 
Dr. Michael Osterholm is the director of the Center for
Infectious Disease Research and Policy at the University of Minnesota.
For more than 30 years, Dr. Michael Osterholm has been
a leader in the fight against every major health threat
on our planet from smallpox to AIDS and ebola.
He has consulted with governments, the World Health Organization,
the Centers for Disease Control, and the US Department of Defense.
He's watching for the next pandemic, and believes it could be bird flu.
How concerned should we be in the United States about bird flu?
Dr. OSTERHOLM:  As a worldwide community,
we have to be very concerned about this.
Pandemics of influenza are like hurricanes, tsunamis and earthquakes,
they occur.  We've 10 of them in the past 300 years,
we've had three in the last century.
WINFREY:  What are the three in the last century?
Dr. OSTERHOLM:  Well, the 1918 pandemic, which was really
a world-defining event, where over 100 million people died.
And we had milder ones in 1957 and '58 and again in 1968 and '69.
And we expect them roughly every 20 to 40 to 50 years.
So in that sense, our time clock is ticking.
WINFREY:  And so, what--what do we do?
Dr. OSTERHOLM:  Well, first of all,
have you to understand that there really are, in a sense,
three different kinds of influenza virus that we worry about,
and that's where I think the public is confused.
There is that which is in the birds.
WINFREY:  Yeah.
Dr. OSTERHOLM:  That virus doesn't really hurt us very often.
WINFREY:  OK.
Dr. OSTERHOLM:  Then we have the flu virus we think every season,
you know, that you and I worry about...
WINFREY:  Yeah.
Dr. OSTERHOLM:  ...we get our flu shot for.
That is a second kind of virus that still kills in the United States
36,000 people a year just routinely. It's the third kind of flu virus
which is the in-between of those two that we worry about.
It's when a virus changes, mutates from the bird virus to the human virus.
That's when we see a pandemic, or a worldwide epidemic,
and that's what we worry about.
WINFREY:  And how does it change?
You have contact with a bird who's infected?
You wouldn't know that it's an infected bird, and then it mutates to you?
Dr. OSTERHOLM:  Right.  In Asia and now in Turkey,
we have enough of the virus out there
that it occasionally can get into a human.
But what makes for a pandemic is when it mutates even more,
and now it human to human transmits. The birds become incidental.
It's me transmitting to you and you transmitting
to the audience and the audience--audience transmitting
to their families.
WINFREY:  Yeah.  It's sitting on a plane and you sneezing on me.
Dr. OSTERHOLM:  That's right.  Unfortunately, I wish it were that simple.
You're actually becoming infectious with the influenza
virus up to a day before you get sick.
So right now, if I have influenza infection
and I'm going to be sick tonight at midnight when I wake up in the middle
of the night with muscle aches, fever and chills,
I've already exposed you right now.
WINFREY:  OK.
WINFREY: Or.
Dr. OSTERHOLM: Or--or--or...
Dr. OSTERHOLM:  ...you could have exposed me,
but I've had my shot this year.
WINFREY:  You've had--OK.  And so would any shot do?
OSTERHOLM: No.
WINFREY: No.
Dr. OSTERHOLM:  That's the problem.  Influenza viruses are very unique.
It turns out that--I think about every year we tell people to get a flu shot.
WINFREY:  Yes.
Dr. OSTERHOLM:  Why?  Because even the every-year flu virus that's
in humans basically is, because of this mutation problem,
it changes enough from year to year that we actually need to get
a new flu shot every year because it's changing.
WINFREY:  Oh, really?  OK.
Dr. OSTERHOLM:  See, you don't get that from mumps or measles
or rubella or all the things your vaccinate your kids for.
WINFREY:  That's right.
Dr. OSTERHOLM:  One shot's good for a long time.
Well, when a virus mutates to the point it becomes a new pandemic strain,
the bird virus jumps to people and now people can transmit it back and forth,
that needs a whole new virus vaccine.
And the problem we have today, Oprah, in the whole world,
with all the pipes and plumbing and machines and buildings
and experts we have, in a year's time we can only make about enough
vaccine to protect about 300 million people in the world.
Well, your audience down here would tell you there's a lot more
than 300 million people in this world.
So what we're worried about today is if a pandemic were to begin,
if this bird virus now mutates to the point where we as humans transmit it,
we will not be with vaccine of any meaningful manner in that first year
to do anything about it.
