Osterholm in the COVID variants: we need to understand what’s to come

Coronavirus cases are falling and the number of vaccinations is increasing. This is good news, right?

Yes, but the COVID-19 strains believed to be more communicable have public health experts warning of a possible further increase in cases.

A new variant of the coronavirus first found in South Africa has now been discovered in the United States. This variant joins others from the United Kingdom and Brazil that were found in the United States. The Brazil variant was discovered in Minnesota.

Cathy Wurzer, MPR News presenter, spoke with Michael Osterholm, an infectious disease specialist at the University of Minnesota. He also served on Biden’s transition coronavirus advisory board.

The following is a transcript of the interview, slightly edited for clarity. Listen to the complete conversation with the audio player above.

You were quoted in The New York Times this week that we should plan for the worst case scenario. But cases are decreasing and vaccination rates are increasing. What worries you most in the coming weeks?

Part of the situation we have now is what I call a mobile baseline. Remember last April, and we had 32,000 cases a day and we thought the house was on fire, it couldn’t get any worse. So we dropped to 22,000 new cases a day on Memorial Day, with people in a state of pandemic fatigue, pandemic rage, without thinking that this was really a pandemic.

So look what happened: in July, we reached 70,000 cases and said, “Wow, this can’t happen”. Again, this is much worse than what we saw in the spring.

So, we reduced the number of cases to around 26,000 per day, close to Labor Day. And then we quickly increased to 200,000 cases a day. We thought “Oh, this is the house that is on fire, it can’t get any worse”. And then we see cases dropping to 150,000 in early December. And then we increased it to 300,000 cases in early January.

We are now down to 150,000 boxes, which is certainly better than 300,000 boxes. But this is our new baseline. And that’s where we’ll jump with the next challenge. And these new variants, we are seeing that these mutant viruses are much more infectious and, in fact, produce much more serious diseases. And I predict that in the next six to 14 weeks, the darkest days of this pandemic will occur.

Which of these variants are you most concerned about?

Well, they all worry me, but for different reasons. And we will see many new ones, because the first three we are talking about are only the beginning of the mutation of these viruses.

The UK virus is now associated with more transmission and more serious diseases, but it has no impact on vaccines or natural protection because it was previously infected. Both the Brazilian and South African strains involve all three – more transmission, more serious disease, in addition to avoiding the type of immune protection that we see with both vaccines and natural diseases.

We have a new report yesterday about another vaccine that is coming that many of us really think is probably the best vaccine we’ve had so far. And it was very effective in areas where we didn’t see the South African variant. Where they did the studies where this variant was present, it actually worked only half the time, not 95% of the time. This is a major concern.

I understand that variants arise when infections occur, right? And these new variants are already in the United States yet, California is easing restrictions, Wisconsin is looking to discard its mask mandate, and some people are considering spring break trips. Are we making a mistake by reopening as soon as these new varieties are gaining momentum?

As I said before, you know, we are very good at stepping on the car’s brake after wrapping it around the tree. This is what we are doing now is basically, in a sense, coming out of what was so high in January with the feeling of “Wow, we avoid that”. Now it’s falling. But, as I just gave the examples, as each time the maximums get higher and our minimums get higher, the new maxim will be substantial.

What I fear is that we will take all necessary measures to try to reduce transmission, in a sense, paralyzing society, as we know it, and that is exactly what had to happen in Europe. We are seeing England, Ireland, Portugal, Denmark, all of these countries basically in total blocks. Schools are closed, businesses are closed, transportation is kept to a minimum, people are forced to stay in their homes. And we still see the transmission increasing in some places where this is happening.

So, I think we just need the residents of our state to understand what’s coming. And it will happen and I just worry that we will be surprised again and we will not put in place the kinds of restrictions that we will need until our hospitals are virtually invaded.

As pharmaceutical companies adjust their vaccine formulas, as the virus mutates, do they need to repeat clinical trials? And does that slow down the process?

It is a very important issue and one that we are all discussing. I think we are looking at this much more like what would happen with flu vaccines, where each year we can really change the antigen or the part of the vaccine for which we extract the antibody. Rather than being a new vaccine that requires full evaluation, it is basically considered just an improvement over the previous one, and you do not need to go into all of these studies.

I think at this point, this is what would happen with these vaccines, we could add additional antigens or change them in the vaccine in such a way that nothing more than an FDA review was needed, but not extensive studies.

There are people listening now who are thinking, ‘Well, I got my chance, at least the first, maybe, and I’m waiting for the second. How much protection do I have now? And what should I do here in the coming weeks? ‘

As long as the UK strain remains the challenge, we have the front and the center, vaccines will be very effective. They work very well against that. We know from the tests that were done with the currently licensed vaccines that even within several weeks, for that first dose, you can have more than 70 to 80 percent protection. So this is a very, very good thing. So, with the second dose, of course, this protection increases even more.

There is discussion now, even if it is not popular and challenging, can we spread the doses even further between the first and the second so that more people are vaccinated with one dose now? I think you will hear more about this being discussed in the coming days, as we think about how we can be better prepared to respond to this increase that we believe is coming in the coming weeks?

Are you still advising the White House on the pandemic?

We are an informal group. After the inauguration, we are no longer part of the transition team. And because of the rules surrounding federal advisory groups, we just couldn’t be automatically transferred to the government. So at this point, the group is still meeting, we are still working with each other and sharing our information with the White House.