Jun 1, 2022
How to handle a third summer with COVID-19
We’re heading into a third summer with COVID-19 and a lot of people are finding it hard to assess their risk in this new stage of the pandemic.
Most of Minnesota, including the Twin Cities, seems to be coming out of a small surge, but cases are rising in southern Minnesota.
By now, two thirds of Minnesotans have had at least two doses of a vaccine. Even more have likely had the virus. The CDC estimated in April that almost 60 percent of people had been infected. Other studies put that number higher, and it’s sure to have gone up with the recent waves of infection.
But, we also know that being vaccinated or recovering from COVID-19 once doesn’t protect people from getting it again. New strains keep popping up. Wastewater samples from the Twin Cities show that people now are spreading a third version of the omicron variant that hit in January.
More than ever, our individual risk of catching the virus or falling ill boils down to our individual situation.
MPR News host Angela Davis spoke with Minnesota Health Commissioner Jan Malcolm and infectious disease expert, Dr. Greg Poland, about the risk of variants, masking advice, when to time a booster, new vaccines coming in the fall and how to cope with a virus that isn’t going away.
Below are highlights from the show that have been edited for length and clarity. Listen to the full conversation by clicking the audio player above. When you look at the most recent number of cases in Minnesota, how do you describe what they show? How are we doing?
Malcolm: It's even hard to count how many waves we've had now and some of the waves really never ended before the next one kicked in. Certainly, over the last couple of months, we've seen cases going back up but at a slower rate than we did with the original omicron strain in December and January.
We've watched this kind of slow build. I think thanks to vaccination and boosting and treatments, hospitalizations have not risen to the same degree. Over the last week or two weeks, we've seemed to be stabilizing a bit. What about deaths?
Malcolm: We have been grateful that we haven't seen as many deaths in this most recent wave. We’ve pretty much been in the single digits. Still, we've lost over over 12,600 Minnesotans over the last two years. Even when we're having five and 10 deaths a day, that's five and 10 too many. Dr. Poland, how about you? Are you seeing reasons for us to be optimistic now or not? What do you see in how we're doing right now as a state?
Poland: We seem to be divided into two categories: People who believe in science, who believe in the effectiveness of public health measures. And those that don't. Those that I would say, sort of live in a world of hesitancy, doubt and rejection of the scientific method.
And so, you see nationwide, it's almost hard to say, almost unbelievable, that since COVID started, one out of every 320 Americans is now dead of COVID. Over a million people, more than we had during the 1918 influenza pandemic. So, as a health care provider you're caught in this odd world where I go into a room and especially early on people were saying, “When can I get the vaccine?” Now we'd go into a room and say, “I notice you haven't had the vaccine.” (And they say) “I don't want that. That's dangerous.”
The problem we're having now is really a complex matrix of time since last booster, the development of new variants and psychological human issues. “COVID fatigue,” as it's being called, should have no rational place in deciding what do I do to protect my life and the life of my family and my community members. And yet, in Minnesota and elsewhere, the majority of people are pretending that the pandemic is over. It is not.
For example, during the omicron wave we’ve just come through, we had more people die in four months than we did with six months of delta last year. That's stunning. We should have learned as a population that wearing masks indoors makes a lot of sense. Social distancing makes sense. Getting my vaccine and my booster makes sense. And yet we've got a sizable minority that doesn't believe that and don't follow those recommendations. Caller question: Some in my family are getting over their first bout of COVID, but others in the same household continue to test negative. Why? And what should we do to stay safe this summer?
Malcolm: The pattern of who gets it and who doesn’t can be a mystery. One of the most important things that we can do at this point is to stay up to date with vaccines and the boosters. It's very clear now that these new variants can evade immune protection, whether that's from a prior illness or from a from a shot that has worn off.
I really appreciate how Dr. Poland laid out the logic case. There’s a lot of virus out there, certainly outdoor environments are much safer. But when you're in an indoor environment around other people, you might just as well expect to that you're going to encounter folks who are infectious. So stay up to date with those boosters and wear masks indoors.
Poland: One thing to remember, when we talk about evasion of immune response, it's not that there's no protection, it's that each of these new variants requires higher levels of antibody to perform an actual lower level of neutralization. So your age, your medical condition, your genetic background, the time since your last vaccine and which variant is circulating, all play a complex role in in determining this.
There's no strict time limit or time interval between when you got infected and when you get your booster. In general, I'd let you recover and wait a month or so and then get the booster as recommended. What do the new variants mean for our chances of getting reinfected?
Poland: Let me be clear to the point of maybe being blunt: If you're not somebody who has been immunized or who's wearing masks indoors around people who are not your family, you will get infected, and you will get infected repeatedly as new variants arise.
These variants will continue to arise as long as large numbers of people are getting infected. And that will occur through both mutation and what's called recombination. That is what these RNA viruses do. I've studied them for almost 40 years. And this is playing out exactly as you would predict, given the distortion of human behavior happening in the context of a worldwide pandemic. For people who have recovered from the virus recently, how long are we protected from getting it again?
Poland: I could have told you the answer to your question with omicron, which is almost certainly what you got infected with. I don't know the answer to your question in the face of BA.2.12.1. I particularly don't know what the answer to your question is should BA.4 or .5, currently ravaging South Africa, spread here. It's changing so fast that it is almost impossible to develop the scientific data fast enough. How do we time our booster shots if you’re trying to stay fully vaccinated?
Poland: If you tested and it was positive, we would consider that the equivalent of a booster. Now, what's going to happen is sometime this summer, we are expecting a variant focus booster. That'll be important because for the second booster the recommendation is based on two pieces of data, both from Israel.
One showing that (the variant focused booster) decreases the risk of death by about 78 percent. Now stop a moment to think about that. What that means is you reduce your risk from .1 percent to .03 percent. A measurable real difference, but a real fractional one. Why? Because you are gaining the value of the previous three doses that you got.
It reduced the risk of severe or serious illness by about two-fold and moderate illness by about that same amount. But that effect only lasted four weeks, and by eight weeks was gone, highlighting the need for updated boosters, or so called variant focused boosters. Caller question: I was exposed to COVID, had a negative test, I’ve had one b…