(upbeat music) - Good evening and welcome to this special edition of "Doctors on Call."

I'm Dr. Mary Owen, faculty member at the University of Minnesota Medical School, Duluth campus and family medicine physician for the Center of American Indian Resources of the Fond du Lac Band of Lake Superior Chippewa.

I'm your host for our special program tonight with noted epidemiologist, Dr. Michael Osterholm.

I want to note that this is a prerecorded program and all questions were received prior to tonight's show.

If you'd like vaccination information, please go to the Minnesota COVID-19 Connector Page listed below.

We'll also have the website link on our webpage.

Joining me by Zoom tonight is Dr. Michael Osterholm, head of the UMN Center University of Minnesota Center for Infectious Disease Research and Policy.

We'll be discussing the current state of affairs regarding the COVID pandemic and answering viewer questions received through email.

Dr. Osterholm, thank you for joining us tonight.

- Well, thank you very much, Mary.

It's really good to be with you.

Thank you.

- What's your current assessment of where the COVID pandemic stands right now?

Indicators show a reduction in the number of infections in hospitalized in Minnesota, will this current trend continue?

- Well, I think it's really the tale of two cities right now.

One is we surely are watching the case numbers dropped and dropped precipitously from their peak that we experienced in early January.

Right now we're seeing nationally cases going from 280,000 per day reported to now down to 80,000 per day reported.

I would just add a caveat to that that back earlier in the year when we were first dealing with this pandemic back in April and July, that time 30,000 or even 70,000 cases was considered a house on fire kind of moment.

So think about from that standpoint we're at today.

But the real question is, with ongoing vaccination occurring in our communities and the fact that these case numbers are dropping so much, does this mean we're kind of over the pandemic?

And this is where the other city, the tale of the other city comes in, and that we're all very, very concerned about the evolution of this what we call B117 variant virus has mutated that has a much higher level of transmission as well as causing more serious disease.

This virus, which originated in the United Kingdom, has now spread through large parts of Europe into the Middle East, it's caused a very, very a substantial increase in cases in those areas.

Many of the countries, such as England, Ireland, Denmark, have been on lockdown literally since Christmas time.

And that is a harbinger we think of things to come.

We're actually seeing in the United States right now quite widespread transmission of B117 at least in 44 states, and it looks like it probably is in all 50 states, just aren't adequate testing capacity.

And if you look at the natural history of what is happening here and compare that to what happened in November and early December in Europe, it's like a deja vu all over again.

Meaning that early on there weren't that many cases that were causing the numbers for the countries to increase substantially, then all of a sudden it took off almost like a match to a pile of dry kindling.

And what we're concerned about is as we get into March, we're gonna see a major surge of B117 occur in this country as well as in Minnesota.

I can say right now that we don't have nearly enough people protected either by vaccine or by natural infection to have a dramatic impact on the potential surge.

At best right now, 35% of the Minnesota and nationwide population are immune from either having had previous infection or as a result of vaccination.

So, you know, we hope that this B117 surge doesn't occur but all the indications right now is it will, and so we're gonna see potentially a very rapid and dramatic change in that case numbers coming down and going back up again.

- You've been talking about this on national television and NPR, including NPR recently, how do you feel that the federal response is to your message?

I know that you are in contact with Biden administration, are they listening to this notice about the tsunami coming and us partying on the beach right now?

Or where are we at?

- Well, I think that at least some of the government's listening to it, the Centers for Disease Control and Prevention, the CDC, actually put out a report almost a month ago highlighting this B117 situation and actually warning that the case numbers could peak in March from the B117 in this country.

And again, as I say, when you look at what it's done other countries in the world, it's a big concern.

Just a simple, but yet not so far from home event, is what's happened in Newfoundland, for example.

They've had more cases in the last two weeks from B117 than they'd had in the entire pandemic up to that point.

And we're seeing clusters like this beginning to develop in other areas, also North America.

So I think the challenge right now is understanding just how much B117 will increase and what it will do to the rates of hospitalization, serious illness and deaths.

As we have said over and over again, the strongest risk factor for bad outcome with this virus is age.

80% of all the deaths in this country are in those 65 years of age and older.

And that's the challenge we're faced right now is if we continue vaccinating as we're doing in terms of who is targeted for vaccination, whether we use two doses or a one dose deferred second dose till later in the spring, we can easily see 30 million Americans 65 years of age and older will not have a drop of vaccine before the end of March.

That would be a real tragedy.

- Regarding that statement of needing to vaccine, use the one dose vaccine and hitting as many people 65 and older, some populations including my own, Native American populations, but also African-American populations and Hispanic populations have seen this virus hit and kill at younger ages.