WINFREY:  To vaccinate the world.
Dr. OSTERHOLM:  We're on our own.  We're back to 1918-like situations.
WINFREY:  Wow.  That's incredible.
What are the chances of this becoming human-to-human?
Dr. OSTERHOLM:  Well, first of all, let me just make it real clear,
this is not a probability issue, it's going to happen, it's going to happen.
What we don't know is which strain it's going to
be or when it's going to happen.
It could be tonight, it could be 10 years from now.
Bottom line is we have a lot to do to get better prepared.
WINFREY:  It's going to happen.
Dr. OSTERHOLM:  Right.
And today, we're talking about, by the way, a disease that,
if it was like a 1918 experience, would kill 180 million- to 360 million people.
HIV-AIDS, which is a very important disease,
in the last 30 years has killed just slightly over 30 million people.
It gives you a sense of proportion and why, when you ask me do I worry,
of all the things I've ever worked on combined, terrorism,
infectious diseases, all these issues,
this one is by and far above all by itself.
WINFREY:  The thing you worry about the most?
Dr. OSTERHOLM: Absolutely.
WINFREY:  Now, you see people running out just like--which was so crazy,
during when everybody was on alert, we were getting the orange alerts
and yellow alerts, people were using duct tape.
And I was always, like, 'What the hell do you think the duct tape'--the
craziest thing--people--you go to supermarkets, people are stocking
up on duct tape.  Now people are getting the mask.
Will the mask actually do anything?
Dr. OSTERHOLM:  Actually, certain kinds of masks can clearly reduce your risk.
The problem with a pandemic of influenza is it lasts for a year or two.
It'll go in waves.  But some communities will
be affected for six to eight weeks at a time, maybe 12 weeks.
WINFREY:  Uh-huh.
Dr. OSTERHOLM:  And so one of the problems
we know we're going to be confronted with is,
during a pandemic, when we will obviously shut borders.
Look what's happening in Turkey right now with just these two cases,
people are shutting borders.
We will basically see, I believe, a collapse of the global economy
as we know it, which means we're going to run out of those things,
things like medical supplies, drugs, masks, whatever.
So, yes, they'll work, but I don't have any belief that much
of this will be available during a pandemic.
WINFREY:  Well, as you're saying this, then that means people
who have access will have the vaccine.
And people who have access will have the masks.
And then people who don't have--just like in New Orleans.
So the people who are the poor people, who are the people
who don't have as much, you know, access to resources will be left behind?
Dr. OSTERHOLM:  Well, it's not even that simple.
All the money in the world, the Oprahs of the world
won't necessarily have access.
WINFREY:  I'm going to get mine now.
Dr. OSTERHOLM:  If we--if we don't have them...
WINFREY:  Yeah.  OK.  Yeah.
Dr. OSTERHOLM:  If we don't have them--it's like the drug Tamiflu,
it's like the vaccine, you can't have a vaccine that doesn't exist.
WINFREY:  Right.
Dr. OSTERHOLM:  And what will you do here at Harpo Productions
during a 12- to 18-month pandemic when you have many
of the people who won't--who will be afraid to come out of their homes,
or you may not have workers that want to come to work?
That's what we've seen in the past.  That--that's not a historical response.
It's the kind of things you have to think about.
It's the Katrina mindset before Katrina happens.
WINFREY:  Wow.  And you're saying it is going to happen?
Dr. OSTERHOLM:  Well, a 1918-like experience is surely a possibility,
particularly if it's this bird flu virus,
which is a kissing cousin of the 1918 virus and why we're so concerned.
WINFREY:  Well--and one of the lessons of Katrina
is about being prepared before it happens
instead of panicking in the middle of it.
Dr. OSTERHOLM:  That's right.
And unfortunately, it is the question about, so what do we do about it?
How prepared should we be?  We live in a world of risk today.
Is it earthquakes?  Is it tsunamis?  Is it terrorism?  Is it infectious agents?
Was it SARS?  What is the next risk?
And one of the problems is it's hard to sort all that out.
As an infectious disease person, I...
WINFREY:  Are you worried?
Dr. OSTERHOLM:  I am worried.  And I'm worried because...
WINFREY:  Are you scared?
Dr. OSTERHOLM:  I'm not scared because I deal with this as a business,
and I'm--you know, failure's not an option here.  We have to get...
