Osterholm: COVID conditions better, but virus 'not done with us'

Some mask and vaccine requirements are beginning to wind down as COVID-19 cases drop off in all corners of Minnesota. Does this mean we’re at a turning point in the pandemic?

MPR News host Cathy Wurzer posed that question to one of the country’s leading epidemiologists. Michael Osterholm leads the Center for Infections Disease Research and Policy at the University of Minnesota.

The following transcript has been slightly edited for clarity. Listen to the full story using the audio player above.

What can we make of the decline in infection rates and easing of restrictions in Minnesota?

We don’t actually quite know that yet. We’re seeing in countries, such as South Africa and in the United Kingdom, that the drop in cases is not coming back down to where it was before the spike occurred.

Nonetheless, it’s going to be a much lower level of infections in our communities than we saw throughout most of December and January. So I think we’re not still out of the woods in terms of having people hospitalized in our intensive care units. But I think that the ability to provide care is going to be much improved over what it has been over the last two months.

Does lifting masking and vaccine requirements make good public health sense?

We have two pandemics going on right now simultaneously in this country and, unfortunately, throughout much of the world.

One is the actual impact of the virus itself and the horrible toll it’s taking on us. But the second one is the pandemic of lack of trust. I think we’re seeing that with governments. We’re seeing that surely with the public health community and even to some extent in the medical community.

This latter one can be as dangerous as the virus itself because it means that this virus can do a lot of things that it might not otherwise do — that we could prevent if people trust what we have to say.

I think the challenge we have right now is: We in public health have not done a good job of communicating, what is the risk? What can we do about it? How can we lower that risk, and then when will we put in place certain actions, and when will we take them off?

A good example is masking. As you have heard me say many, many, many times, the concept of masking to me is kind of like talking about any vehicle that may have tires on it. I would argue that an ATV has tires on it and so does a 747. But they’re two very different kinds of vehicles. We talk about masking like it’s one monolithic kind of activity. And the vast majority of people today that are using gaiters or face cloth coverings have very ineffective means of preventing transmission of the virus from that infected person or to a susceptible person.

And yet we mandate that, and to me, I think until you actually determine how to get people to wear N95 respirators — these more tight face-fitting masks — or the KN95s, I don’t understand the benefit of masking as a mandate, nor have I from the beginning. If we could do it with much more effective protection, then we’d have a leg to stand on.

Are we setting ourselves up for another variant to come along like omicron?

We are, in the sense that we want to protect the immunocompromised [and] those who have underlying health conditions that would put them at a higher risk of serious illness. Unfortunately, we are going to have to acknowledge they’re going to have to do a lot to protect themselves.

I wish we had another answer. And what I mean by that is they are going to have to understand who they’re having contact with. They have to know that wearing N95 respirators can do a lot to reduce their risk, and they have to know, particularly if you’re immunocompromised, you have to have those four doses of vaccine on board. Not just three but four doses. So there still can be that kind of protection.

But the bottom line is: A public health mandate only works if people are willing to do it, and what you’re seeing is a general rebellion right now against this. Monmouth University just came out with a recent poll that shows 70 percent of Americans now agree with the statement that at this time, we accept COVID is here to stay. We just need to get on with our lives.

We’re back to the drawing board to say, OK, we’re now here at this time where case numbers are going to come down dramatically. But you know what? Another variant could show up tomorrow, and that could be just as bad as omicron. Will we even have any credibility left to get people to do certain things so that we don’t overwhelm our health care systems? What does that mean? We don’t have good answers for that right now, and that’s our responsibility to have those answers.

How can we transition from pandemic to endemic in a careful way? Given the politics of this country, is that impossible?

There’s two parts to that question. No. 1: I don’t have a clue what endemic means. I’ve written books on epidemics, pandemics, endemic disease. I’ve written many, many articles about it. Endemic implies that in a sense, it has now become just a normal part of everyday life.

But let me take us back a year ago. It was a year ago this very week I said publicly that I thought the darkest days of the pandemic could still be ahead of us. Even though vaccines were flowing and the case numbers had dropped precipitously from that early January peak, that was because I saw what the variants were doing already.

We had the alpha variant. We had the beta variant. We had the gamma variant. And I looked at that and said, “What would keep additional variants from occurring that could basically evade immune protection or could be much more infectious?”

You saw what delta and omicron brought us in the [last] year. I see that same potential still being there going forward.

Even though we have higher levels of vaccination, which have been critical — critical in reducing severe illness, hospitalizations and death — I still maintain, we have a pandemic of the unvaccinated. Because if you look at the number of people who have been seriously ill, who have died, it is still largely among the unvaccinated. We can have another variant come out that causes us to have to reconsider what are we going to do again.

The second point is, what we do we call a disease that is a real problem, then kind of goes away for a while, but then comes back as a real problem? Do we go from a pandemic to an endemic back to a pandemic?

The point I’m trying to make here is this is all semantics. What we need to come to grips with is we’re not done with the virus. It’s not done with us.

Unlike influenza, when you have a new pandemic influenza virus occur, it jumps from animals to humans. It stays in humans, and with humans, eventually, that virus becomes a milder virus infection. It becomes a part of seasonal flu.

We’ve watched the SARS-CoV-2 virus jump to many animal species. We’ve talked about the issue of the white-tailed deer infections, which has been remarkable.

Now we have a whole new reservoir — a term we use to call where the virus might reside, where the mutations can occur. It would not surprise me a bit that we would see more spillbacks from the animal population to humans again.

There are still real challenges with this virus that we just don’t understand, and if it was ever a time for us to have great humility of scientists and public health practitioners, it’s now. To say, I hope that in fact, we don’t see more variants emerge. That can be really problematic.

But as I’ve also said, hope is not a strategy and at the same time, if [more variants] do occur, are we prepared for them again? What are we going to do better next time than we’ve done for omicron, which has literally broken many of our health care systems around the country.

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