Osterholm: Twin Cities emerging from 'viral blizzard'

Researchers at the University of Minnesota's medical school think the current outbreak of COVID-19, due to the omicron variant, could be reaching its peak within the next two weeks in the Twin Cities metro area. Sewage tested in several Twin Cities treatment plants shows a drop in omicron levels, but the variant continues to spread in other parts of the state.

University of Minnesota infectious disease specialist Michael Osterholm predicted a “viral blizzard” due to the omicron variant a few weeks ago. He’s been right. Below, Osterholm looks to what might be ahead for Minnesota.

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

Are we starting to dig out from the ‘blizzard’?

We clearly are in the Twin Cities area. The number of new cases is dropping every day. That doesn't mean that we're seeing a major drop in hospitalizations — or even deaths —because those are lagging indicators. But in greater Minnesota, it appears that that is probably offset by about one week to 10 days. And we probably won't see the peak activity there [until] well into next week.

What can we learn from the experience in other countries like South Africa? What happens after cases drop and people relax?

It's interesting because the drop actually can be a different experience in different locations.

Let's just take South Africa and the United Kingdom. South Africa saw that very rapid increase as you noted, and then within a period of about four weeks, case numbers started dropping quite precipitously. The problem is that they've not come back down to baseline — they're still running 10 to 12 times higher than they were before omicron ever showed up. So there's a right side tail, you might say, to that big peak and curve that's in South Africa.

In the United Kingdom, it's even more complicated. We saw again that same very rapid ascent. The number of cases increased very quickly. Then it started coming down, much like we saw in South Africa. However, it then hit a point where it leveled off and started going back up again this past week.

We also saw that very same kind of thing happening with the delta wave in the United Kingdom. And so it is far from over. That may be what we will see here in the United States: the big peak will actually come down substantially, but the ongoing activity could still be a real concern.

You correctly predicted that schools would have large-scale absences after the holidays. Many districts have resisted moving to distance learning. What do you make of that?

It was more about common sense than anything to do with politics or science. And unfortunately what we did is we draped it in politics and science. The issue is, with omicron, kids are going to get infected, whether they stay at home or they go to school. This is a highly infectious virus.

My concern all along was not about the fact we didn't want kids in school — we clearly want our kids in school. But if you don't have teachers, bus drivers and staff to oversee them and supervise their activities, that's not a school. When you have janitors, in the sense, babysitting younger kids, that's not education.

We've basically dug in so deeply on this issue that we just haven't used common sense. If this was a true 38-inch snowstorm with 20-40 mph winds and a below 20 temperature, nobody would say to send your kids to school. If this was a hurricane coming, no one would say to send your kids to school. And some of us just said, “Give us two to three or four weeks at most, and the surge will be over with. Teachers will be back, bus drivers will be back, staff will be back. Then you can go back into the education learning mode.”

So I find it unfortunate that we couldn't see that very common-sense approach and instead got locked into this idea: Our kids must be at school at any cost. That put a lot of school superintendents in a very difficult spot. What were they to do if they had a very limited number of teachers or staff to actually run the school that day?

But there’s a lot of parental pressure to keep schools open.

The problem is with those parents who had schedules to maintain, they still had to stay home with sick kids. And that's the point. We knew that parents were going to have those work schedules interrupted — terribly unfortunate, wish it didn't happen. It's happened in my own family where we've had to have parents stay home because of sick kids. And that's just the reality of this surge.

With the state so backlogged on test data, do we have the visibility we need to know what's really going on with this virus?

You don't have to be within 100 feet of a forest fire to see the forest fire. You can be a few miles away and still appreciate it. I think that's where we're at with omicron in our schools. We didn't have to be in every school to realize that there was tremendous transmission going on in schools and in the community, and in some cases, it was just impossible to distinguish which was which. But there was no question that we saw substantial transmission in both locations.

As far as the numbers, I have said for the past four weeks that case numbers don't mean a lot to me right now. Number one, we have so many people who have not been tested who had been ill because they couldn't get access to testing. Those individuals will never even be counted. And that is many, many individuals.

Second, the health department has been backed up by thousands and thousands of cases because of this huge surge. Even with an extraordinary effort to try to count cases to reconcile who's been reported, what laboratory report does what match up with — we know that the numbers are still but a small portion of those who are really infected. So I continue to focus really on hospitalizations and deaths. While they're lagging indicators two to three weeks late, they've been giving us our best estimate right now of what's really happening in our communities.

With so many people infected with omicron, are we headed in the direction of herd immunity?

I don't buy herd immunity. I have not bought herd immunity for a long time. This dates way back to 2020.

That is for the following reason: Immunity is not durable with this virus. You look at all the people who've been reinfected with omicron, who previously had delta and who had even alpha earlier in the year. Look at even the vaccine breakthroughs we've seen in terms of those who have been vaccinated.

Let me make it very clear: Vaccination is still a key part of our efforts because we know you have about a 20 fold lower risk of dying if you've been vaccinated versus not being vaccinated. You want to be vaccinated just to protect yourself from severe illness.

But on a whole, we still see people becoming infected. And this is going to continue. So the idea that we're going to have a one and out here with a lot of people getting infected, and then we're covered … If this were measles, we could say that. This is not. This is a coronavirus that people are going to be susceptible to again in the future.

And we're going to have new variants show up. Omicron is not the last of the variants to show up. We have to be prepared to live with this. And that's what some of us have been trying to do, is find the way to live with COVID. As much as we have had to live with it over the past several years.

People with weakened immune systems can now get a fourth COVID vaccine. What’s the advisability of that for everyone?

My heart goes out to the people who are immune-compromised to know every day that they risk the possibility of getting infected and having a serious illness. We must do what we can to help protect this very vulnerable population.

The data is clear and compelling about fourth doses for those who are immune-compromised — that you can in fact boost the immune response. Even if nothing else, we're on a limited short-term basis, maybe months, where they'll have increased protection.

Right now the data is really too early for us to assess in terms of a fourth dose for everyone. Israel is doing a study currently looking at this issue. They are vaccinating across a wide breadth of their population with a fourth dose. We'll have to wait and see what that data shows. But for now, the important message is: If you’re immune-compromised moderately or severely, please get that fourth dose.

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