'It's going to be tough'—epidemiologist Dr. Michael Osterholm on reopening offices

By Kevin J. Delaney

Coronavirus infections are worryingly increasing in the US again. What does this mean for the organizations that have reopened their offices, and those that are assessing whether to do so? For answers, I spoke with Dr. Michael Osterholm, a leading US epidemiologist who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. Here is a transcript, edited for clarity, of our conversation about the outlook for the virus and the safety of workplaces.

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Courtesy Dr. Michael Osterholm

What's your outlook for a new wave of infections or the level of infections that we might see in the US?

I think we're going to see a substantial increase in the number of infections right up through the time when a vaccine becomes available, and at least through early to mid winter.

We're entering flu season here—how much will that complicate the situation?

At this point, I don't think we can really say with any certainty what the fall flu season might look like. If you look at what happened in the Southern hemisphere during their winter or our summer, it was actually one of the mildest seasons they'd had on record. The challenge is: how do the coronavirus and the flu virus compete in a population or do they? So at this point, if it follows the pattern of the Southern hemisphere, it's maybe a much less severe year this year. But we just don't know.

For people in organizations making decisions about what can be done safely and how long this will last, what are the essential things to consider?

First of all, we just have to make the absolute assumption that we're going to get through this. We are. What's important is what do we need to do to get through it? Number one is we are going to see a substantial increase in activity through the fall. It's happening now, it's beginning to increase, and it's going to continue to increase. The second thing is that in terms of how we protect ourselves, we unfortunately have a very divided country at this point. It's not based on the science, but it's much more ideology. Do you believe there's going to be a problem or not? We may have blue states and red states, and blue counties and red counties in this country, but by the time this virus is over with, we're going to have only Covid-colored counties and states. 

It's going to continue to expand. The numbers are going to continue to increase. We estimate that right now only about 10% to 12% of the US population has been infected with this virus. Even with a vaccine arriving early next year, we're not going to see much impact from the vaccine through at least the middle of next year. We're going to have a lot of days ahead in which we have to confront this virus without the tools of vaccines. For the world, it may be several years before many of them will have access to vaccines.

What is your expectation for how 2021 plays out?

You're going to see more vaccine become available, typically in the high-income countries. The United States, Europe, parts of Asia are going to see substantial amounts of vaccine start to become available. The question is how well does it work? And we don't know that yet. We may have a vaccine that only works 50% to 60% of the time, which means we'd still have a lot of people, even if everybody got vaccinated, who would still be vulnerable to the infection. 

The second thing is that we know there will be substantial numbers of people who already said they won't take the vaccine because they don't believe this pandemics is real, or they don't trust the science around vaccines. I think we're going to see ongoing transmission and substantial problems with this virus for some time to come. And then of course, in the middle- and lower-income countries, vaccines aren't even going to be available in any meaningful way for many months. We just don't have the capacity to ramp up and make vaccines like that in any short order.

Last week I spoke with one of the heads of a company that is doing testing and prevention for organizations. He said that with symptom tracking, distancing, masks mandatory at the workplace, and regular testing of employees, it was safe for companies to return to the office. And his expectation was that people would come to the office with the virus, but that with all of these protocols the virus wouldn't spread in the workplace. Does that seem reasonable to you?

When you look at the Asian countries in particular, they've done an amazing job of knocking down this virus transmission. I don't want to minimize the potential that we can truly reduce the amount of transmission and hopefully minimize the number of cases that occur before more vaccine becomes available. But at the same time, we have many people who don't believe that this pandemic is real, who will or will not comply with measures like distancing and so forth that we would need. Look no further than what's happened at the White House The one place in world that's supposed to be the most bubbled and protected is the White House—and look what happened. 

I don't think that we can say that in the United States this is going to go away with all of our concerted efforts. We have so many people who don't abide by distancing, which is really the number one most important way to slow down transmission. Using cloth face coverings and surgical masks surely help decrease transmission. We need to reserve the N95 respirators for health care workers. That's critical, we still have a shortage of those. At this point is it's fair to say that we still have a real challenge ahead of us in terms of this virus.

If you were running a company, would you be willing to reopen your office?

I think it's going to be tough right now. I think particularly in the United States with the amount of activity we have here we're going to continue to see an increasing number of cases. Right now we're on a major uptick in cases. I think this is going to continue to be a challenge. And just as you saw how difficult it was to bubble the White House and keep the virus out, you're going to see a very similar situation right now in terms of the country.

What's your view of the current state of testing and rapid testing, like the Abbott rapid testing?

We're already seeing the shortcomings in that rapid testing situation. This White House experience is poster child number one. Many of us have been saying that. That is a real challenge. Testing in and of itself with these rapid tests will surely detect some of the cases, and maybe even most of the cases. But it'll never detect all the cases. And all you need is just one individual to 'sneak through the system' and you can have a real problem. You don't need five torpedoes to get your ship to sink. One does it.

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