'This Pandemic Still Has Legs': COVID-19 Expert Q&A

Lambeth Hochwald

November 05, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

With so much COVID-19 news breaking this week, including the authorization of vaccinations for children ages 5 to 11 and a Jan. 4 federal mandate for workers at any company that employs at least 100 people to be vaccinated or get tested weekly, we wanted to sit down with Michael T. Osterholm, PhD, director of the University of Minnesota's Center for Infectious Disease Research and Policy, to discuss the pressing COVID-19 issues we're facing right now.

WebMD: Now that kids ages 5 to 11 are eligible for a COVID-19 vaccine, what still concerns you?

Osterholm: Right now, you have a situation where about a third of parents are indicating they will get their kids vaccinated as soon as possible. Then there are a third of parents saying, "Maybe, I will wait and see," and the final third who are saying, "No way." Now we need to see how many of that middle group of parents will get their kids vaccinated. That could determine what the holiday season will look like.

WebMD: How do you feel about the Biden administration's mandate for workers to get vaccinated or get tested weekly by Jan. 4?

Osterholm: A lot of people don't realize that ongoing transmission will keep occurring in this country. If you look at what we're seeing in the Southwest, you can see what's happening ― case numbers are increasing quickly. The bottom line is that we have 65 to 70 million people left to get infected. That's the challenge we have. Look at the Four Corners. In those four states [Arizona, New Mexico, Utah, and Colorado], case numbers are going way up, and Colorado's governor just announced they're deferring elective procedures. All of this sets the stage for why this mandate is so important.

WebMD: Will we ever move from pandemic to endemic?

Osterholm: In my podcast, I go into the challenges of vaccines. One thing I try to put forward is that the euphoria we had almost a year ago when the vaccines became available was real. At the time, data were showing 99% protection against illness, hospitalization, and death. That was before we understood what would that look like 6 to 8 months later. Just add up the issue of variants as well as the number of people not protected. Then look at the people with evidence of protection, and we don't know how long and how well it will last. This pandemic still has legs, and it's why we have to have a huge dose of humility about this virus.

WebMD: When it comes to the booster, some people are getting antibody testing to help decide if they need one. Good idea?

Osterholm: Under no condition should you use antibody testing as a gauge of whether or not you need a booster. We don't know what antibody studies mean. Just because you make an antibody at a higher level, we don't know yet how this connects to protection. Until we have some sense of correlative factors, such as how much do T cells play a role and what does protection mean and studies where we can correlate immune response and different kinds of antibodies, you can't use antibody testing as a reason to get the booster ― or not.

WebMD: How are you feeling right now about where we are in this pandemic?

Osterholm: I think a lot about: How much do we know? How much did we think we knew? For example, the vaccines are remarkable but they're not perfect. That's a key message.

Also, if this was a typical vaccine, we would have spent 5 to 6 years studying and looking at long-term immunity. We would have gone into the approval process with an exhaustive dossier.

We couldn't do this because we were in a pandemic, so once we established the safety of the vaccines, we were in a situation where our goal was to study how to best use them, including what the doses should be and how many doses a person should receive.

We're all learning that and trying to understand this. And this is important: This isn't indecision or incomplete information. We're learning. It's an evolving science. The thing I'm learning is to have an even bigger dose of humility about this virus.


Michael T. Osterholm, PhD, director, Center for Infectious Disease Research and Policy, University of Minnesota.


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