switch in perspective was humbling. “You never forget that, nor should you.” 

Protecting people from pain and suffering is the end game for Osterholm. He takes the losses hard—and remembers them forever. “I came from a very painful childhood,” he says. “And there is nothing that’s more rewarding than to relieve someone of pain, or to find out what you can do to make sure something bad doesn’t happen to somebody again.”

A fundamental in the field of epidemiology is the importance of getting medical messages to the public clearly, accurately, and in a timely enough fashion to slow the course of infections. But media appearances are only the public-facing side of what Osterholm does. His most important role, according to Dr. Mark Schleiss, a U of M virologist, is as a researcher. 

“People have an idea of research in infectious diseases being a wet laboratory where you have an incubator, flasks, and tubes and some kind of assay that you’re running on some kind of a germ,” Schleiss says. “That’s the kind of stuff that I do. But a big part of what Mike does is sift through information, applying scientific principles and analysis to ask if conclusions that are drawn are really valid.” Schleiss points out that it was Osterholm’s ability to synthesize all of the known literature on a very simple question—does the flu shot work?—that provided the framework for CIDRAP’s answer (that answer: not as well as you think it does). 

“I think that’s an important point,” he says. “That this is not just sort of his wise and reasoned opinion as somebody who’s been there a long time. A lot of it is really hard data gleaned from meticulous analysis of large amounts of information.” 

For his part, Osterholm breaks down his job description simply: “I probably spend 90% of my time learning,” he says, “8% of my time making mistakes, and 2% of my time trying to get it right.”

Osterholm believes this pandemic is still in its early stages and won’t slow down until we have a vaccine or reach herd immunity, which would happen near 60 percent total infection. With the inherent amount of illness and death, Osterholm says we must recognize coronavirus as an attack on the very social fabric of our world. “If this doesn’t move us to do a careful examination of who and what we are as a society, or who we are as communities and families,” he says, “then I don’t know what will.” 

*****

Mike Osterholm is taking quarantine as seriously as Minnesota’s most important epidemiologist should. He declines to do interviews in person, and he says he rarely leaves his house—he hasn’t even seen his five grandchildren in person since March 10. (He hates the term “social distancing”—he insists on referring to it as “physical distancing”—meaning he can still be social.)

He’s used to spending his free time doing things like attempting to swim the English Channel, which he’s done on three occasions, coming within three miles of the French shore in ’86. (When I ask him if he would every try again, he pauses long enough for it to become obvious he has yet to give up on the idea.) But now, at 67, he has no time for 12-hour training swims in Lake Minnetonka—no free time at all, in fact—and he belongs firmly within a high-risk category for COVID-19, and that means staying home. 

When I reach Osterholm’s romantic partner, Fern Peterson, she’s on her way to Best Buy to pick up even more audio-visual equipment: a camera, some cables, an equalizer. Osterholm and Peterson are divorcees, both with grown children, who met at a bipartisan fundraiser for FairVote Minnesota a couple of years ago.

“I never believed in love at first sight,” Peterson says, “but I think we came from the same star.” They both have small-town Iowa roots, for one, and they’re both strong, independent people. She says that early in their relationship they exchanged long emails as Osterholm flew all over the world. It was only in March, with the pandemic looming, that they made the decision for Peterson to bubble up at Osterholm’s place for quarantine. 

Peterson is used to Osterholm’s pace—“I used to joke that I got in 50 words a day, now it’s down to about 25”—but since the outbreak, she’s made supporting him her mission. “I see it as my calling,” she says. “He can’t worry about the inconsequential stuff right now—so I keep a chicken in a pot and his Diet Pepsi in the fridge.” She said Osterholm used to take daily eight- or nine-mile walks, but now she does her best to get him on 15-minute strolls through the neighborhood. 

The AV equipment is for Osterholm’s TV appearances. He has the style of a scientist: He wears the same blue blazer over a light blue dress shirt open at the neck, his 1990s beard now clean shaven, his big brain topped with neat silver hair. He employs the same mannerisms during each appearance, no matter the network: tenting his fingertips together while awaiting the question from whatever anchor and then responding with colorful countrified metaphors involving Minnesota winters, nine-inning baseball games, and protecting the president with squirt guns. 

Most of us encounter Osterholm and his ideas on WCCO, MPR, CNN, or FOX. And it’s in this realm where his ability to take complicated ideas and midwesternize them into what his longtime colleagues refer to as Osterholm-isms really stands out, especially for an epidemiologist, where communication skills can be a little on the actuarial side. 

