Osterholm: Newest COVID variant could drive hospitalizations higher here

Boxes of N95 masks sit in storage.
University of Minnesota infectious disease specialist Michael Osterholm recommends wearing N95 masks and says cloth masks will not protect against COVID.
John Moore | Getty Images

XBB1.5 is the newest COVID-19 omicron subvariant and it’s spreading now across the United States. The World Health Organization calls it the "most transmissible yet."

While it hasn’t reached Minnesota in significant numbers, its spread is renewing worries of another wave of COVID cases and hospitalizations.

“Many people believe that we're done with this virus, but the virus isn't done with us,” Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, told MPR News host Cathy Wurzer Tuesday. “I think that's the challenge that no one wants to hear, but it's the reality.”

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

What do you think of this new highly-transmissible variant?

If we've learned nothing about this virus over the course of the past three years, expect the unexpected. Let me just take us back to a period in 2020-21, right in that December-January time period. We saw the alpha variant emerge in Europe and thought, “Oh no, this is going to wreak havoc in the United States.”

Well, in fact, over the next several months it did wreak havoc in places like Minnesota and Michigan, and almost did not touch most of the United States. Why? We don't know.

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So now you have XBB1.5, the new variant you just mentioned, that is so highly infectious. Surely it is having a substantial impact on cases, serious illness, hospitalizations and deaths in the northeastern part of the United States.

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

But so far here in Minnesota, we've seen very little of it yet. Does that mean it won't come? I don't know. If it does come here, and we do see this variant show up, I think we could see a substantial increase in the number hospitalized right now.

We're averaging about 560 people a week there in the hospital with COVID. We're averaging about 180 deaths a month. Those numbers could change substantially if XBB1.5 does show up.

At least 10 countries in Europe and Asia have imposed new virus testing on passengers coming from China. This kind of feels like 2020 all over again. Is there a reason for caution?

Well, right now we have to first of all take a step back and ask ourselves what's happening globally, not just China.

Right now, if you look at the actual rate of deaths worldwide, the Scandinavian countries are recording the highest of anyone in the world, and this is not yet XBB1.5. Why is that happening? We're not sure.

If you look at Japan, they this past week have had the height of their case numbers in the entire pandemic. And, ironically, this is caused by another variant B.A.5 for which they had a previous surge in August and September. Why a second one of such magnitude? We don't know.

Hong Kong right now, surely part of China but as an independent area, it is likely this week have the highest rate of deaths are recorded for any area in the world during the entire pandemic to date.

And I could go through the laundry list of what's happening in South America, what's happening in parts of Europe, and of course, what's happening here in the United States. And I think you really hit it right on the mark by saying many people believe that we're done with this virus but the virus isn't done with us. And I think that's the challenge that no one wants to hear, but it's the reality.

So what happens then if the WHO says, ‘Well, we're done here now. The global pandemic emergency is over’? And the Biden administration is looking at ending the emergency declaration by spring. What happens after?

Well, let's not confuse policy statements with scientific fact. You know, I had the very uncomfortable situation a few months ago, of being in a New York Times story: The sentence immediately below the president saying, ‘The pandemic is over,” [was] me saying, ‘No, it's not.’

And what the president was referring to was more from the standpoint of life moving on, we were out and about, we were coming back into our communities. But there was a minor detail that we still have a lot of cases. Today, we're seeing about 470 deaths a day with COVID. And to put that into comparison, the number one cause of death by cancer is lung cancer, and that's about 350 deaths a day.

So this is still a very substantial public health problem. And you can declare whatever you want because you want to move on. But don't confuse the fact that the virus doesn't care what your policy statements are.

Once the emergency is lifted, what does it mean for vaccinations, for costs of vaccinations and testing, and that kind of thing?

Well, we're already really in a challenging position even before they may lift the public health emergency. There isn't financial support for Congress to take these drugs, vaccines and even respiratory protection devices, like N95 respirators, and move them into the community. This is a real challenge.

Whether they drop the emergency declaration or not, I think we have to expect as a country that over the next months, we will be on our own at state and local levels to really deal with this issue with much less support from the federal government.

This is a real concern to me, because I still think that the importance of antiviral drugs that can surely reduce the risk of people becoming seriously ill, being hospitalized and dying is really being challenged right now.

We know of multiple companies that are working on antiviral drugs that could be highly effective, even more so than Paxlovid, that have now put them on the shelf saying, ‘Well, there's no market in there for us. The federal government is done buying. So you know, we're not going to do any more research on them.’

We have a listener, Will, who wants to know (and this is reference to these new variants): Is anyone working on a preventative vaccine? Are the new variants any progress being made?

There is a lot of work going on and you're going to hear about a series of articles that are coming out tomorrow in the New England Journal of Medicine, in which at least several groups have looked at how effective the new bivalent vaccine is in terms of its production of immune response compared to the original vaccine. And their conclusion was that it wasn't any different. It was not like a big advantage.

