Osterholm on COVID variants: We need to understand what's coming

Coronavirus cases are falling and vaccination numbers are rising. That's good news, right?

Yes, but COVID-19 strains that are believed to be more transmissible have public health experts warning about a possible new surge in cases.

A new coronavirus variant first found in South Africa has now been discovered in the United States. That variant joins others from the U.K. and Brazil that have been found in the U.S. The Brazil variant was discovered in Minnesota.

MPR News host Cathy Wurzer spoke with Michael Osterholm, an expert in infectious diseases at the University of Minnesota. He also served on the Biden transition coronavirus advisory board.

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The following is a transcript of the interview, lightly edited for clarity. Listen to the full 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 falling and vaccination rates are rising. What worries you the most in the coming weeks?

Part of the situation we have right now is what I call a shifting baseline. Remember back last April, and we had 32,000 cases a day and we thought the house was on fire, couldn't get any worse. Then we dropped to 22,000 new cases a day by Memorial Day, with people in the state of pandemic fatigue, pandemic anger, not thinking this was really truly a pandemic.

Then look what happened: By July, we hit 70,000 cases and said “My, this can't happen.” Again, this is by far worse than we saw in the spring.

Then we got case numbers down to about 26,000 a day around Labor Day. And then we quickly jumped up to 200,000 cases a day. We thought “Oh, this is the house is on fire, this can't get any worse.” And then we watch cases come down to 150,000, early December. And then we went up to 300,000 cases in in early January.

Now we're down to 150,000 cases, which surely feels better than 300,000 cases. But this is our new baseline. And this is what we'll jump off on with the next challenge. And these new variants, we're seeing these mutated viruses are much more infectious and do actually produce much more serious illness. And I anticipate over the next six to 14 weeks, the darkest days of this pandemic are going to occur.

Which of these variants concern you the most?

Well, they all concern me, but for different reasons. And we're going to see many new ones as these first three that we've talked about are just the beginning of these viruses mutating.

The U.K. virus is associated right now with more transmission and more severe illness, but not in any way impacting on the vaccines, or natural protection of having previously been infected. Both the Brazilian strain and the South African strain involve all three — more transmission, more serious illness, as well as avoiding evading the kind of immune protection that we see with both vaccines and with natural disease.

We have a new report yesterday on another vaccine that’s coming forward that many of us actually thought was probably the best vaccine that we've had to date. And it was very effective in areas where we didn't see the South African variant. Where they did the studies where that variant was present, that actually only worked half the time, not 95 percent of the time. That's a big concern.

I understand that variants crop up when infections run wild, right? And these new variants are already in the U.S. yet, California is easing restrictions, Wisconsin's looking at jettisoning its mask mandate and some folks are thinking of taking spring break trips. Are we making a mistake by reopening just as these new strains are building momentum?

As I’ve said earlier, you know, we're very good at pumping the brakes in the car after we've wrapped it around the tree. That's what we're doing right now is basically we are, in a sense, coming off of what was that high in January feeling like “Wow, we've avoided it.” Now it's coming down. But as I just gave you the examples, how each time the highs get higher, and our lows get higher, the new high is going to be substantial.

What I fear is that we will take all the steps necessary to try to reduce transmission by in a sense, bringing society to a halt, as we know it and that's exactly what's had to happen in Europe. We are seeing England, Ireland, Portugal, Denmark, all these countries in basically total lockdowns. Schools are closed, businesses closed, transportation is reduced to bare minimum, people are ordered to stay in their homes. And we still see transmission increasing in some locations where that's going on.

So I think we just need to have our state's residents understand what's coming. And it is going to come and I just worry that, we'll be surprised again and we won't put into place the kinds of restrictions we're going to need to until our hospitals are virtually overrun.

As pharmaceutical companies tweak their vaccine formulas, as the virus mutates, do they have to rerun clinical trials? And does that slow down the process?

It's a very important question, and one that we all are discussing. I think we're looking at this as much more like what would happen with influenza vaccines, where every year we can actually change out the antigen or the part of the vaccine that we elicit the antibody to. Rather than being a new vaccine that requires total evaluation, it's basically just considered an improvement on the previous one, and you don't need to go into all those studies.

I think at this point, that is what would happen with these vaccines, we could add additional antigens or change them out in the vaccine in such a way that it wouldn't require anything more than FDA review, but not the extensive studies.

There are people listening right now who are thinking, ‘Well, I did get my shot, at least the first one, perhaps, and I'm waiting for my second one. How much protection Do I have now? And what should I be doing here the next few weeks?’

As long as the U.K. strain is the one that continues to be the challenge, we have front and center, the vaccines are going to be very effective. They work very well against that. We know from the trials that were done with the back currently licensed vaccines, that even within several weeks, so that first dose, you may have upwards of 70 to 80 percent protection. So that's a very, very good thing. Then with the second dose, of course, that protection increases even more.

There's discussion right now, even though it's not popular and challenging of, can we space doses out even further, between first and second to get more people vaccinated with one dose right now? I think that you're going to hear more about that being discussed over the course of the next few days, as we think about how can we better be prepared to respond to this surge that we think is going to be coming in the next weeks?

Are you still advising the White House on the pandemic?

We are as an informal group. Once the inauguration occurred, we no longer are part of the transition team. And because of rules around federal advisory groups, we just couldn't automatically be moved into the government. So at this point, the group is still meeting, we are still working amongst ourselves and sharing our information with the White House.