Osterholm: 'Substantial' number of COVID infections in Minnesota

CATHY WURZER: This week may be the last of mild warm weather before cooler fall temperatures really settle into Minnesota. This is the third fall season we've experienced since the COVID-19 pandemic began. And so far, unlike the two before it, this fall looks almost normal. School's in session, malls and airports are bustling, there aren't many masks to be seen.

Even Joe Biden declared the pandemic over on the television show 60 Minutes back in September. But if COVID has taught us anything, it's that more twists may be in store. To answer our questions about what this fall might look like, Michael Osterholm is on the line. He's an epidemiologist and the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Welcome back to the program.

MICHAEL OSTERHOLM: Thank you very much, Cathy.

CATHY WURZER: When you and I last talked, you mentioned that the level of infection among your friends and colleagues was something you hadn't seen since the start of the pandemic so many people were COVID positive in your world. Are those numbers lessening?

MICHAEL OSTERHOLM: Well, actually, they're not here, at least in Minnesota. We are still seeing a substantial number of people who have milder illness who are test positive by the home test but never reported. So from that perspective, we're still seeing lots of infections.

The good news is that we're not seeing big increases in the number of severe illnesses, hospitalizations, and deaths. But I think that's a challenge we have ahead of us as what we're watching right now in Europe is very concerning, where we're beginning to see what they have described in France as the eighth wave of COVID and major increases in serious illness, hospitalizations are occurring there. And that in the past has been a harbinger of things to come for here in the United States.

CATHY WURZER: Just read a really good article in Nature magazine to prep for our chat today. And as the author says that evidence, as you say, is building that the Northern Hemisphere is on course for a surge of COVID-19 cases this fall and winter. Is it because of waning immunity and people going back to more normal social gatherings or something else like a new variant?

MICHAEL OSTERHOLM: Well, Cathy, this is that era of where you have to just acknowledge, I don't know. We're in uncharted territories. We had spent the first two years of the pandemic in what I call the kind of mountain peaks, mountain valley occurrence of cases-- these big peaks in cases associated with new variants, and then cases would drop off, people would want to conclude that somehow we'd gotten through the pandemic, only to have another peak occur, such as we saw with alpha, delta, and omicron variants.

Then, about 14 weeks ago, we hit what I call the high plains plateau, where cases didn't peak like we'd seen before, but they didn't drop either. It just stayed high and then level. And that's really where we've been most of the summer.

Throughout the summer in the United States, COVID has been the number four cause of death and remains so, even today. Now, we don't know what the next shoe is going to look like when it drops. But I think what we're seeing is these new variants that are coming out of the BA.5 world, this most recent variant part of omicron, is highly, highly immune evasive.

Meaning that it can escape the protection that we develop from either being vaccinated or from, in fact, having been infected before. Now, vaccine's still our best shot to deal with this, but we don't know where these immune-evasive strains are going to take us and what that's going to mean.

CATHY WURZER: What do you think about the potential effectiveness, then, of the new booster?

MICHAEL OSTERHOLM: Well, we don't know and we have to say that. Right now, all the data we have would support that at least for a period of time, it will do a lot to reduce serious illness, hospitalizations, and deaths. And that's a good thing. It's very much like influenza vaccine.

We never ever tell people that they won't get influenza, but that also, particularly for those that are at highest risk of serious illness, those who are older or have underlying health conditions, getting a flu shot is a really, really smart thing to do. It'll help you.

Well, the same thing is really true right now with the COVID vaccines. This new bivalent booster shot that we have surely can provide more protection. But I also have to be honest and say I don't know where we'll be three or four months from now. And we need to let the public know that-- that this is a battle against a virus that just keeps throwing 210-mile an hour curveballs at us.

CATHY WURZER: I wonder if that's why many people just are looking at the new booster and kind of shrugging. I don't know. The uptake on the new booster isn't great.

MICHAEL OSTERHOLM: You're absolutely right. Only about 4.4% of the US population that's eligible to receive the booster has gotten it. I've gotten mine. I urge everyone else to get it, because while it's not maybe perfect protection, it surely is some good protection for now.

