Michael Osterholm on how new COVID variants could change the pandemic's trajectory

About 1.67 million doses of COVID-19 vaccines are being administered to Americans daily, but some public health experts are concerned that vaccinations aren’t happening fast enough.

Bloomberg estimates that at this rate, it will be eight months before 75 percent of American adults are fully vaccinated. At its current pace, Minnesota won’t vaccinate 80 percent of the state’s population until October. Only 12.8 percent of the state’s residents have so far received at least one shot.

As vaccinations continue, new variants of the virus are spreading. Scientists worry that the vaccine could be less effective against these mutations and that infection rates might rise again if one of these variants becomes the dominant strain.

Thursday, MPR News host Kerri Miller spoke with the University of Minnesota’s Michael Osterholm about the emergence of COVID-19 variants and what they will mean for the country’s vaccination efforts.

Guest:

• Michael Osterholm is an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He is also a member of President Joe Biden’s COVID-19 task force.

The following is a lightly edited transcript of highlights from the conversation with Osterholm. To listen to the full conversation you can use the audio player above.

I saw your appearance on Meet The Press on Jan. 31, saying the darkest days of the pandemic could be ahead, and I was pretty shocked. I mean, 18 days have passed, a lot has happened. How are you feeling about that now?

I'm more convinced that that's actually the case. I think right now what we're seeing is basically the lull before the storm. I liken it in a sense to — imagine we're all sitting on this beautiful sand beach on the Gulf somewhere. Blue skies, temperature of 80 degrees, slight breeze, not a cloud in the sky. And we're trying to tell people, "Get ready to evacuate." Everyone is saying "Why? this makes no sense." But we can see that Category 5 hurricane 400 miles south of the beach heading straight towards the beach. And that's what these variants represent right now.

Is the Category 5 hurricane, specifically the B.1.1.7. Because we're hearing that it will end up being the dominant variant or the others that are emerging?

Yeah, it is the B.1.1.7 variant. Just to give a background so people understand: A variant of this virus is just one that has experienced mutations. And they do that all the time. There have been many, many, variants of the virus since its first emergence. But we have a category of variants called variants of concern — VOCs. And these are viruses that have mutated to do one of three things or a combination thereof.

First, do they transmit easier, more widespread, than the other viruses would do? More transmissibility? Number two, do they cause more serious illness, including death? And number three, are they able to evade the immune protection that we get from either vaccine or natural infection, and in some cases, even the treatment with the monoclonal antibodies?

The B.1.1.7 variant, which some people refer to as the U.K. variant, which emerged in England, which has now spread to a number of areas throughout Europe and the Middle East, has those first two characteristics. It surely is much more transmissible 30 to 70 percent more transmissible, and it surely is causing more severe disease, including increased deaths and hospitalizations.

But it hasn't yet, in a widespread manner picked up that third characteristic, the one about evading the immune protection. …

Just this week, CDC is updated, it's now in 42 different states documented, I'm sure it's in all 50 states. And what we're following right now is almost a similar scenario, as we saw in the European countries that have been so hard hit by this virus in terms of, you know, weeks of early transmission where the level appears to be low, but then it picks up very quickly. And if you think about doubling numbers, you know, two to four to eight to 16 doesn't mean big changes. But if you start doubling 2,000 to 4,000 to 8,000 to 16,000. Those are big numbers. And that's what we're worried about — this virus is following that same path in North America as we have seen in Europe and the Middle East.

OK, a couple of questions about what you've said. I also am reading about this Bristol variant that has also emerged named for a town in the U.K. that also carry some of these qualities, characteristics that you've just talked about. So what are you hearing and understanding about this new variant?

Well, you know, Kerri for the couple of people in this audience who are old enough to remember the 1960s music scene, there was a famous song by The 5th Dimension called the "Age of Aquarius, Let The Sunshine In." And I have to tell you, day after day after day, and this is happening for the last six weeks, I just keep hearing in my head, this is the dawning of the age of the variants.

They have fundamentally changed the game with this particular pandemic. And we have to respect them, we have to try to understand what they mean. I actually think I know less about these viruses today than I did six weeks ago.

The more we learn, the more questions we have about what's going to happen. I haven't even mentioned the other variants, one you mentioned, but also one called P.1 from Brazil or B.1.3.5 from South Africa, which have acquired part of one and two characteristics, more transmissibility is more serious illness. But what's really concerning is they've acquired a third bucket of opportunity. In other words, being able to evade the immune protection, at least to some degree from the vaccines or natural infection.