So given that we're also hit at much higher levels or numbers than the general population or the white population.

So would you suggest that we also recognize that piece and vaccinate for younger in those populations at the same time with the one dose?

- You know, Mary, the challenge we have right now is whether you're a teacher, whether there is racial and inequity that occurs, et cetera, you know, I'm sitting here looking at how can we save the most lives?

How can we actually reduce the overburdening of our healthcare system to the point of compromising care?

And as we've just put out a document this week, really exploring that issue, acknowledging the point that you just made, also acknowledging that there are other groups that believe that they should be at the top of the list such as teachers.

In the end, again, even taking into account racial inequality, we have shown that if you vaccinate 65 years of age and older, you'll save that many more lives.

So we don't want to leave anybody behind, no one.

But the choice of continue to do what we do and seeing a big increase in cases, and we demonstrate that in our papers, I hope people go to our website and look at that.

And it does include experts from around the country, a number of people, not just individuals from our centers.

So I hear you and you're absolutely correct in your assessment, but when we look at the actual population challenges we have, using a 65 years of age and older prioritization right now would save the most lives.

- Okay, thank you for that.

You know, it said that the faster that we get everyone vaccinated, the less chance we have for the spread of the variants.

It doesn't spread quite as quickly.

Given that how slow our vaccine rollout is occurring, are we doomed to always be chasing our tail?

What's your thought on this?

- Well, the variant situation deserves a little bit more explanation.

You know, we've had variants since day one with this pandemic.

They are just viruses that have mutated, have some change in the virus.

It's only been really in the last three months that we've talked about variants of concern, meaning that of the thousands and thousands of variants that have occurred, there are ones that have taken on special characteristics that make them even more challenging or dangerous.

And the three buckets of concern we've had with variants of concern is number one, are they much more transmissible?

In other words, as we've seen some, they may be 30 to 70% more transmissible or more likely to transmit the virus to someone else.

Number two, do they cause more severe illness?

And we surely have evidence that that's occurring with some of the variants.

And then number three is one that is overshadowing all of this is do they evade the immune protection provided by vaccines or a natural infection?

And so far the B117 variant that we have confronting us now in North America really fits into bucket one and bucket two.

Clearly it's much more transmissible and clearly it causes more severe illness.

We don't have evidence yet that it's actually evading the immune protection afforded by vaccines or by natural infection.

Now, there is a new B117 strain in England that has just acquired that but we're not seeing that circulate widely at all through much of the world.

Then there are two variants that have received lots of attention, P1 or 1135, P1 is from Brazil, 1135 is from South Africa, they have spread to some degree around the world, and in fact, P1 has been found right here in Minnesota, but their spread has been quite minimized relative to the B117.

These latter variants would obviously have real concern if in fact we were to see vaccines be reduced in their effectiveness because being infected by one of these variants is still unclear to us just how much of these vaccines would be compromised, but surely something real there.

So when you ask, are we gonna be out of the woods with vaccination, it's gonna depend a lot on what happens with the variants, which then leads me to my final point, is that right now, we all want to get ourselves vaccinated.

And I understand that, as a country we want to use the vaccine here.

But we have a global obligation for vaccination which I think is compelling, and it's not just based on humanitarian reasons.

Surely that's sufficient or enough to want the world to get the vaccine, but what we're seeing these variants spin out right now where they're actually beginning to occur is in fact in the face of natural infection and the immunity from that.

And so, if low and middle-income countries continue to see transmission of this virus at a high level, it's gonna keep spitting out variants that are gonna now be dangerous to us in the rest of the world.

So getting the low and middle income countries protected is a huge priority for us right now.

We need to do that, not just for humanitarian reasons, which is enough, but because also it's a very strategic response, meaning we don't want to have vaccines in high-income countries become compromised because now we see variants circulating that developed in low and middle-income countries that we could have prevented with more vaccination.

That's the challenge we have.

So I wish I could give you a clear cut answer, I'm hopeful, I hope that in fact by the middle to the end of next summer, things are gonna be much better in this country, but as you and I both know, Mary, hope is not a strategy, and so it's gonna really depend on what happens with these variants.

- Thank you, that actually is very helpful and it does answer another question by one of our viewers.

Another question from a viewer is, you've talked about how we know about these variants, but our audience wants to know how fast can scientists discover when there's a new strain of coronavirus and how are governments communicating with one another about these things?

- Well, we can actually discover them quite quickly, we have in place the laboratory testing to do what we call sequencing, actually determining the genes of that particular virus.

And so, in the United States, we're catching up behind.

Just a month ago, we were 42nd in the world as a country goes in terms of the number of isolates we're sequencing compared to what was occurring in our population.

