Osterholm: There's a new COVID variant. Should we be worried?

Michael Osterholm
University of Minnesota infectious disease specialist Michael Osterholm.
Courtesy of the University of Minnesota

There’s a new COVID-19 variant on the radar called BA 2.75. MPR News Reporter Catharine Richert talked with virus expert Michael Osterholm about the latest insights. Osterholm is a veteran epidemiologist and the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

This transcript has been edited for clarity. Use the audio player above to listen to the conversation featured in the broadcast.

We have had omicron BA.1, we've had omicron BA.2, and now we have BA.5. Is this mutation of the virus really different than previous iterations of omicron?

The sub-variants that we've seen emerge from omicron actually are different. In fact, all the sub-variants of omicron that we've seen emerge are somewhat different from each other. In fact, BA.5 right now is by far the most infectious and most likely to evade immune protection from people who've previously been vaccinated or previously had an infection. So this is a challenge.

And on top of the fact that we now see the emergence of BA.5, in many areas of the world with increasing number of cases, we've just documented a new variant — 2.75 — which actually may replace BA.5. So we're a long way from being done in terms of understanding the full impact of omicron.

One thing that is really different about the pandemic in 2022, is that we have so much home testing. With little tracking happening on the public health level, and so many people testing at home, how much do we actually know about the state of the pandemic at this point?

We really know very little about the actual number of cases occurring in our community, with some exceptions. And that exception is how many severe cases are occurring because we are still tracking those via hospitalizations and deaths.

While we have much less testing going on in our public health settings where we did PCR testing in the past, we actually also see in many instances, people not even using home testing. They think that “I may have COVID,” someone in their household has been confirmed to have COVID with testing, so they don't get tested when they get sick. So at this point, we at the very most are accounting for only a very small percentage of the people who are actually infected.

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We have vaccines, we have booster shots. How effective are the vaccines that are available right now against this version? And with so many people haven't gotten earlier versions of omicron, does that add any additional protection?

One of the challenges we have right now is understanding just how well the vaccines are working and what are they working for. What I mean by that is, there is increasing evidence that, particularly with BA.5, there is limited protection from the vaccines and previous exposure to SARS-CoV-2 — meaning previously had an infection — against becoming infected again or for the first time.

What we do know is that with BA.5, that previous vaccination, particularly having your full booster shots on board, actually can reduce the likelihood of having serious illness, hospitalizations and deaths, that may have very limited ability to change whether you get infected or not. The same is true for even those who had BA.1, the original omicron sub-lineage that came out in December and January.

We actually see today, many of these individuals getting reinfected with BA.5, there's limited protection there. So we know that one of the challenges with these variants and sub-variants is immune evasion, the ability to actually avoid the protection you might have from your immune system, having either been exposed previously to a vaccine or previous virus. This is a huge challenge.

Additional booster shots are available only to people over 50 and some people with weakened immune systems. But we're hearing news out of Washington that the Biden administration is going to be considering and pushing for booster shots for all adults. What do you think of this strategy?

I think right now, getting as many booster doses on board as you can is great news. It is surely — as we see from data in Israel — reducing serious illness, hospitalizations and deaths. But do I think we can boost our way out of this pandemic? No. We have to understand that it's not realistic to think that every few months, we're going to get another booster.

If you look at just the attrition we've seen between those who got to the first two doses to the third, to those who got the third to the fourth, it has been a marked reduction in the number of people who are eligible to get it who actually got it. I think that turning a vaccine into a vaccination right now for many people is a very difficult thing to do. So I don't see boosting as being the answer.

Our group is actually working very closely with experts from around the world to help we call a vaccine roadmap for coronavirus vaccines to come up with better ones. The ones we have now are surely very powerful tools that have reduced the risk of serious illness, hospitalizations and deaths, but they're not the perfect tool at all. We need better vaccines. And so I think until we get those we're going to be caught in this, “Well, they do some things OK. Some things are not doing so well.” And just understanding that I'll still take the part to do some things OK.

We're also hearing that Moderna and Pfizer, the two biggest manufacturers of vaccines in the United States, are creating an omicron-specific vaccine that could be available this fall. How would authorizing boosters to all adults right now complicate the rollout of those more specific vaccines? Or would it really not make much of an impact?

I don't think it's going to make much of an impact, because they've already signaled that if you've had your booster doses, up to now, you'll still be eligible to get the sub-variant vaccine this fall. My point is, I'm not sure how much difference is going to make because by the time those BA.5 sub-variant vaccines are out there, I think BA.5 will probably be long gone. And we'll be on to BA.7 or to pi, or sigma or something else, as we're now seeing this emerging BA.2.75. I don't know what the virus is going to be three to four months from now when those variant vaccines will be available.

So potentially too little too late, by the time it's ready.

