Osterholm: Minnesota caught in ‘viral blizzard'; care systems strained

A person in PPE stands at a bed of a patient.
Nurse Jeanette Rupert works with a patient in the COVID ICU ward at Methodist Hospital in St. Louis Park, Minn., on Dec. 21, 2020.
Evan Frost | MPR News 2020

Across Minnesota, many schools are returning to distance learning and some restaurants are shuttering again, all because of yet another wave of COVID-19 because of the spread of the fast-spreading omicron variant.

The state's positive test rate hit a new record last week of 15.6 percent, according to Minnesota Health Department calculations.

Michael Osterholm
Michael Osterholm
Courtesy of the University of Minnesota

According to the University of Minnesota’s Michael Osterholm, the next few weeks could be the equivalent of a viral blizzard. Osterholm heads the University of Minnesota’s Center for Infectious Disease Research and Policy. Osterholm spoke with MPR News host Cathy Wurzer.

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

We heard from M Health, Fairview [that] there's no slack in the system. And while [they have] beds, [they don’t] have the people to attend to patients. It seems not long ago, we were talking about a shortage of bed space, what's on the horizon as omicron spreads?

Well, we all recognize we've just been through two years of very difficult times with regard to health care ... And what we can do to provide good quality health care today is: How many health care workers do we have? Who's trained to do this? Are they going to be there? And we've been hanging on by the skin of our teeth with regard to the number of health care workers that can provide care. 

So it's not about the beds, you know. You can have more beds if you've got them in your hospital, but they're going to be empty because you don't anybody to take care of the patients. Or what has made the current situation so difficult is this widespread infection in the communities — which means now that we're surely upping the number of people who are seeking health care. But at the same time, we have many health care workers who are fully vaccinated — who have basically a good protection against serious illness, hospitalizations and deaths themselves — but they've got to be off work because they're infected. 

And so we can expect to see — and we're seeing this now in a number of states — 20 percent to 30 percent of health care workers suddenly [are] not there. And that is a huge challenge.

In fact, we have examples already in multiple states where they've gone to crisis standards of care. Where they're asking health care workers who test positive — who have minor symptoms (the cold-like symptoms) — if they will continue to work with an N95 respirator on and cohort them or put them with patients who are already infected with COVID. So it's not likely that they can do any harm beyond, you know, their own infection. 

But that's where we're at right now. This, I've not seen in all of my career, this type of situation.

So I'm assuming that you are then in favor of what the CDC is recommending. That the isolation time for those who tested positive should be shortened. But what about the requirement that you don't have to have a negative test to go back to work? Many people have questions about that.

Yeah, you know, this has been a communication issue. I think, at best, it has been a challenge. 

But first of all, let me just really make the case for the fact that we are in crisis standards of care right now. I'd rather have somebody who is infected with COVID, who is relatively well, who has an N95 respirator on at the bedside of somebody (who) did not have anybody along that bedside for eight hours. That's what we're up against. This is truly, as we call it in the military medical parlance, this is triage medicine. So this is the challenge we have right now. 

So, I actually support the CDC’s position. The other thing is, we've really been almost arguing about but how many angels can dance on the head of a pin about these tests. Because many of these lateral flow tests — the kinds of tests we're talking about their antigen test you can get over the counter — are not necessarily that reliable in terms of telling you are you really infected or not. We know that we have lots of what we call false-negatives, who really are infected — who basically do not show up positive. So, if somebody does take a test at five or six days, I'm not sure what it means. 

And I think that's been a huge challenge to begin with, is just how far can we use this testing to tell you: Are you infectious or not? We don't know.

So I think the bottom-line message is: we don't want people who are infected to be in work areas, if at all possible. Obviously, we don't want them in our schools. We don't want them in health care. We don't want them in everyday business. But when you have crisis situations, where you may not be getting life-saving drugs to people, you may not get in life-saving health care to people. I think we have no other choice but to do this.

You mentioned schools, early data showed that the omicron variant has led to an increase in hospitalizations for unvaccinated kids. Is this a time to go back to distance learning to rein in the spread?

I even have a more, you might say in-your-face criteria. To even have teachers and support staff and bus drivers that can safely watch over your kids to school on a given day? We're seeing many locations right now with 25 percent to 30 percent absenteeism of teachers because they really are sick or at home infected. So I think this is a time we have to take a step back on the schools. We all want our kids in school, they should be in school. But at the same time, if you don't even have the staffing to safely — and with good supervision — hold schools how can you say that this is going to be positive for the kids to have them in school?

At the same time, I would agree completely that the transmission issues in the community are a real challenge if kids are at home, but we're seeing now major transmission in schools. We have a number of states that have documented large outbreaks that occurred in schools. So you can't say schools are safer. 

Finally, people say: “Well, but you know, we need our kids in school, I have to work.” And, I understand that very, very much. The problem is, you're going to be home anyway, for at least part of the time, because it is inevitable that most of these kids are going to get infected and get sick. And so that challenge is also just being realistic … 

So I think at this point — to me — the first standard I look at with kids is: Can you actually open the school with adequate supervision and educational experiences with the uninfected or recovered adults? And if you can't, then that's the first indication [that] school is not the place you want to have your kids today.

Some folks with a weakened immune system can get a fourth dose of the vaccine as early as this week. Israel has already begun offering fourth doses to high-risk groups. What do you make of that move?

I think right now, it’s the thing we should be doing. We're still trying to understand just how these vaccines work best, meaning: what is the spacing? How many doses? 

We can't spend the rest of our days dosing the world every six months. It's not going to happen. But at least for now, the data from Israel supports that for those who are immune-compromised, they will actually have a better response after the first three, plus one more. 

I would urge them to get that and get it as soon as possible because — again — the challenge is the surge is here right now. And once you get vaccinated, you're really talking about 10 to 14 days before you see that immune system pick up that we're looking for. And so time is of the essence. You can't get vaccinated today and expect that you're gonna have protection tonight.

So it sounds like this could get pretty intense in the next three to four weeks?

It is intense now, and it’s only going to get worse, and I think that if everyone could just take a step back; you know, de-politicize it. 

Just know we are in a viral blizzard. As I shared with you a month ago, saying a '“viral blizzard is coming,” it's here, and it's going to get much worse before it gets better. 

But it is short-lived. I think in three to four weeks, we're gonna see case numbers begin to level off if not start to drop precipitously. So that's the good news.

People hold out please, this is not going to be months and months. This wave is going to be in the weeks ahead.

Listen to the full conversation using the audio player above.