And so we need much better information, we have been in a sense flying blind for the past months with this issue.

Now the new administration has made this a priority, they're allocating resources, they've put CDC in charge of trying to enhance this.

So this will be very, very helpful.

But the point being here is that even if we find that these variants are circulating in our communities, it doesn't really change what we do beyond trying to get people vaccinated, beyond trying to keep people limited in how they might share the virus in the community, meaning we just can't automatically go back to what once was 18 months ago.

And so we're gonna have to look carefully at that and determine if these variants should take off.

What does that mean for us?

Right now, if it's B117 and you've been vaccinated, one, even two doses, and your partner is, and your friends are, I don't see any reason why you can't get together and live life like you did before the pandemic.

Now some will be critical of that and say, well, we don't have enough data yet to know if in fact one can be infectious asymptomatically, meaning having been vaccinated and getting reinfected and transmit.

But if you really buy that that's the issue, then we're gonna be like this forever, meaning we'll never ever get rid of the masks, we'll never ever be able to open up everything the way it once was.

And I don't think Americans are gonna live like that.

I think there's gonna have to be some public health understanding and acceptance of just what is the risk?

How much are we assuming once somebody is fully vaccinated and people are gonna get back to living life again in a way that I think we have to understand what the risks are, but we can't stand in the way of saying, "Oh, until we get more data, everyone has to basically still go through all the kinds of issues of quarantine and not getting together, et cetera."

I think that's gonna be a real challenge.

- Okay, thanks.

You answered in there a couple of other questions that people have about what they can do or when are they free after they get vaccinated, so that was helpful.

A lot of people wonder about ibuprofen interfering just on the vaccine themselves, interfering with the vaccine.

Have you heard anything on this?

- You know, we've heard about you shouldn't take ibuprofen before vaccination, you shouldn't take ibuprofen after vaccination, and yet there are no formal recommendations against that.

So, you know, at this point, I surely wouldn't comment beyond saying that, until the CDC or the FDA issued some kind of alert suggesting that the immune response will be reduced because of ibuprofen, my sense is that that's not a problem and won't be, but we need to surely clarify that for the public.

- Okay.

Another common question that people have is if they are immunocompromised, in particular one person asked if they have a multiple low CDA counts.

- Well, again, I truly can't give medical advice on a TV show here, you should contact your individual provider to learn about that.

But being immune-compromised, just as was stated, should not be a reason not to get vaccinated.

And in fact, some would say it's even a greater reason why to get vaccinated.

So at this point, contact your private physician, but don't assume because that's your status that you shouldn't get vaccinated.

You may be someone who really needs it to address your immune deficiency.

- A lot of people wonder, they've had strong reactions to the flu vaccine in the past or to other vaccines in the past, anything to control the response or the reaction to the vaccines?

- Well, these are very different vaccines, and we're at the point of possibly licensing another new technology vaccine in the days ahead.

The two that are currently on the market, as you know are messenger RNA vaccines that have had their own series of reactions after the vaccination process.

And by reactions, I'm talking about more the kind that occur hours afterwards.

We had a fever, chills, muscle aches, but improved dramatically with usually 24 hours.

So, you know, to me, I would say, this is surely a possibility that you can get a reaction, many people find that a badge of approval when they have some symptoms because it says the vaccine's working, it's doing its job.

Now, the new vaccine, an adenovirus vaccine we'll have to see just how they work out, what that means.

Also, we have vaccines now being made out of cell culture environments with insect cells.

And so we'll see how they work but the one thing that's clear is that on the messenger RNA vaccines, at least, the rate of severe reactions is very low, less than the area of one per million population.

And so, and all of these are ones that resolve quickly, particularly with epinephrin.

So, you know, in a sense, we wouldn't surely tell you not to get a vaccine because you've had a potential problem with influenza vaccines.

That would not be a contra-indication for getting this vaccine.

- Okay, we're gonna jump back on a question regarding the variance.

The incipient national surveillance system which tracks genome sequencing and coronavirus sampling is critical.

The data it produces is used to identify and track the new spread of variants.

What are your thoughts about the importance of and current problems in building a national genome sequencing database?

- Well, we're a day late and a dollar short.

We should have been doing this all along so that we would have the kind of information we need today.

I'm confident that the private sector, the academic labs, and the public health labs with leadership from CDC will be building a very robust system over the days ahead.

I wish it were done now, but it's very important.

We do need it, we need to not be flying blind with regard to what viruses are impacting our communities.

And all I can say is that it's coming, stay tuned, and hopefully we'll be better every day.

- Anything you recommend that we as citizens can do to advocate this path?