But at the same time, I'm watching very carefully kind of sleeping with one eye open to see what these new sub-variants that are highly immune evasive look like. We've not seen any COVID virus strain up till now that has this ability to escape immune protection like we're seeing with the current viruses that are emerging around the world.

CATHY WURZER: Many people, as you know, have been infected twice, three times. Do we have any idea of the effects of repeat COVID infections? Is it like getting a cold? Or do we know about any long-term ramifications beyond long COVID? You know what I'm saying?

MICHAEL OSTERHOLM: Yeah. Obviously, long COVID is a huge issue, as we've talked about before. In terms of getting reinfected may in part be to what kind of lifestyle you're living and are able to protect yourself. If you're out in the public, you have kids in school, et cetera, you often can't protect yourself. You're going to be vulnerable to getting a second or third infection.

The question is, what kind of immunity you get from that? And I think the sense has been that even if you do get reinfected, you're much less likely to have severe illness by having some immunity on board. But then that could all be rewritten by these immune-evasive strains.

Imagine if four or five months from now we're sitting here talking about the fact that, yep, I got my vaccines, yeah, I already had COVID, but this new virus is actually able to evade or basically not be impacted by that immune protection. And that's a very challenging thought, but it's one we have to look at very carefully right now.

CATHY WURZER: We should say that, of course, the flu is right around the corner. Hospitals can get pretty slammed in a bad flu year. And influenza has not been a big concern the last two years. But might that change this season?

MICHAEL OSTERHOLM: Well, first of all, let me just say that nobody can predict with any accuracy what's happening with flu. Contrary to many media reports, the Southern Hemisphere hardly got hit by flu at all during their winter or summer months. There was an increase in kids in particular in Australia, but that was about it.

We didn't see it in South America. We didn't see it in Africa. But I think what's missing right now in the discussion, people have very little understandings of how our health care system in this country are hanging on by a thread-- a thread. We have closed hundreds and hundreds of hospital beds around the country because we don't have enough health care workers.

People have left the profession in droves. We have people in hospitals that should have been transferred to long-term care facilities months ago, but there's nobody to work in long-term care facilities so they're now taking up a hospital bed. If we see even a minor bump, a bump, not a big SURGE a bump in cases right now of either flu or COVID, we will take the health care system to the most extreme position it's been in since the entire beginning of the pandemic.

I don't think people understand that. That is a dire situation we're in right now day after day after day.

CATHY WURZER: What do you make, then, of the president declaring that the pandemic is over? That doesn't seem to help the situation.

MICHAEL OSTERHOLM: Well, as I was quoted in the New York Times the next day, I thought that it was not helpful. But on the other hand, let me just say he was really reflecting where most of the public is. The public is over it.

And so from that perspective, he was basically truthful. Now, what we need to do is help orient the public to say, I wish it were done. As much as you might be done with this virus, it is not done with you yet. I can't wait to come on this show one day and say, well, it's behind us now. We're done.

It's like in May declaring winter is done. We got that season out of the way. We don't know what this virus is going to bring us again. And so we have to be mindful of why we need to get vaccinated, why we need to continue to make sure that we have drugs that are effective. We're beginning to worry about viral resistance to what drugs we do have.

We are certain that these new strains that I just talked about, if they become reality everywhere, will take away all the monoclonal antibody treatments we have left. We won't have anything else that resistant. So I think that we just have to keep the public's eye on the fact that I know you're going to live your life.

I know that if you go into a public place, no one but maybe you will be wearing an N95 respirator. But the bottom line is you can't take away viral gravity. This virus is here. It's going to continue to do what it's doing. And we can only just share with the public what you can do to protect yourself.

CATHY WURZER: All right. I wish I had more time with you. Thank you so much.

MICHAEL OSTERHOLM: Thank you very much.

CATHY WURZER: That's Michael Osterholm. He's an epidemiologist and the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota.