Contagious Conversations / Episode 48. The Costs of Getting Sick
Transcript
Claire Stinson: Getting sick can be expensive. As we all know, when an illness prevents us from doing our jobs, there's work that doesn't get done. We can miss paychecks, our kids may be impacted, the effects go on and on. This is especially true of chronic and mental health diseases. A full 90% of the nation's spending on healthcare each year is for noninfectious conditions like heart disease, cancer and diabetes, according to CDC.
And as far as infectious disease goes, we only have to rewind a couple of years to see the impact the COVID pandemic had on, well, everything and everyone from restaurant workers, educators and parents to healthcare, shipping and financial markets around the world. By the end of 2023, COVID's total economic costs reached $14 trillion in the United States alone, according to researchers at the University of Southern California. Worldwide, of course, that price tag was much higher.
And that's our topic today, the economics of disease and what CDC and public health are doing to keep our population, and ultimately our economy, safe from the impacts of health threats. This is Contagious Conversations, the podcast from the CDC Foundation, an independent non-profit that builds partnerships to help the Centers for Disease Control and Prevention save and improve more lives. I'm your host, Claire Stinson.
Every episode we hear from inspiring leaders and innovators who make the world healthier and safer for us all. Today we'll hear the story of a coordinated effort to stop a potentially deadly outbreak.
Dan Filardo: It's considered perhaps the most contagious viral illness that exists, and it can spread very rapidly.
Claire Stinson: And we'll consider the economic consequences outbreaks like this can have, with someone who's spent his career helping communities all over the world prepare.
Dan Filardo: I can tell you that every time we have these kinds of outbreaks, it costs us. Then the question is, how much would it have cost not to have had this happen?
Claire Stinson: That's all ahead. Our story starts in Chicago with this man.
Alex Sloboda: I am Dr. Alex Sloboda. I'm the medical director of immunizations and emergency preparedness, the Chicago Department of Public Health. Yeah, so we learned about the case on March 7th.
Claire Stinson: The Chicago Department of Public Health was notified about someone who'd been hospitalized. It was a one-year-old child with a rash made up of flat red spots as well as a fever and cold-like symptoms. Taken together, these symptoms were typical of one disease, measles. Now you may be thinking measles, really?
Dan Filardo: Yeah, measles. It's the classic pediatric or childhood disease that causes a fever and a rash. But it's not just a little rash.
Claire Stinson: This is Dr. Dan Filardo.
Dan Filardo: I'm a medical officer with the measles team at CDC.
Claire Stinson: You may think of measles as an illness your parents or grandparents had to deal with, and you wouldn't be wrong. Measles was eliminated in the United States in the year 2000 due to decades of solid cooperative public health efforts. That's the word health experts use, by the way, eliminated. It means that a disease is no longer present in a certain area because of that public health work. It means we're safer. But if a disease isn't eliminated everywhere, then it can and does still pop up.
And that's just what happened earlier this year in Chicago. But if you're like many people, you may be wondering why was someone hospitalized because of a childhood illness? Well, measles can be fatal and not just to children.
Dan Filardo: The truth is that most people who develop measles will recover and will not have long-term problems with it. But what we know about measles from the years before it was eliminated, and certainly from before the time that we had a vaccine against measles, is that a small percentage of people will suffer horrible effects. Pneumonia, where measles causes an infection of the lungs, or especially in infants who are under one year of age, it can cause really profound diarrhea and dehydration and can lead to really severe disease because of that.
Claire Stinson: Another measles complication is encephalitis, an infection that causes swelling of the brain. Encephalitis can lead to long-term problems or even death. Such cases are rare. But before there was a measles vaccine ...
Dan Filardo: When there were thousands of cases of measles in the US on an annual basis, then you would see people suffer long-term problems or unfortunately die of measles every year.
Claire Stinson: Another thing about measles is that it spreads really easily. It's airborne and it stays in the air for up to two hours. That means that if you enter, say, a room or a shopping mall or board a bus where someone with measles was an hour or two ago, you could catch it. It's considered to be one of the most contagious viral illnesses in existence.
As they investigated the outbreak in Chicago, Alex Sloboda's team found out something else about the person who had been hospitalized with measles.
Alex Sloboda: We learned that this was a new arrival, so that's the term we use for many of our migrants and asylum seekers that recently arrived to Chicago in the last couple of years, predominantly from Venezuela. But this individual was a new arrival, living at a new arrival shelter.
Claire Stinson: A shelter with about 1800 people living in close quarters and all the staff working there. And now a resident had caught a highly infectious, potentially deadly, disease.
Alex Sloboda: Obviously this is a big concern to us. A very congregate setting and you breathe it in, that's how you can get infected.
Claire Stinson: And he says he wants to make one thing clear. The migrants didn't bring measles with them from their countries of origin. In fact, the first patient to get it, that one-year-old had just been vaccinated only weeks before. And though one dose of measles vaccine is 93% effective at preventing measles according to CDC. They also know there's a small percentage of people who don't respond to the first dose of the vaccine, fewer than 4%. That may have been the case here.
Alex Sloboda: They just were in a situation where they got exposed to it in the city of Chicago and then it turned into an outbreak. But we've tried to really separate the two things that there's measles in Chicago, anybody can get it.
Claire Stinson: Especially considering the disease's highly contagious nature and close quarters of the migrant shelter. Alex Sloboda and his team needed to move fast.
Alex Sloboda: We literally, I think 11 p.m that night, we went to the shelter. At the time, there were about 2000 people living there. And so, effectively, those 2000 people had been exposed. We had to wake people up and tell them the situation, particularly around the quarantine, but then we had to act pretty quickly.
Dan Filardo: The measles team at CDC heard about the first case in the outbreak when it was really first reported to Chicago.
Claire Stinson: That's CDC's Dan Filardo, again, talking about when CDC was first brought in.
Dan Filardo: Because this case was in a large congregate setting, we were really in communication with Chicago right off the bat. CDC really works at the invitation of the state and local health departments that we support. So state and local health departments have the lead, and when a state requests on-the-ground assistance, CDC can really respond rapidly.
Alex Sloboda: On that Friday when we started, it was very daunting. We just had to do a lot of education about measles vaccination. Arrivals have already been through so much in their journeys to the U.S. and to Chicago, and so it was just another hardship that they had to go through.
Claire Stinson: In total, the team and its community partners vaccinated 882 people at the shelter and verified that 784 others had been vaccinated previously, according to CDC. Ultimately, the team's efforts resulted in coverage of 93 percent of those at the shelter.
Alex Sloboda: So it was a very intensive effort.
Claire Stinson: The team was also monitoring residents and shelter staff for symptoms to prevent further spread, but that wasn't all. Some of the migrants had already moved into the community or to different shelters. So the team started the same process at those other shelters while working with the community to educate people, vaccinate those who needed it and monitor for new cases. And since infectious disease knows no boundaries, they also made sure the city of Chicago and its larger community were informed every step of the way. To aid their efforts, CDC created something called infectious disease models that used special algorithms to determine how and where in the city the outbreak might develop.
Dan Filardo: And that modeling work helped set the expectations for how the outbreak might evolve in realtime. And it was really helpful to Chicago and Illinois decision-makers on the ground who were coordinating the response.
Claire Stinson: This intensive teamwork went on for weeks to slow, and then halt, the outbreak. On May 30th, six weeks had passed without new cases. The city of Chicago declared the outbreak officially contained. In total 57 cases had been confirmed: 52 among residents, three among shelter staffers and two among others in the Chicago community. But the story could have gone differently.
Alex Sloboda: It could have been so much worse if we didn't act as swiftly and safely as we did.
Claire Stinson: Those infectious disease models CDC created helped the team see how things might have gone, had the response been weaker, a response that had not involved numerous healthcare and community organizations and others working tirelessly for weeks to stop the virus from spreading.