WINFREY:  Do you have your mask?
Dr. OSTERHOLM:  We do have masks.
WINFREY:  OK.
Dr. OSTERHOLM:  And the problem is, I have to be honest
and say I don't have enough masks to get me through one.
So in a sense, it's almost as if I almost had a spare tire, not quite.
You know, I'm like everyone else, and that's why
we have to do much better in terms of preparing us as a community,
as a country, as a country, as a world.
Remember, the whole world is going to be vulnerable here.
A pandemic is not going to just affect one country one time.
WINFREY: You were saying that the issue with
the mask is there just won't be enough.
Dr. OSTERHOLM:  There's two things.
There won't be enough and you need to have the right kind.
Just a piece of cloth across your face, as we saw in many of the
shots from Asia during the SARS epidemic,
will not do that much too protect you.
WINFREY:  Why?
Dr. OSTERHOLM:  Because think about the surgical mask.
Why does a surgeon wear a mask?
A surgeon wears a mask basically so they don't breathe
and cough onto the patient.  These are special kinds of masks.
They're different.  When you wear a mask like this,
you're attempting to seal the sides as well as through the mask.
When you're worried about influenza,
I'm worried that someone in this room who is infected, infectious,
breathing the air, putting the virus out, I'm going to share that air with them.
Well, those side vents are going to fill in.
So in many cases where you've seen pictures
of people with surgical masks on, it really is potentially
as much cosmetic as it is real in terms of protection.
WINFREY:  So they're kidding themselves.
And you were saying, though, that the virus lives outside
the mask for two to three days, and so the mask is then
contaminated at the end of the day.
Dr. OSTERHOLM:  Right.  If I had influenza and you could
use the modern technology of videography here and you could
see all I'm spewing on this audience right now,
I've nailed about the first five rows here throughout the interview,
as have you.  And what happens is these microparticles,
like perfume-like particles that you don't see...
WINFREY:  Yeah.
Dr. OSTERHOLM:  They basically end up drying quickly.
And this is why winter is very important for influenza,
because the lower humidity makes these dry and which
actually makes the virus survive in there.
It falls down onto the surface.  Surfaces become contaminated.
So as I'm around someone, my mask gets contaminated
and it's just--the point is you have to be careful with your hands,
because one of the other things we all as humans do often,
hands to the eyes, hands to the nose, hands to the mouth.
And so mask is only part of the entire response.  It's not everything.
WINFREY:  I'm listening to you, I feel hopeless.
Dr. OSTERHOLM: Yeah.
WINFREY:  Because I don't have a vaccine, I don't know where to go,
I can't get the vaccine, I--you know?
Dr. OSTERHOLM:  You can't feel hopeless.
You can't feel hopeless, because, for example,
there are things you can do.
WINFREY:  Well, not hopeless, but I feel like I--I don't know what to do.
There's nothing I as a citizen can do about this.
Dr. OSTERHOLM:  What we need to do is understand
how we're going to care for our people.  How are we going to get food?
The food that we eat today doesn't sit in warehouses somewhere,
it literally is produced, moved by ocean freighter over land trucking
and in your grocery store within days.
The milk that comes from the farms today that you drink in the morning...
WINFREY:  Yeah.
Dr. OSTERHOLM:  ...actually came from the farm 24 hours before.
And so if we interrupt things on a global basis with transportation,
we basically have that fear and panic.  We have a very different...
WINFREY:  That's why you're saying it's going to shut the world economy down.
Dr. OSTERHOLM:  Right.  And we have to prepare for that.
And that's--we have to help citizens understand,
'What should I stockpile?  What shouldn't I?' Let's make sure we don't...
WINFREY:  What?  Tell me now, tell me.
Dr. OSTERHOLM:  Everyone should have enough food today
so that they could basically be in their homes for four
or five weeks if they needed to be.
The area that we're in big trouble on--you can have canned goods,
whatever--the area that I worry about most is, frankly,
our pharmaceutical supplies.
Today, 80 percent of all the drugs that we take in the United States,
the raw ingredients come from offshore.
Basically, we've outsourced almost all of our drug-making capacity
in the world.  Very thin supply chains, meaning there's one plant in
one country with a whole lot of ingredients that come together that then
move that drug to the United States.  If that shuts down, we have a problem.