My whole sense is that if we're chasing variants for the vaccine, to decide what to put in it, it'll always be a day late and a dollar short.

Speaking of boosters, kids are now eligible for them. And very small children under five are getting their first round of shots. How is this phase of the vaccination campaign going so far?

I have to say that if you look at young children, it's a terrible problem. Not one that should have been unexpected. Right now, the best data we have, as of this past week indicates only about two percent of children under the age of five, nationally and statewide, have gotten their vaccine.

So again, it goes back to that issue of turning a vaccine into a vaccination. Big difference. And right now, I think many parents felt like, you know, we went through the COVID experience last year, we're done. We don't have to worry about it anymore. It's not a serious problem for kids. And I think that we're going to see only a very limited number of kids being vaccinated even by the time school starts.

You mentioned another variant that you're watching right now. Tell us more about this variant and what we know about it.

Well, the variant of concern that we are looking at right now with regard to omicron is BA.2.75, first seen in India [and] now circulating in some parts of Asia. And it appears to have even increased immune evasion properties versus BA.5.

It's really too early to tell yet. This could turn out to be a non-issue, or it could turn out to be the replacement to BA.5, we just don't know. And this is the uncertainty that no one wants to have today. But it's the uncertainty that is required to understand just how fast these viruses are evolving and what that means for possible human illness.

What else should we know right now?

You know, we're in this for the long haul. COVID is one of those situations where the public is done with it, but the virus has not done with us. And I think that that's a really hard message. And the White House is struggling with that right now. Because they see that ongoing challenge. They see hospitalization rates rising. While they haven't at all come close to what they were during the worst of the delta/omicron surges, we're still talking about 2,000+ deaths a week in this country from COVID.

And the question is just what will we accept as everyday life? What will we live with? And we're all struggling with that right now and trying to reduce the number of cases trying to reduce long COVID for certain, but not knowing just what the future holds.

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Audio transcript

KATHY: Experts keep saying the pandemic is not over, but evidently, most of us are ignoring that message. Very few people wear masks anymore. There are no restrictions on travel or social gatherings. Yet, there's a fast spreading COVID variant among us, BA.5, which researchers like Dr. Eric Topol call the worst variant yet.

There's also a new variant on the radar called BA.2.75. NPR reporter Katherine Richard talked with virus expert Michael Osterholm about the latest insights. Dr. Osterholm is a veteran epidemiologist and the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

KATHERINE RICHARD: So I guess the first thing I want to start with is we have had Omicron BA.1. We've had Omicron BA.2. And now we have BA.5. Is this mutation of the virus really different than previous iterations of Omicron?

MICHAEL OSTERHOLM: All of the subvariants that we've seen emerge from Omicron actually are different. In fact, all of the subvariants of Omicron that we've seen emerge are somewhat different from each other. And in fact, BA.5 right now is by far the most infectious and most likely to evade immune protection from people who previously have been vaccinated or previously had infection. So this is a challenge.

And on top of the fact that we now see the emergence of BA.5 in many areas of the world with increasing number of cases, we've just documented a new variant, 2.75, which actually may replace BA.5. So we're a long ways from being done in terms of understanding the full impact of Omicron.

KATHERINE RICHARD: So one thing that I think is really different about the pandemic in 2022 is that we have so much home testing. And I'm wondering, with little tracking happening on the public health level and so many people testing at home, how much do we actually know about the state of the pandemic at this point?

MICHAEL OSTERHOLM: We really know very little about the actual number of cases occurring in our community with some exception. And that exception is how many severe cases are occurring because we are still tracking those via hospitalizations and deaths. While we have much less testing going on in our public health settings where we did PCR testing in the past, we actually also see in many instances people not even using home testing.

They think, oh, I may have COVID. Someone in their household has been confirmed to have COVID with testing so they don't get tested when they get sick. So at this point, we at the very most are accounting only a very small percentage of the people who are actually infected.

KATHERINE RICHARD: So we have vaccines. We have booster shots. How effective are the vaccines that are available right now against this version? And with so many people having gotten earlier versions of Omicron, does that add any additional protection?

MICHAEL OSTERHOLM: One of the challenges we have right now is understanding just how well the vaccines are working and what are they working for. And what I mean by that is that there is increasing evidence that particularly with BA.5, there is limited protection from the vaccines and previous exposure to SARS-COV-2, meaning previously had an infection, against becoming infected again or for the first time.

What we do know is that with BA.5, that previous vaccination, particularly having your full booster shots on board, actually can reduce the likelihood of having serious illness, hospitalizations, and deaths but may have very limited ability to change whether you get infected or not. The same is true for even those who had BA.1, the original Omicron sub-lineage that came out in December and January. We actually see today many of these individuals getting reinfected with BA.5. There's limited protection there.

