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Osterholm: Americans will live with the coronavirus for decades

This interview is the first in a series of conversations MarketWatch will have with some of the leading voices in the US on the COVID-19 pandemic

On January 20, just nine days after the Chinese health authorities published the DNA sequence for a new coronavirus that made dozens of people sick in China, Dr. Michael Osterholm, an epidemiologist at the University of Minnesota, in a e-mail“I’m sure this will trigger our next pandemic.”

The next day, the Centers for Disease Control and Prevention confirmed the first U.S. case of someone infected with what came to be known as COVID-19. Since then, as the outbreaks escalated and the virus spread to Europe, and then to America, Osterholm, a flu expert with experience in the CDC leading the Infectious Disease Research and Policy Center, became one of the country’s leading voices on the pandemic , which weighs everything from masks to contact detection.

Osterholm’s position is sobering. The 67-year-old expects the new coronavirus to be present for the rest of his life. He does not believe that wave theory (a first wave, a pause, followed by other waves) will apply to this pandemic. “That’s not the case here,” he told Marketwatch in an interview.

Market overview: One of the things I’m quite interested in is the conversation and hope surrounding a vaccine. Do you think we have misconceptions about what it means when we have a vaccine?

Michael Osterholm: Everyone sees the vaccine as a light switch: on or off. And I see it as a rheostat, that will take a long time, from turning on from the darkest position to the lightest position. If you expect a light switch, you’ll be worried, confused, and in some cases very disappointed with what it might look like with a vaccine in those early days to months.

Market overview: I saw one piece in The Atlantic this week and I thought they positioned it right. They described it as the beginning of the end.

Osterholm: It will not be. We will deal with this virus forever. Effective and safe vaccines and hopefully with some durability will be very important, even crucial tools, to combat it. But the whole world will experience COVID-19 until the end of time. We are not going to vaccinate ourselves out here for more than eight billion people in the world. And if we don’t get lasting immunity, we may routinely look at revaccination, if we can. We really need to learn to deal with living with this virus, at least all my life, and at the same time, it doesn’t mean we can’t do much about it.

Market overview: Do you think we’ll see some of these vaccines fail in clinical studies?

Osterholm: One of the challenges we have is: what do we mean by failure? What is the definition? Some people now believe that any vaccine that is not like the measles vaccine will become a challenge, meaning they have to work 93% to 98% of the time. I don’t think this is going to happen with this vaccine. That does not mean that there will be no effective vaccine at 50%, 60% or 70%.

We must continue to pay attention to safety signals. We must ensure that over time we can assure the public with open and transparent data that: This is what you can expect in terms of responses, this can cause long-term complications.

Market overview: A lot has changed when it comes to the distribution of medical information. You did some peer review and worked with magazines. Do you think some of these preliminary scientific writings are shared to the public too early?

Osterholm: Oh absolutely. We are now drinking from a fire hose in terms of new information. You can make the case that is important because we are able to learn things that can have a very real impact on the patient outcome and therefore it is crucial that the data is collected. But there is also a downside to it, because it involves an increasing amount of marginal, if not potentially incorrect, information.

Market overview: Do you think we will see clear waves of outbreaks in the US?

Osterholm: No no. They are not waves. We have never had a pandemic because of the coronavirus. We’ve had flu pandemics. With a flu pandemic, you get real waves, which means you get a first major spike of cases, after which the numbers drop significantly without any human intervention. It is nothing we do. We never understood why that happens and a few months later you get a second wave. This is not currently happening here.

This is like a forest fire, full speed ahead. And wherever there is to burn human wood, it will do it. What we see, however, are these peaks in cases where human mitigation strategies have ended, or they don’t stick to them … This is just one constant pressure that occurs.

Market overview: And human softening [like mask wearing or social distancing] refuses?

Osterholm: Turn right. And everyone expects it. Look at Hong Kong, which does an excellent public health follow-up, and yet they still have a problem. Think of this as a major forest fire. If you get in your way, you will be burned. The best we can do is try to spend as much as possible. But even knowing that if you just suppress it, it will come back. The cinders are still there because we never really put it out.

Market overview: What do you think is the biggest failure in the American response?

Osterholm: We failed because we declared victory over the virus when we had nothing to do with it. This virus is ready to be transmitted in our communities and we thought we had done enough to get rid of it. It’s like a fire brigade. “I only put out half of the forest fire, but you know, I put out half of it, so we’re done.” And then see what happened. It has burned more hectares since we gave up than before we gave up.

Market overview: At what point did you realize the severity of this virus?

Osterholm: I could just see it based on all the data we had, and it was one of those “oh my God” moments. No one was sure how a coronavirus is going to work, and unfortunately it fulfills all my worst nightmares. A challenge that has not yet been fully understood is what kind of sustainable immunity we get from infection and vaccine. We are now making assumptions that will take a long time. If not, it really makes things more complicated. If you’re at double, triple and quadruple risk with this virus, that’s not a pretty picture.

Market overview: We are getting closer [herd immunity] by a vaccine? Or is the goal to keep as many people as possible safe?

Osterholm: Again, it goes back to the question we just discussed: is there lasting immunity? Because the herd’s immunity is based on the concept that once you have immunity, it will persist. One of our goals has been to postpone as many cases as possible until the vaccine is available and use it as a means of protecting 50% to 70% of the population. But we don’t know what immunity means to natural diseases or vaccines. The herd’s immunity is still that theoretical state in some ways, but we’re not sure we’ll ever do that.

This Q&A has been edited for clarity and length.