I think that's a little premature yet, in that we do have data from several other locations that are not going to be published tomorrow, that actually support that the bivalent vaccines are doing very well and reducing serious illness, hospitalizations and deaths among older individuals, which is where we are seeing the lion's share of serious illness.

So I don't want the public to be confused tomorrow. Yes, there's work going on. Right now I can tell you without any doubt that getting those vaccines, particularly for those who are older, who may have underlying health conditions is the very best and most important thing you can do to protect you or your loved ones.

Because the uptake of the vaccinations is not great among all age groups, does the messaging have to change and what is that?

We really are all at a loss to understand how can we better a message and then have that message result in a behavior change? Meaning, i.e. ‘I go and get my vaccine.’

And I wish I had an easy and magical answer. I don't. No one does. We lost 180 people last month here in Minnesota due to COVID. You have at least a threefold greater likelihood of surviving COVID as an older individual if you've been vaccinated versus someone who has not been.

So I think that the challenge we have right now is: How do we help translate these data, this information that we have showing how well it works, to people in the short term? I'm afraid that this has become such a politicized issue we're not going to see that and what we will see of course, are these death numbers staying elevated when they surely could come down.

Your best advice? Just take the usual public health precautions?

Basically, be vaccinated with as many doses as you're eligible for, including the bivalent dose right now.

Second of all, if you do become ill with COVID, interface quickly with the healthcare system so that if you're eligible for Paxlovid or any of the other antiviral drugs, you get them.

And, of course, wear your N95 respirator in public places. If I go to the grocery store, I go to any pharmacy or anything like that, if I go to the university, I wear my N95 and I feel very protected. A regular cloth mask will not protect you. You have to use that N95. Take your own health under your own control. And if you do those three things, that's going to help you a lot.

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Audio transcript

[MUSIC PLAYING] CATHY WURZER: Later this month, the World Health Organization meets to consider whether the COVID pandemic is still a global health emergency that says China wrestles with an explosion of COVID infections. Crematoriums and funeral homes in that country are awash in dead bodies, according to satellite imagery taken over several large Chinese cities.

Meanwhile, there are reports that the Biden administration could end this country's COVID emergency by the spring. Now, all of this is happening as a new Omicron subvariant, one the WHO calls the most transmissible yet, races through this country. As experts have said, the virus is not over us, even though we're over it. One of those experts is on the line. Dr. Michael Osterholm is an epidemiologist and the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Welcome back.

MICHAEL OSTERHOLM: Thank you, Cathy. Good to be with you.

CATHY WURZER: What do you think of this new highly transmissible variant?

MICHAEL OSTERHOLM: Well, if we've learned nothing about this virus over the course of the past three years, expect the unexpected. And what I mean by that is let me just take us back to a period in 2020, 2021, right in that December, January time period and we saw the alpha variant emerge in Europe and thought, oh, no. This is going to wreak havoc in the United States.

Well, in fact, over the next several months, it did wreak havoc in places like Minnesota and Michigan and almost did not touch most of the United States. Why? We don't know.

So now you have XBB.1.5, the new variant you just mentioned that is so highly infectious. Surely it is having a substantial impact on cases, serious illness, hospitalizations, and deaths in the Northeastern part of the United States. But so far here in Minnesota, we've seen very little of it yet. Does that mean it won't come? I don't know. If it does come here and we do see this variant show up, I think we could see a substantial increase in the number hospitalized.

Right now, we're averaging about 560 people a week that are in the hospital with COVID. We're averaging about 180 deaths a month. Those numbers could change substantially if XBB.1.5 does show up.

CATHY WURZER: OK, so it's still an unknown. Well, as you know, at least 10 countries in Europe and Asia have imposed new virus testing and passengers coming from China. This kind of feels like 2020 all over again. Is there a reason for caution?

MICHAEL OSTERHOLM: Well, right now we have to, first of all, take a step back and ask ourselves what's happening globally, not just China. Right now if you look at the actual rate of deaths worldwide, the Scandinavian countries are reporting the highest of anyone in the world. And this is not yet XBB.1.5. Why is that happening? We're not sure.

If you look at Japan, they this past week have had the height of their case numbers in the entire pandemic occur. And ironically, this is caused by another subvariant, BA.5, for which they had a previous surge in August and September. Why a second one that's of such magnitude? We don't know. Hong Kong right now, while surely part of China but as an independent area, it is likely this week to have the highest rate of deaths recorded for any area in the world during the entire pandemic to date.

And I could go through the laundry list of what's happening in South America, what's happening in parts of Europe, and of course what's happening here in the United States. And I think in your opening, you really hit it right on the mark by saying many people believe that we're done with this virus, but the virus isn't done with us. And I think that's the challenge that no one wants to hear, but it's the reality.