So I'm going to tell you to go stockpile drugs--well,
one, most people could never afford to do it.
WINFREY:  Right.
Dr. OSTERHOLM:  Number two, your health plan wouldn't let you do it.
If you're under a prepaid health plan, you get 30 days and that's it.
And number three, right now, as we sit here, there are over
40 drugs in this country that are in short supply or not available
because just one chink in the supply chain interrupted that.
We have to deal with that.  We have to figure out how are we
going to allow people to have more drugs so they don't worry
like a Katrina event, 'I'm separated from my drugs.'
WINFREY:  Yeah.
Dr. OSTERHOLM:  In this case, it wouldn't be physical damage,
it would basically be, 'I can't get to the pharmacy to get my drugs,'
or the pharmacy doesn't have them.
WINFREY:  OK.  So I got my food supply.
Dr. OSTERHOLM:  You've got your food supply.
WINFREY:  I don't have my drugs.  I got water.
Dr. OSTERHOLM:  And you--well, you want to make sure on water.
This is where you want to ask your community here.
Go ask the city of Chicago, 'How much chlorine do they have?'
Today, many of the cities in this world have no more than five
to seven days' of chlorine on hand to actually use
and purify that water supply.
WINFREY:  Yeah.
Dr. OSTERHOLM:  Just-in-time delivery again.
We have a whole world that's set up around this kind of environment.
WINFREY:  So interesting, because these are all things we take for granted.
I've never thought one moment about how much
chlorine does the city of Chicago have?  Yeah.  Yeah.
Dr. OSTERHOLM:  Or your electricity.
Who's going to run the utility plants? Who's going to haul your garbage?
Who's going to bury the dead?  In 1969, the last pandemic we had,
which was a mild one, the average time from a casket being made
till the time it was in the ground was six months.  Large inventory.
What offended us more than anything in Katrina?
WINFREY:  It's the--the dead just lying on the streets.
Dr. OSTERHOLM:  Seeing those dead lying there in that water with the thing.
See, I believe if we have this kind of event, and we can't manage
in a timely, respectful and honorable way our dead,
that's what tips populations over the top.  In 1918, we did dig holes.
We buried people in holes.  In the months of September
and October of 1918, 7 percent of the residents of Boston
between 20 and 40 years of age died.  That's what we're talking about.
And today, in this country, you think
you're going to get intensive care medicine.
WINFREY:  What percentage did you say?
Dr. OSTERHOLM:  Seven percent died.
WINFREY:  Seven percent between the ages of 20 and 40.
Dr. OSTERHOLM:  Yes.  Today, there are 105,000 mechanical
ventilators in this country, the kinds of things you think of in intensive
care rooms; 80,000 are in use every day for just routine medical care.
We have no surge capacity whatsoever.
Nobody will have intensive care medicine during a flu pandemic.
So we have to think now.
WINFREY:  Just like what we have had the preview of seeing
in New Orleans is what you're talking about.
Dr. OSTERHOLM:  New Orleans has so many lessons for us,
even though it was a natural disaster of a very different kind, very limited.
The thing that was different in New Orleans,
Oprah, 47 states and the federal government, whatever part of it,
could respond and basically could help.  During a pandemic,
Chicago, Bangkok, San Francisco, Waukee, Iowa,
all of these communities around the world are going
to be in it at the same time.  There isn't going to be anybody there.
That's why Secretary Michael Leavitt, the secretary of Health
and Human Services in this country has said,
'Understand, you will be largely on your own.'
He's been very honest, he's been very forthright and fair to say that,
because nobody's going to bring in the cavalry during that time,
it won't exist.  And we have to prepare our communities now.
So we want to know in Chicago, what are they doing if they
needed to handle a major increase in dead bodies.
WINFREY:  So everybody should be asking that of their city government?
Dr. OSTERHOLM:  And every company should be asking that.
WINFREY:  And I should be asking that of my company.
Dr. OSTERHOLM:  You should be asking that of Harpo.
WINFREY:  And to not to ask ourselves these questions would
mean we didn't learn the lesson from Katrina?
Dr. OSTERHOLM:  Exactly.  And I think the second part of it is
that's going to be the difference between being hopeless and being hopeful.
WINFREY:  OK.
Dr. OSTERHOLM:  We're going to come out the other end.
It's how well we can come out the other end.
WINFREY:  OK.
