U's Osterholm expects new COVID surge, moderate hospitalizations

Virus Outbreak Second Boosters
Vials for the Moderna and Pfizer COVID-19 vaccines are seen at a temporary clinic in Exeter, N.H. on February 25.
Charles Krupa | AP 2021

Experts are keeping an eye on two new subvariants of COVID-19 that have been found in Minnesota. New data from the state health department shows four people outside the metro area have been infected with BA.4 and one with BA.5 which had been found in other countries, and appears to be able to infect those who are supposed to have immunity from COVID.

COVID infections are increasing in Minnesota. Hospitalizations are also going up in the state as Wednesday 2,120 cases were reported. That total excludes home COVID tests. Michael Osterholm, veteran epidemiologist and the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, joined host Cathy Wurzer to share his insights.

The following transcript has been edited for length and clarity. You can listen to the full conversation using the audio player above.

What do we know about these subvariants’ ability to dodge the body's immune system?

In terms of the variant evolution, when we went from BA.2 to now BA.4 and BA.5, there was actually one in between, which is the primary variant causing illness right now in Minnesota, BA.2.12.1. It gets even more complicated. I think that in the long run, it's very likely that BA.4 and BA/5 will become very dominant subvariants here. And we have experience now in South Africa and Portugal to see that, in fact, these are very highly infectious variants.

If you think you were infected with BA.1 or BA.2, what's the likelihood that you could get hit with BA.4 or BA.5?

Well, this is one of the challenges we have as you may recall, in all the times that we've talked about this virus there really are two aspects to its transmission and illness that are really critical. One, clearly BA.4 and .5 are more infectious subvariants than we've seen with the other omicron variants, so it likely will take over and dominate.

The second thing is it does evade immune protection you've had before. And in fact, in South Africa, they found that there was virtually no protection for those who had had BA.1 infection just six to 12 weeks ago from getting BA.4 BA/5.

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What did provide the most protection was previous infection and being vaccinated. This is why the vaccines, while they're hardly perfect, are remarkable tools yet that will actually offer a substantial amount of protection against BA.4 and .5.

Even with this immune evasion, most of the illnesses we see are actually milder. We're not seeing anywhere near the hospitalizations we saw with the omicron wave for example, in South Africa, their peak was last week in terms of hospitalizations with 2,800, whereas they were at 9,900 during the omicron peak for hospitalization. We will see more transmission, but we're probably going to see most people having a milder type of illness.

How might approval of vaccines for kids help in this situation that we're talking about?

Right now, we have the 5- to 11-year-old approval for two doses, only 29 percent of the kids are vaccinated, and this vaccine has been approved since November.

I don't think any of the booster dose data for 5- to 11-year-olds is going to have much impact because we can't get kids vaccinated with even one or two doses.

As far as the younger kids, I think you're going to see exactly the same kind of phenomena. Should the FDA approve the vaccine for younger than age 5 — the data we have right now suggests that they're going to wait. It is still a huge challenge in terms of getting our kids vaccinated. Converting a vaccine into a vaccination is really difficult in this age group.

Are we doomed to deal with a parade of variants, each one more contagious than the last?

You know, probably the three most important words that I've learned to say and said with a heartfelt meaning: I don't know.

At this point, we could see the ongoing unfolding of COVID with this particular variant and all the subvariants that we're seeing. And maybe over time, we would just have a whole series of you get infected, get protection for a while, then you're vulnerable again. What I really am concerned about is that omicron won't be the last new variant. Meaning an entire new type of SARS-CoV-2 virus emerges pi or sigma, one of the other Greek letters that will denote a new variant. Those could actually be 210 mph curveballs, they could be much more infectious, or they could surely evade immune protection.

We could see another omicron like moment in the days to months ahead, we don't know. And I think the public, however, has decided that it's done with the virus. I can't emphasize enough, the virus is not done with us yet, as tired as we all are. And I know you and I are very tired of this virus. But the bottom line is that we just don't know what the future is going to bring us.

Health officials keep saying that we're still in a good position. We have the vaccines, we have antivirals if you get sick, but how robust is the system to get those drugs?

Well, unfortunately, I have spent many, many hours in the past several weeks just trying to assist friends and colleagues, who absolutely should receive the drug who are infected, who have a confirmed test, who have had terrible problems securing it.

We even had one very large medical center in this state that I got involved with, because the nurses line for people who called in who said, ‘I've been infected, I have a positive test. What do I do?’ The nurses were instructed tell him ‘well, unless you're seriously ill, we'll treat you.’ Which is absolutely the wrong answer. And you know, through the some intervention, the medical center changed its messaging to say ‘no, this drug is for you at the earliest stages of infection to take so you don't get seriously ill.’ But the fact that there was that much misinformation out there, and the availability of the drug is really spotty. I know people who have gone to 10 or 15 different pharmacies to try to find the drug.

We have a lot of work yet to do on on the aspect of getting people on this drug. You're hearing about some breakthrough infections where people end up having illness after they take the drug — yes, that's true — but it is doing an amazing job of keeping people out of hospitals, and getting seriously ill, if they can get it.

So where does the issue lie that this is a federal government? Or is this on a state by state level?

Well, we first of all have to acknowledge that we have a problem. It has to start at the local level to figure out who has access to these drugs, how do they get them, how do streamline the process. One of the challenges we're having right now is that we've seen counties and states across the country pulling back on testing and not making a PCR testing available so that people can actually get a confirmed test.

Some places will actually take the lateral flow test as evidence. But the problem with those lateral flow tests, the at home test, is that they're often not positive in the first three to five days of illness. That is a challenge because you have to have the drug within five days of your first symptoms to be eligible to receive it.

What are your thoughts as we head into the fall and winter?

One of the concerns I have right now about the COVID-19 vaccine picture is that we're putting a lot of eggs in the basket of a omicron subvariant vaccine. But one of the challenges we have is if a new variant emerges, the sub-omicron type variant may very well not be the right one to have for the vaccine.

The vaccine we currently have right now is from the ancestral strain in Wuhan. It covered alpha, beta, gamma, delta and omicron to the extent so in the end it still may be the best vaccine.

What will you be watching for here in the next couple weeks?

I fully expect that we're going to see a lot of additional cases. In the last seven to 10 days, I'm aware of more people, friends, colleagues, who are infected with this virus in any subjective 10 day period in the entire pandemic. It's remarkable.

What we're looking is what will happen with hospitalization, serious illnesses and death. I do believe that they will still be somewhat moderate and we won't see big increases there.

We're just going to have to keep moving forward and knowing that this virus is going to continue to throw curveballs at us and we have to be prepared for that.