CATHY WURZER: So what happens then if the WHO says, well, we're done here now? The global pandemic emergency is over. And then the Biden administration apparently is looking at ending the emergency declaration by spring. What happens after that?

MICHAEL OSTERHOLM: Well, let's not confuse policy statements with scientific fact. You know, I had the very uncomfortable situation a few months ago of being in a New York Times story, the sentence immediately below the president saying the pandemic is over and me saying, no, it's not. And what the president was referring to was more from the standpoint of life was moving on. We were out and about. We were coming back into our communities.

But there was a minor detail that we still have a lot of cases. Right now, today we are seeing basically about 470 deaths a day with COVID. And to put that into comparison, the number one cause of death by cancer is lung cancer, and that's about 350 deaths a day. So this is still a very substantial public health problem. And you can declare whatever you want because you want to move on, but don't confuse the fact that the virus doesn't care what your policy statements are.

CATHY WURZER: Once the emergency is lifted, what does that mean for vaccinations, for costs of vaccinations and testing and that kind of thing?

MICHAEL OSTERHOLM: Well, we're already really in a challenged position even before they may lift the public health emergency in that there isn't financial support from the Congress to take these drugs, vaccines, and even respiratory protection devices like N95 respirators and move them into the community. This is a real challenge. And so whether they drop the emergency declaration or not, I think we have to expect as a country that over the next months, we will be on our own at state and local levels to really deal with this issue with much less support from the federal government.

This is a real concern to me because I still think that the importance of antiviral drugs that can surely reduce the risk of people becoming seriously ill, being hospitalized, and dying is really being challenged right now. We know of multiple companies that are working on antiviral drugs that could be highly effective, even more so than Paxlovid that have now put them on the shelf, saying, well, there's no market in here for us. The federal government's done buying, so we're not going to do any more research on them.

CATHY WURZER: Say, I'm glad you brought up the drugs and drug companies. We have a listener, Will, who wants to know-- and this is in reference to these new variants-- is anyone working on a preventative vaccine for the new variants? Any progress being made?

MICHAEL OSTERHOLM: There is a lot of work going on, and you're going to hear about a series of articles that are coming out tomorrow in The New England Journal of Medicine-- the embargo is at late afternoon tomorrow-- in which at least several groups have looked at how effective the new bivalent vaccine is in terms of its production of an immune response compared to the original vaccine. And their conclusion was that it wasn't as-- it wasn't any different. It was not a big advantage.

I think that's a little premature yet in that we do have data from several other locations that are not going to be published tomorrow that actually support that the bivalent vaccines are doing very well in reducing serious illness, hospitalizations, and deaths among older individuals, which is where, of course, we are seeing the lion's share of serious illness.

So I don't want the public to be confused tomorrow. Yes, there's work going on right now. I can tell you without any doubt that getting this vaccine, particularly for those who are older, who may have underlying health conditions, is the very best and most important thing you can do to protect you or your loved ones.

CATHY WURZER: So I've asked you this before on, well, Almanac on TPT last Friday. I'm going to ask you this on the radio. Because the uptake of the vaccinations is not great among all age groups, does the messaging have to change? And what is that?

MICHAEL OSTERHOLM: You know, Cathy, we really are all at a loss to understand, how can we better message and then have that message result in a behavior change? Meaning, i.e., I go and get my vaccine.

And I wish I had an easy and magical answer. I don't. No one does. It's clear when you still continue to see-- I mean, look. We lost 180 people last month here in Minnesota due to COVID. You have at least a three-fold greater likelihood of surviving COVID as an older individual if you've been vaccinated versus someone who has not been.

So I think that the challenge we have right now is, how do we help translate these data, this information that we have showing how well it works to people in the short term. And I'm afraid that this has become such a politicized issue we're not going to see that. And what we will see, of course, are these death numbers staying elevated when they surely could come down.

CATHY WURZER: And your best advice, you say that we're going to be kind of on our own here, just to take the usual public health precautions.

MICHAEL OSTERHOLM: Yeah. Basically, be vaccinated with as many doses as you're eligible for, including the bivalent dose right now. Second of all, if you do become ill with COVID, interface quickly with the health care system so that if you're eligible for Paxlovid or any of the other antiviral drugs, you get them. And of course, know that if you wear your N95 respirator in public places, like if I go to the grocery store, I go to any pharmacy or anything like that, if I go to the university, I wear my N95, and I feel very protected.

A regular cloth mask will not protect you. You have to use that N95. But take your own health under your own control. And if you do those three things, that's going to help you a lot.

CATHY WURZER: All right. Always appreciate the time. Thank you so much.

MICHAEL OSTERHOLM: Thank you.

CATHY WURZER: Michael Osterholm is an epidemiologist, the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

[MUSIC PLAYING]

SINGER: (SINGING) It'd be so cruel if I didn't love my body.

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