Osterholm: 5th COVID wave 'absolutely' possible

Michael Osterholm
Michael Osterholm at Minnesota Public Radio in St. Paul in 2011. Osterholm is the director of the University of Minnesota’s Center for Infectious Disease Research and Policy.
Tim Post | MPR News 2011

Updated: 8 a.m. Tuesday | Posted: 1:47 p.m. Monday

Cathy Wurzer’s very first guest for her new show, Minnesota Now, could not be more timely or important. Michael Osterholm is the Minnesotan who is helping all of us understand what’s happening with the COVID-19 pandemic and is regularly called upon to share that insight nationally, as well. Osterholm is the director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

Later, Wurzer was joined by MPR News data reporter David Montgomery to update listeners about the latest COVID-19 impact in Minnesota.

Use the audio player above to listen to the full conversation. Below is an edited transcript of Wurzer’s interview with Osterholm.


COVID-19 cases are ticking down across the country, not in Minnesota, but in other parts of the country. Given the figures, do you think COVID-19 booster shots are still needed?

Boosters are absolutely a part of the future. When you think about what we've done with these vaccines over the course of the last 18 to 20 months, and it’s noted today with Colin Powell’s death, these vaccines are really incredible, but they're not perfect. They are protecting a lot of people at reducing the severity of the illness and transmission [of the virus] in our communities.

But when these vaccines were first conceived of, and studies have been done to look at them, there were two buckets of concern. One was safety. We've answered the safety question with hundreds of millions of people now vaccinated around the world. We have lots of data showing the very good safety profile for these vaccines.

The second bucket — how best to use them — is still up in the air. What kind of a dose should you use? When should you give the vaccine? What's the dose spacing? Might you mix-and-match some of the vaccines to get maximum protection?

And that's what we're trying to answer now. This is what I call corrected science. You'll learn, you implement, you study it, and we're trying to make it better. So these boosters almost don't really fit in the category of boosters. All along we should have probably had a three-dose vaccine for the mRNA vaccines and we should probably all along had a two-dose approach for the Johnson & Johnson vaccine.

And that's what we're catching up with now — the idea of how we can provide even better protection.

In Minnesota, the case numbers are high, hospitals in the state are stretched really thin. What's fueling the rise in the state’s COVID-19 cases?

Well, this is clearly a pandemic of the unvaccinated in the sense of the most serious illnesses and the large number of deaths.

And what we have to understand is that if you are not vaccinated, you can't run out the clock on this virus. It will find you and you will know a COVID-19-related outcome. Hopefully it's a mild illness, but it very well could be serious illness or even death, as we're seeing now here in Minnesota.

But we have to acknowledge that we're not really sure, when we had this surge with this new delta variant, why we saw it unfold as it did initially in June in the Ozark region of the country, then spreading basically more to the Southern Sunbelt states and at the same time, starting in the northwest, and then we saw it move into the southeastern states. Then we saw it in Kentucky, Tennessee, West Virginia. And then it kind of skipped over a certain part of the Northeast and really hit Maine, Vermont and New Hampshire. And then about the same time, it took off in the Upper Midwest as the Western part of the country continued to expand its problem. And suddenly North Dakota, Minnesota, northern Wisconsin, northern Michigan were particularly hard hit.

And why this kind of “voyage of the virus” happened? We don't know. But we're now experiencing to a certain degree what the other states did two and three months ago.

Dr. Anthony Fauci was out Sunday saying that unvaccinated Americans could pose a threat to any progress that we've made, potentially sparking a fifth wave of COVID-19 infections. Do you see a fifth wave in our future?

Absolutely. There's no daylight between Fauci and I on that issue. Just remember that 65 million Americans who could be vaccinated right now are not. That is more than enough human wood for this coronavirus forest fire to burn.

So we'll see when the case numbers come down with this surge, just as we have with the previous surges.

And you may recall last spring that I thought the darkest days of the pandemic were ahead of us. And we were facing that June period when everybody said, “Oh, it's done.” We've got vaccines, hardly any cases — and then look what happened. Well, that's going to happen again because you have places like New York City, LA and other large metropolitan areas with lots of people.

We've also seen in many other countries. The United Kingdom is a good example. They today are approaching their high number of cases that they actually had back in June in July, when delta was such a serious problem, and they're back up again.

I can't say this enough times: If you are not vaccinated, this virus will find you. And you will know a COVID-19-related outcome. We could see again major activity. [It could be this] winter, next spring, I don't know when but it's not done. It is not done. The one thing that will help us get it done is to get vaccinated.

What are the chances we get really unlucky, and some of the new variant pops up or is delta simply too powerful?

I learned a long time ago. It’s kind of like when you go to Vegas, you never want to bet against the house because you're probably going to lose. There's a system in place there.

With Mother Nature, it is the same thing. I've never bet it against genetic roulette tables. You know, when a virus is up there mutating every time and knowing that the vast majority of the world is not yet vaccinated, and there's lots of infections out there, it's surely possible that a new virus variant is going to come forward that could really throw a monkey wrench into things.

There are three categories of concern we have with these variants. One: Are they more transmissible? — Much like the delta [variant] is, alpha was twice as transmissible as the previous strains, and delta was twice as infectious as alpha.

Then you worry about the second bucket: Does it cause more severe illness? We're not sure wth delta that happens; we do know that with alpha it did.

And then the third bucket is: Does this variant actually allow for escape of immune protection from either previous infection itself and the immunity you received from that or from vaccine? Of the three categories right now, the one that really is of most concern is transmissibility. That seems to be the “Lion King.” If nothing seems to be outpacing delta right now, but if it were, it would have to be a virus much more infectious than delta, which I can't even imagine what that would look like.

On the other hand, we have to be cognizant of what if it does start to have this immune escape, and it even makes the vaccine protection more susceptible. And so we're watching this very, very carefully. And you know, we’ll hopefully not have that happen. But like I said before, I would never want to bet against Mother Nature.

When does COVID-19 become endemic, kind of like it hangs around like the flu?

First of all, I do believe that will happen. Second of all, I don't know when.

Every morning I get up I scrape those 5 inches of crusted mud off my crystal ball. And every day, it seems cloudier and cloudier. If we see a major change and variant, and they do something different than they're doing now, that could surely cloud the picture of: When does it just become like flu? Like every year, we have some cases, we may have some moderate increase in cases.

But that is not what it's doing now. I think we forget about the fact of just what damage this virus has done with over the 700,000 deaths that have occurred, 1 out of every 500 Americans has died from this virus. That's amazing when we look at the fact that there are now over 140,000 kids in this country who have been orphaned, or whose sole caregiver has died, because of COVID-19. I think, you know, you start to get a sense of the impact. And so we've got a ways to go yet, but we never should ever, ever, ever count this virus out.

Correction (Oct. 19, 2021): A previous version of this transcript had incorrect information about the data around the chance of the delta variant causing severe illness. The above version has been updated and corrected.

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