Dan Filardo: And had the outbreak response not been as quick and as robust, there easily would've been over a hundred cases and maybe hundreds of cases.
Alex Sloboda: But yeah, that's what we do in public health. We respond to crazy situations and we just work our way through them and do the best we can. And yeah, it was a tough situation, but it was very memorable and pretty amazing.
Claire Stinson: That's Dr. Alexander Sloboda, the medical director of Immunizations and Emergency with the Chicago Department of Public Health. And Dr. Dan Filardo, a medical officer with CDC's measles team, talking about the response to a measles outbreak in Chicago early this year. And one thing that Dr. Sloboda said really stuck with us, and that was about the group of people most impacted by this outbreak, the migrants staying in that Chicago shelter.
Alex Sloboda: I think that was probably the hardest part for a lot of new arrivals in the shelter, is not being able to go to work for a certain amount of time because they want to work, they want to start earning money so that they can start making an American life for themselves.
Claire Stinson: As we've mentioned, when you're sick, you can't work, or if you do work, you certainly can't be as productive. And this simple fact leads to all kinds of repercussions for families, schools, workplaces and entire economies.
Which takes us to the second part of today's episode, the economic impact of illness. We'll hear from someone who has spent a long career in the trenches of infectious disease all over the world about why disease preparedness can be the difference between economic stability and potential disaster. That's coming up.
Dr. Michael Osterholm has worked in epidemiology for more than five decades.
Dr. Michael Osterholm: I've had roles in every presidential administration since the Reagan administration, trying to do whatever I could to help.
Claire Stinson: Besides those serious bona fides. He also writes books.
Dr. Michael Osterholm: In 2017 in Deadliest Enemies, I laid out over several chapters what a influenza pandemic would look like in a modern world.
Claire Stinson: When that book came out, he says some folks accused him of trying to scare people. But then a couple of years later, a real-life pandemic shook the world.
Dr. Michael Osterholm: And while it turned out that COVID was not influenza, it really performed in many ways like an influenza pandemic. It was a two-year rollout and the number of deaths were ironically comparable to what we saw with COVID, et cetera. And I think that one of the things that has struck me is our unwillingness to use creative imagination to understand what the future could bring.
Claire Stinson: Michael Osterholm is the director of the Center for Infectious Disease Research and Policy, or CIDRAP, which he describes as the intersection of science, data and policy. They analyze public health preparedness and the responses to emerging infectious disease all over the world. This means that among other things, Dr. Osterholm spends a lot of time thinking about the cost of infectious diseases.
Dr. Michael Osterholm: For example, if you had outbreaks in schools with these vaccine-preventable diseases, you interrupt education substantially. Now, what's the cost of that? What does that mean? What happens when kids fall behind? What happens when the teachers can't teach? And unfortunately, we don't have a lot of these things qualified or quantified in terms of what they really mean economically.
Claire Stinson: Those who have been affected by infectious or chronic illness know what it means to miss work or school and how the impacts can snowball, especially for people living from paycheck to paycheck, which according to Forbes advisor was 70 percent of Americans in 2023. Dr. Osterholm says, we need to reframe how we think about preparing for infectious disease outbreaks. And that means shifting from simply considering the costs of preparing to focusing on the costs if we fail to prepare.
Dr. Michael Osterholm: And so from that standpoint, I'd have to say that economics do play a role because it's the old line from the old oil FRAM commercial when I was a young boy where he had said, "You can pay me now or you'll pay me later."
Claire Stinson: Remember those ads? I didn't. But we looked them up. Here's one from the early 1970s complete with a greasy repair guy rolling out from under a car.
Advertisement: This is a main bearing job, about $200, and this? This is a FRAM oil filter. It's about $4. If the guy who owns this car and put four bucks into one of these when he had his oil changed, chances are he wouldn't be putting 200 bucks into one of these. Well, choice is yours. You can pay me now or pay me later.