“I’ve told you this before—if it doesn’t play at the S & D Cafe in Waukon, Iowa, at the 10 o’clock coffee klatch,” he says on a phone call, “we’re missing the mark.” 

But whereas a generation ago the names Osterholm and Fauci comprised all of epidemiology to America, now, in our politicized 24-hour new cycle, his voice is just one of a Greek chorus of cable TV doctors and pundits who believe they are doctors. I realized Osterholm was no longer America’s midwest voice of reason when more than one friend synthesized his message as that of “the anti-mask guy.” I felt myself getting defensive on his behalf—my friends reducing his 45-year career in epidemiology to one stance on one topic in a pandemic. 

At a certain point in May there became a tribal entrenchment around masks, and Osterholm’s apparent dissension from the CDC’s position caught him in the whirlwind. The mask issue became a defining stance, albeit garbled in transmission.

His message, to be clear, was never anti-mask, just that homemade cloth or even medical-grade surgical masks do not offer the empirical protection of an N95, currently reserved for specialized uses and settings. Homemade masks are an idiosyncratic, though potentially effective, means of diminishing transmission, but they are not a license for a carefree trip to Lunds for somebody in their 60s .

It’s a message that may be too nuanced for 2020, and thus Osterholm, in some eyes, has become just another truther, albeit one whose message satisfies neither ideological pole. 

“I mean, the amount of hate mail I’m getting right now over this issue is remarkable,” he said. “This is the terrible, unfortunate situation: It’s because this has become linked to the president.” 

“If this doesn’t move us to do a careful examination of who and what we are as a society, or who we are as communities and families, then I don’t know what will.”

Osterholm has never had to work harder to avoid being used by cable news producers as a combatant in a talking-point battle. An epidemiologist is one of the few roles left in the country where nonpartisanship is crucial to credibility, and credibility is crucial for trust. But Osterholm’s refusal to hide his ambivalence about masks has turned him into an unintentional iconoclast. “I’m just trying to save lives. That’s all I care about. I don’t care about the politics. I think going on a show to talk about Trump’s masks is a distraction. And our group has the best science on this.” 

I’m starting to feel bad for asking him about it, and I can hear him sigh. “When you mandate something, you’re telling people this really works. I wish life could be that simple.” 

So I ask him if he wears a mask. 

He tells me he wishes everyone could wear a fitted N95 and be assured the surety of protection. “Reducing risk is great,” he says. “I don’t have a problem wearing a [cloth] mask to reduce risk. ... But what I don’t want also to do is give people the tacit approval that you can kind of just carry on anyway—because these aerosols leak in and out of cloth masks and the surgical masks substantially.”

Osterholm can’t help asserting the truth, even when the truth complicates the directive. He is confident that people will come around over time. “There’s so many experts who declare themselves experts,” he says. “You can’t be declared an expert, you have to act like an expert—and that means you have to tell people what you know and don’t know. And when you get new information, you share that, and you say, This is what I’ve now learned. And I think that’s what people are looking for, whether you call that an expert or not.”

******

“It was not the coronavirus pandemic that killed George Floyd,” Floyd’s family lawyer, Benjamin Crump, said from the pulpit at George Floyd’s memorial service in downtown Minneapolis. “It was that other pandemic—that pandemic of racism and discrimination.” In a speech one week earlier, Minneapolis City Council member Andrea Jenkins called on state and local officials to declare racism a public health emergency. Hearing Crump’s words, it felt painful to remember that for months, for an entire Minnesota spring, we were terrified to go outside.

Overnight, thousands of Minnesotans came to the resolution that it was imperative to overcome the fear of one outbreak to get in the street to fight the other. 

Epidemiologists often reference a threat matrix, which balances deadliness and virulence to rank the various pathogens in the epidemiological environment. But in Deadliest Enemy, Osterholm points out that threat matrix mathematics isn’t how regular people think about sickness or risk. They instead consider disease and death through a matrix of emotion. 

“We’re going to see the impact on those less fortunate. How it’ll be disproportional to them. And we have to ask ourselves, ‘Is that okay?’”

For instance, he writes that we tolerate 40,000 U.S. highway deaths a year, but when the I-35W bridge collapses over the Mississippi in 2007, killing 13 people, we deem it wholly unacceptable. Similarly, more than 1,000 Minnesotans were dead from an unseen virus, but a cop with his knee on the neck of an unarmed black man gave many the courage to face it in protest of a more insidious public health threat. 

On a phone call the day after Floyd’s memorial service, Osterholm recalls watching the ceremony at home, but in lieu of answering questions about his personal feelings, directs me to his CIDRAP podcast, which he opened with a carefully measured statement about what he considers to be the darkest time in our city’s history: the tragic murder of George Floyd, the loss to his family and to the community, and the riots and destruction that followed. He believes that this moment in history will be studied for generations, and as we face the monumental task ahead in examining and building the kind of society we want, we have no choice but to do so while staring down 2020’s other pandemic simultaneously. 

“We’re not sure what the risk is,” he says about the thousands of protesters grouped together wearing cloth masks. His brain goes into Sherlock Holmes mode—rapidly pinging between all the angles: any known case studies, the history of pandemics, and the anecdotal probabilities of the protesters vs. the police. He says bringing crowds together is definitely a risk factor for the virus, but says the protests are being held outside, and he cites a Wuhan study where only one of 320 outbreak clusters occurred out of doors. Then he compares this coronavirus to the 1918 flu virus that caused one of the deadliest modern pandemics and says War Bond parades held in certain cities to raise money for WWI did cause outside transmission. Finally, he points out that protesters were tear-gassed, which causes coughing, a potential factor in increased transmission. As is sharing air inside in a paddy wagon or in a holding cell. 

At press time, three weeks past Floyd’s killing, no surge in cases had yet materialized.  

Osterholm remains adamant that three months ago there was clear and compelling data to shut the economy down and to order Minnesotans to stay at home—he’s sure that Gov. Walz’s decisions slowed transmission and saved lives. “That part’s real,” he says. The biggest challenge, he says, is that this virus has unique properties that will make its propagation unique as well. “If this situation unfolds like an influenza pandemic would, we would expect to see cases decreasing regardless of what the human activity does now.” While cases are dropping and leveling off in some states, in many others the numbers appear to be  rising. 

*****

Mike Osterholm has seen a darkness approaching for longer than almost anybody. In 2017, he predicted a pandemic in Deadliest Enemy. In 2005, he predicted a pandemic in Foreign Affairs. But he doesn’t take pride in any of this, nor does he think his predictions are all that bold. He doesn’t even believe that COVID will be the last pandemic in his lifetime. “This is Mother Nature,” he says. “It’s like saying we’re going to stop earthquakes, hurricanes, and tsunamis.” 

But he does believe we can be better prepared for the next one. “It’s never too late to do the right thing,” he notes. “We obviously didn’t have in place the kinds of tools—the vaccine platforms, the protective equipment, the policy drafts—that we could have had for this one.” As he said to CNN’s Don Lemon one night: “The government can’t protect you.” 

In Deadliest Enemy, Osterholm writes, “the purpose of public health is to promote social justice”—which he understands to mean replacing bad deaths with good deaths. He asks me to imagine finishing my life in a long-term facility, dying without a funeral. He says most people don’t want to think about death and suffering, but it’s his job to do exactly that. 

“You know what I worry about more than anything?” he asks. “That in the next 16 months more kids are going to die in this country from measles than die from COVID-19. Because we’ve virtually stopped vaccinating kids.” 

It’s his job to play chess when others are playing checkers, to worry about a cascade of secondary disease caused by COVID. 

“There’s always going to be a top 10 causes of death,” he says. “If you eliminate the current top 10, I’m not sure [the next 10 are] any better. So one of the challenges we have is this sense of competition: ‘These people are dying more than these people, so these people are more important,’ and they’re not. They’re all important.” 

In this way, he agrees with Floyd’s family lawyer—our country is facing twin pandemics, and COVID is reflecting that in its impact on communities of color.

“We’re going to see the impact on those less fortunate,” he says. “How it’ll be disproportional to them. And we have to ask ourselves, ‘Is that okay?’” 

He absolutely has his eye on future pandemics, though admittedly, “you’re not going to plan your next vacation in the middle of a heart attack,” he says, coining an instant-classic Osterholm-ism. “But the bottom line is we so often don’t prepare until we are in the middle of a crisis.” 

Osterholm says he would love the last hurrah of his career to be an honest and detailed evaluation of this one. “My job is to just tell the truth.” He’s optimistic that the truth can inspire an actual comprehensive preparation for the next pandemic, which he believes is inevitable. Until then, he intends to keep calm and to keep telling the public what he knows and what he doesn’t know. Epidemiology is by its very nature a long game, and Mike Osterholm can’t help but to hope for a shot at what’s next. 

This article originally appeared in the July 2020 issue.

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