Epidemiologist Dr. Michael Osterholm on what the UK variant means for the pandemic's 3rd act

As a prominent epidemiologist, member of President Joe Biden's COVID-19 Advisory Board and a frequent expert commentator on the pandemic, Michael Osterholm, PhD, is skilled at transforming complex information into metaphors digestible for the general public.

It's clear Dr. Osterholm has perfected this messaging strategy over the past year as he's issued warnings about the pandemic's trajectory alongside encouragements to maintain public health precautions. His latest messaging comes in the form of a warning about the U.K. variant B.1.1.7, which is rapidly spreading across the U.S. as many states opt to lift or scale back virus restrictions.

"This is the perfect storm," Dr. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, told Becker's. "Here is Europe locking down and having problems containing B.1.1.7, even with vaccinations and previous infection histories. Here we are opening up as wide as we can. We are literally just walking into the mouth of the virus saying, 'Don't worry.'"

Based on emerging data, Dr. Osterholm said the U.S. could see a surge of B.1.1.7 cases within the next few weeks. He predicts the variant will primarily infect children returning to in-person learning who will then spread it to their parents and other adults. 

During a March 17 interview with Becker's, Dr. Osterholm discussed what a potential surge could mean for hospitals, why he's a proponent of delaying second COVID-19 vaccine doses and the importance of maintaining humility amid the pandemic, among other topics.

Editor's note: Responses have been lightly edited for length and clarity. 

Question: In the March 11 episode of your Osterholm Update podcast, you talk about what the "third act" of COVID-19 could look like. Can you elaborate on this? 

Dr. Michael Osterholm: We have to acknowledge that this is, in part, unknown territory, so I'll give you my best estimate. If you look at B.1.1.7, it's clear there is increased transmissibility and more serious illness. That by itself is a real challenge. The good news is that our current vaccines cover it. 

In Europe, once B.1.1.7 hit about 50 percent of all viruses, you saw surge activity begin to occur. Most of these countries are dealing with B.1.1.7 with really intense lockdowns, as you've seen in England. Malta and Hungary are two countries that have been actively vaccinating. They have both also had extensive previous experience with the virus. In fact, Hungary right now has the third-highest death rate in the world. There were surely lots of people in those two countries who've been infected and could have protection. Yet, if you look at the curves right now for Hungary and Malta, you will see they are in exponential growth, and it's all B.1.1.7. If you look at a number of other countries in Europe, it's increasingly widespread in spite of what lockdown activity they've had, as well as what they're doing with vaccines — which isn't as extensive as ours — so take that as background.

In the U.S., we are surely vaccinating, but if you look at the rate at which we're vaccinating and the number of people who likely have been previously infected, we're talking about at most 50 percent of the population being immune to this virus. In countries with similar population-based protection, we are seeing that once this takes off, it still creates major challenges. I have no reason to think why it won't here. 

Some of my colleagues are saying this isn't going to happen because seasonality will kick in, and we're getting to the summer months. Go tell that to the people in South America right now, who are still in late summer or early fall. There has been no reduction. Explain to me why the big peak we had in July, which occurred primarily because of activity from Southern California to Southern Georgia, was also the same geographic area that largely contributed to the peak in January. Does that sound like seasonality to you? It may one day become a seasonal virus, but right now we don't have any evidence of that, so you can't count on that at all. We don't know why the number of cases came down dramatically in January. You can't argue that it was more stringent mitigation strategies. You can't argue that something new happened where people were now distancing more. This virus is going to do what it's going to do. What we can best do is protect ourselves by not being exposed and getting vaccinated.

Q: Do you envision a situation in which hospitals are again overwhelmed with COVID-19 patients amid a B.1.1.7 surge?

MO: That's the question. The one area where we may do well is that we're vaccinating more people in older age groups. We know 80 percent of deaths, serious illness and hospitalizations occur in those age 65 and older. So that is going to be one issue. The second issue is what proportion of the population is going to have severe illness among those who are younger. In Europe, we are seeing a higher proportion of younger patients who are experiencing serious illness and need hospitalization. The rate of serious illness is still substantially lower in that age group, but it's higher for each age group than in the past. So we don't know what that would add. We're really unclear right now what this is going to do in terms of overall number of hospitalizations.

Q: You have actively been calling for the U.S. to recommend extending the interval between the first and second COVID-19 vaccine dose to vaccinate more people more quickly before a potential surge, and Canada recently issued its own recommendation on the matter based on a review of the data. When would the U.S. need to make its own recommendation decision in order to prevent a B.1.1.7 surge? 

MO: Last month. I think the fact that the Brits and Canadians have done it makes it unfortunate that we haven't. Bottom line, I would just call for an intensive and comprehensive review. What are the data on vaccine efficacy? What are the data on immunology? What are the data on variant issues? What are the data if we model B.1.1.7 activity with delaying a second dose? One thing I want to be really clear on is that I'm not calling for skipping the second dose. I'm talking about if a B.1.1.7 surge occurs over the next eight to 10 weeks, what can we do to delay getting a second dose and then come back and get our second doses once vaccine supply ramps up in April or May? The Canadian statement was very clear and compelling. They came right out and said, look, vaccine science tells us that you wouldn't expect to see a sudden loss of protection with a vaccine that is this highly effective. I agree with that. 

One of the concerns I have is that governors and mayors are, in a sense, trying to make all those who want vaccines feel like they can get it. But remember we are still administering about 2.7 to 2.9 million doses a day. Most of that is all Moderna and Pfizer, so it is a two-dose approach. That means we're really only vaccinating 1.3 to 1.4 million new people a day. Even if we directed all the vaccine supply right now to those 65 and older, it would still take us two weeks or more if we stop vaccinating everyone else and just inoculated them. That doesn't even count for the ones who have already been vaccinated and still need a second dose. Given the fact that we opened vaccines to everyone, we are diluting substantially our ability to vaccinate those 65 and up. At this point, I think we're missing an opportunity to provide protection to prevent serious illness, hospitalization and death.

Q: Your warnings of a B.1.1.7 surge come as some states lift restrictions and the public's perception is that the worst of the pandemic is over. What metrics or observations do you lean on to get a sense of the public's perception about the pandemic? Commercial airlines and travel figures? People in your own neighborhood resuming normal activities?

MO: Those are all very, very important to look at. I understand why people feel like they want to be done with this pandemic. It makes perfect sense. The problem is it's also like wanting to defy gravity if you don't like it; it's still going to operate. This virus is going to do what it's going to do, so we have to adjust accordingly. To me, one of the greatest tragedies is to die from COVID-19 one week before you were scheduled to get your vaccination. You've made it this far. That's the challenge we have. How do we help people get through? B.1.1.7 is covered well under this vaccine. It's not like the other variants we still have to worry about. It would be a painful irony to lose people now after a year of working hard to keep people from getting infected.

If you see what's happening right now, this is the perfect storm. Here is Europe locking down and having problems containing B.1.1.7 even with vaccinations and previous infection histories. Here we are opening up as wide as we can. We are literally just walking into the mouth of the virus saying, "Don't worry." The variants in general create a whole new situation. It's no longer what inning we're in, but what quarter because it's a whole new ball game. It's hard for people to accept or acknowledge that, so this is where humility comes in. 

Q: In a past podcast episode, you've spoken of the importance of creating "winnable moments" during the pandemic. What has been one winnable moment for you?

MO: I had my first dose of the vaccine and have deferred my second dose. When that needle went into my arm, I cried and not because it hurt. It was just such a relief to have that one dose on board. That was an incredible winnable moment. And I look forward to getting my second dose, but I'm not afraid to between now and then live my life as I've been living it.

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