Claire Stinson: And that's Michael Osterholm's argument. Just as basic car maintenance can save us a ton of grief and cash down the road, so does prepping for major outbreaks of infectious diseases like the flu or COVID. After all the costs of failing to prepare, well, they can be high. Remember, COVID's total economic costs reached $14 trillion in the United States alone by the end of 2023. And if that sounds high, let me take you to where the truly staggering figures live. Not the area of pandemics and germs, but the domain of non-infectious disease.
Take heart disease and stroke. Together, they kill more Americans than anything else, costing our healthcare system 254 billion each year according to CDC. So that's 254 billion last year, 254 billion this year, next year, and again the year after that–if not more. In total, CDC finds that chronic illnesses like heart disease, cancer, diabetes and Alzheimer's make up 90 percent of the $4.5 trillion our nation spends annually on healthcare. Interventions to prevent these illnesses could save a lot of lives and do us a world of economic good. So could preparing for the next major infectious outbreak says Michael Osterholm. Something really big like ...
Dr. Michael Osterholm: The COVID-19 pandemic was the single one event that has done more to really hit public health square in the eyes than any other event. More than a hundred million people moved into the extreme poverty category in the world during the pandemic.
Claire Stinson: Again, the COVID pandemic is estimated to have cost the United States at least $14 trillion. And in some ways, he says COVID wasn't even as bad as it could have been. Unlike the deadlier SARS or MERS viruses, it killed fewer than 1 percent of people who were infected. The next pandemic could be a far deadlier strain.
Dr. Michael Osterholm: There is nothing that's going to keep the next coronavirus pandemic from being one that kills 25 or 30% percent of the people.
Claire Stinson: 25 to 30 percent. That's one out of every four people or more.
Dr. Michael Osterholm: Now think about how that would look in your community if that happened.
Claire Stinson: Outbreaks can happen anytime. And that's why it's important to do that cost benefit analysis and to invest more, he says, than we're investing now.
Dr. Michael Osterholm: We're basically putting the investment across the board, all governments of the world, including private sector efforts, such that I could buy two F-22s every year, and that would cost more than all the research money going into flu.
Claire Stinson: Imagine two shiny fighter planes standing side by side. Got that image in your mind's eye? Okay, so each of those F-22s carries a price tag of about $350 million according to the Center for the National Interest. And needless to say, maybe, the United States owns more than two. That $700 million for just the pair. He says that's more than the total number of dollars worldwide going into research for influenza. Influenza, which he says, is likely to play a role in a major outbreak down the road.
Dr. Michael Osterholm: And so again, the loss in the community to what happens, which wouldn't have to happen, is really critical. And I think part of what could we do different is we not only have to make investments in the tools that we need, and if they cost a few billion dollars, look what a pandemic costs you.
Claire Stinson: Or what the next one might cost in terms of health and our ability to survive and thrive economically.
Thanks to Dr. Michael Osterholm for talking with us. He's a regents professor at the University of Minnesota, director of the Center for Infectious Disease Research and Policy and proud Iowan.
Thanks for listening to Contagious Conversations, produced by the CDC Foundation and available wherever you get your podcasts. Be sure to visit cdcfoundation.org/conversations for show notes.
You may have noticed we've expanded the way we do things on today's show beyond the single interview format. We plan to keep doing that. So if you like what you just heard, please pass it along to your colleagues and friends, rate the show, leave a review and tell others. It helps us get the word out.
One more thing. Michael Osterholm also told us that there's a certain irony in public health work. It may be one of the only fields where success means the appearance of failure. Because if we're making the right investments to be truly successful in our community's public health efforts, nothing happens.
Dr. Michael Osterholm: We should try to be like the Maytag repairman on the TV ad, ‘You don't need me.’ And if we do our job really well, that will be the thing we'll all be remembered for: he was a darn good Maytag repairman guy.
Claire Stinson: As that old ad went.
Advertisement: It's not often that anybody needs us Maytag repairman. That's why we're the loneliest guys in town.
Claire Stinson: #publichealthgoals. Join us next time.
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