So we know that one of the challenges with these variants and subvariants is immune evasion, the ability to actually avoid the protection that you might have from your immune system having either been exposed previous to vaccine or previous virus. This is a huge challenge.

KATHERINE RICHARD: So right now, additional booster shots are available only to people over 50 and some people with weakened immune systems. But we're hearing this news out of Washington that the Biden administration is going to be considering pushing for booster shots for all adults. What do you think of this strategy?

MICHAEL OSTERHOLM: Well I think right now, getting as many booster doses on board as you can is great news. It is surely, as we've seen from data in Israel, reducing serious illness, hospitalizations, and deaths. But do I think we can boost our way out of this pandemic? No. We have to understand that it's not realistic to think that every few months we're going to get another booster.

If you look at just the attrition we've seen between those who got the first two doses to the third to those who got the third to the fourth, it has been a marked reduction in the number are people who are eligible to get it who actually got it. I think that turning a vaccine into a vaccination right now for many people is a very difficult thing to do. So I don't see boosting as being the answer.

Our group is actually working very closely with experts from around the world to what we call a vaccine roadmap for coronavirus vaccines to come up with better ones. The ones we have now are surely very powerful tools that have reduced the risk of serious illness, hospitalizations, and deaths, but they're not the perfect tool at all. We need better vaccines. And so I think until we get those, we're going to be caught in this, well, they do some things OK. Some things, they're not doing so well. And just understanding that I'll still take the part that they're doing some things OK.

KATHERINE RICHARD: We're also hearing that Moderna and Pfizer, the two biggest manufacturers of vaccines in the United States, are creating an Omicron-specific vaccine that could be available this fall. So how would authorizing boosters to all adults right now complicate the rollout of those more specific vaccines? Or would it really not make much of an impact?

MICHAEL OSTERHOLM: I don't think it's going to make much of an impact because they've already signaled that if you've had your booster doses up to now, you'll still be eligible to get the subvariant vaccine this fall. My point is I'm not sure how much difference is going to make because by the time those BA.5 subvariant vaccines are out there, I think BA.5 will probably be long gone. And we'll be on to BA.7 or to Pi or Sigma or something else or even, as we're now seeing, this emerging BA,2.75. I don't know what the virus is going to be three to four months from now when those variant vaccines will be available.

KATHERINE RICHARD: So potentially too little too late by the time it's ready?

MICHAEL OSTERHOLM: My whole sense is that if we're chasing variants for the vaccine to decide what to put in it, it'll always be a day late and a dollar short.

KATHERINE RICHARD: So speaking of boosters, kids are now eligible for them, and very small children under five are getting their first round of shots. How is this phase of the vaccination campaign going so far?

MICHAEL OSTERHOLM: Well, I'd have to say that if you look at young children, it's a terrible problem and not one that should have been unexpected. Right now, the best data we have as of this past week indicates only about 2% of children under the age of five nationally and statewide have gotten their vaccine.

So again, it goes back to that issue of turning a vaccine into a vaccination, big difference. And right now, I think many parents felt like we went through the COVID experience last year. We're done. We don't have to worry about it anymore. It's not a serious problem for kids. And I think that we're going to see only a very limited number of kids being vaccinated even by the time school starts.

KATHERINE RICHARD: You mentioned another variant that you're watching right now. Tell us more about this variant and what we know about it.

MICHAEL OSTERHOLM: Well, the variant of concern that we are looking at right now with regard to Omicron is BA.2.75 first seen in India and now circulating in some parts of Asia. And it appears to have even increased immune evasion properties versus BA.5. It's really too early to tell yet.

I have to say that this could turn out to be a non-issue, or it could turn out to be the replacement to BA.5. We just don't know. And this is the uncertainty that no one wants to have today, but it's the uncertainty that is required to understand just how fast these viruses are evolving and what that means for possible human illness.

KATHERINE RICHARD: What have we missed? What else should we know right now?

MICHAEL OSTERHOLM: We're in this for the long haul. COVID is one of those situations where the public is done with it, but the virus is not done with us. And I think that that's a really hard message, and the White House is struggling with that right now because they see that ongoing challenge. They see hospitalization rates rising.

While they haven't at all come close to what they were during the worst of the Delta and Omicron surges, we're still talking about 2000 plus deaths a week in this country from COVID. And the question is just what will we accept as everyday life. What will we live with? And we're all struggling with that right now and trying to reduce the number of cases, trying to reduce long COVID for certain, but not knowing just what the future holds.

KATHERINE RICHARD: OK, thank you so much, Dr. Osterholm.

MICHAEL OSTERHOLM: Anytime. Thank you. Tell Kathy hi.

KATHY: Thank you, and hi back to you. That was NPR reporter Katherine Richards speaking with epidemiologist Michael Osterholm about the latest news with the coronavirus. There is much more from this conversation on our website, nprnews.org.

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