- Well, I think the most important thing right now is to understand it isn't over till it's over.

And I fear a lot of people right now are making the assumption, because case numbers have come down, that in fact the pandemic is over.

And I worry very much about loosening up society, which as everyone else, I'm tired, I'm frustrated, angry, about just what we have to go through day after day.

You know, people who lose their jobs, they don't have a roof over their head anymore, they're hungry.

1/5 of all families in this country right now are in a food shortage situation.

So all of that's there.

We want to move on so badly.

Oh, we do.

But I worry that this next wave that could be coming with B117 could be very dramatic.

And so what we have to do is help people understand that we're almost there, we hope, but we've got this last one to get through.

By the time it ends, vaccine numbers will increase substantially, and then hopefully our vaccines will persist in being protective.

We won't see the variant activity that compromises immune response to vaccine become the variant of real concern in all of our communities.

But we don't know that yet.

So I'm hopeful, but as I said earlier in the show, hope is not a strategy.

But at the same time, we at least have a better understanding of who and what our enemy is today with this virus than we did four months ago.

- Great.

A lot of people have questions about timelines.

Someone says, "I have a 12 and a 15 year old, both have asthma.

I've hoped to return them to school in the fall.

What's the realistic expected time that our kids might be getting these vaccines?"

Any thoughts on that?

- At this point, there are studies ongoing, as you know, kids are approved down to age 16 for one of the vaccines, 18 for the other.

Studies are ongoing right now that would take that down to 10 years of age and roughly there.

And then I think additional studies will be conducted very quickly in those younger than 10.

Once that all happens, I think these vaccines can be approved quite quickly.

I can't say that by next fall they'll be approved, but we're hopeful that that might be the case.

That surely would make a lot of people feel a lot better.

I, for one, as I have five young grandchildren and I can't wait to have them be able to get vaccinated and be protected.

- Yes, I think regarding the grandchildren, I think all of us are just waiting to be able to be in touch with one another, to support one another that way.

It almost feels like we're in an age similar to the pre-antibiotics age, this unknown, and even though we do have treatment.

So where do you see us in the future?

We don't know where these variants are going, we don't know how much control have them, where do you see us next year, for instance?

- Well, you know, it's gonna be all about the variants.

I've told people, I feel like I'm back in the 1960s and the song keeps humming in my head from the 5th Dimension.

For those few of you listening who are old enough to remember that song is the dawning of the Age of Aquarius.

Let the sunshine in.

And that song goes, this is the dawning of the age of the variants.

I hear that played over and over again.

The variants are gonna have such an important impact on what happens with this infection and what it does.

So, so stay tuned, we just don't know yet.

- Thank you.

I think we have time for another question, is research being done into the possible genetic connections with more severe COVID-19 disease, reactions and outcomes, and do the genetic components have an effect on the effectiveness of the vaccine as well?

- You know, we surely have emerging evidence that our own immune response is a very important part of the illness that we see.

And so from that perspective, yes, our immune response, as based on our genetics, is very important.

Something as simple as long-haulers disease, that chronic condition that tends to occur after people have had it is much, much more common in women than in men.

You know, why does that happen?

What are the correlates of protection of the vaccines and how does that relate to age, gender, race, ethnicity, et cetera?

So I think at this point, yes, it does, and we're gonna be learning a lot about the genetics and the immune response of humans with this virus for the years to come.

In some ways, it's almost like a New Renaissance of study and efforts, much like we saw in the early to mid-1980s with HIV.

Anyone who was in the area of medicine knows that as much as we studied HIV, we learned so much about the human immune response.

And, and we're going through that very new learning experience right now.

- Someone asks a very specific question regarding our immune system and the immune compromised status.

And that's, do you think it's possible that the immune compromised COVID infected patients and other chronic infected receiving ongoing COVID medical interventions without cure could be the next Typhoid Mary of these pandemics?

- It's possible but I think at this point we're learning about them also and how to best treat them.

We know that using the issue of immunotherapy is not likely to be helpful and may actually spur on the development of variants.

But I think this is where drug discovery is gonna play a very important role.

- Dr. Osterholm, we just have about a minute or so, is there anything else that you would like to tell us?

- No, I think you hit it all.

I appreciate the opportunity to be with you today and thank you, Mary, for all you do at UMD is clearly a very, very important part of our educational experience in this state and to all of us that love the Duluth area.

We just are so glad that you're there and I could be with you today.

So thank you.

- Well, thanks for your message both on a local, state, regional, and national level.

- Thank you.

- I want to thank Dr. Michael Osterholm tonight.

The discussion tonight is both timely and informative, thank you for watching and good night.

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