So expect we're going to see many, many more variants. There was a confusing article in the media just in the last two days about a series of new variants here in the United States. And the researchers that did the work were absolutely right on target, their message was correct. But they said these variants aren't causing us any unique problems, meaning that they weren't one of the three buckets, the media took that to mean variants don't cause problems. And I just come back to reaffirm, some of them are real big problems.

To be clear, this is not unusual in a virus that variants would emerge. But you're saying you really can't track the path of what these variants will do, because they're kind of new beasts to be studied?

Well, what's happened is, they've acquired an ability to mutate that we haven't seen before. In fact, in the early days of the pandemic, when we had talked about kind of aging the virus and that it was relatively new into humans, likely having been in animals first, we actually base that on what was that time some kind of orderly increase in mutations that would occur. Now we're seeing viruses go from, you know, three or four mutations to 23 mutations just like that.

Remember, a year ago, right now, this virus had hardly even tamed the world at all. I mean, it was not there. And so what's happened is over the course of the past year, particularly as we've had more and more immunity, developing people previously infected, for this virus to survive, and actually proliferate, one of the things that wants to do is basically get around that immune protection that our previous infections for vaccines have given us. They didn't have to worry about that a year ago, because there was really very few people out there.

We call this basically microevolution, the virus is adapting to the conditions. And the problem is the way it's adapting. It's concerning us about our immunity. The second thing, it's kind of in the survival of the fittest, this B.1.1.7 is much more capable of being transmitted. That's why we're so concerned that the conditions that we took even six to 10 weeks ago, may not be sufficient to reduce transmission now.

Meaning if I went to an indoor air environment, and there was some virus in there, because somebody was infected, but I had a mask on, I didn't spend too much time in there, I might not have gotten infected today, that might be a situation where you would get infected just because of the increased virus. That's what makes us so challenging right now. It's not being transmitted any different ways than we see with the previous viruses. It's just that there's more of it. There's more of it in the air, and it's more likely to to infect you.

When you said, the darkest days of the pandemic, may be ahead. You said that on Meet the Press and you're this morning saying yes, this is what I see. Does that mean darkest days being when we were at the top of these spikes in November, December, January? Is that what this is going to look like in the next 60 days?

Well, let me just give a sense of what we call shifting baselines, it’s something I've been trying to help people understand because it really reflects and how they think about where we're at and what's going on.

We are today at, you know, 75,000 cases reported today, and everybody is feeling really good about that — 75,000 cases a day in July was a “house on fire” event. But if you go back to the beginning of the pandemic, you know, the first real big peak we saw in the United States was in April, when New York in particular was hit, but Chicago, Detroit, Atlanta, Seattle, Boston, you know, very little even activity in the upper Midwest, we hit 32,000 cases a day. And that was really bad.

We got down by Memorial Day to 20,000 cases. And then the southern states from Southern California to Georgia lit up in July, we went up to 70,000 cases, remember, 32,000 was really bad. And then we got back down to 26,000 cases at Labor Day. And in fact, it was on Meet the Press shortly after that. And I said, I thought we'd hit 200,000 cases by Thanksgiving. People thought that was crazy.

On Nov. 20, we hit 200,000 cases, then we came back down to 160,000 cases in mid-December. But then look what happened in early January, it hit 300,000 cases. So you see as a curve line here with the number of cases just keep going up and up and up for the highs and the lows.

So what I'm concerned about is we're in one of those decreasing case number times, which is great, but none of us want to see anybody get infected, sick or hospitalized or die. So listen, we have to celebrate this. But what this has done is given us this false sense of security: we've won. If you just think about this right now we're loosening up everything, governors and mayors are under such pressure to loosen up everything. When you look at vaccine, it's coming and it's in right now with the B.1.1.7. This vaccine will work but we're not going to have nearly enough in time. Our studies have shown that if we keep up the current vaccine efforts we’re doing now, by the end of March we will still have 30 million out of 54 million persons in this country over age 65 who have not had a drop of vaccine. Those people are going to be at high risk for this virus. And I think it's going to take off in early to mid-March. And we're gonna see that next big peak, and it will very possibly exceed what we saw in January.

Listen to the full conversation by using the audio player above.

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