What’s next for the pandemic, and how worried should we be about monkeypox? Dr. Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota, explains what to expect next with COVID-19, monkeypox, virus cases across the globe, and new variants such as BA.2.12.1 on a new episode of The Osterholm Update. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

“I think ‘difficult’ is a very fitting term that can be used to describe so many different parts of what’s happening with COVID in North Korea. It is a disaster. Of course, there’s the upfront challenge of trying to understand with some certainty levels of morbidity and mortality that they’re seeing from this virus, which is clouded by the lack of transparency that you mentioned. However, at the same time this is a country that doesn’t have the resources or ability to conduct wide scale testing for COVID. So there are multiple factors that limit our understanding of the complete situation there. And I think what’s been reported there over the past week, really illustrates that notion. Remember, this is a country that in previous years experienced severe famine and many, many thousands and thousands of deaths that they actually kept somewhat secret from the rest of the world. Of course, a number of confirmed cases from this outbreak, which is described as explosive, have been identified and officially reported as Omicron… Omicron spread in a population that hasn’t effectively shielded its most vulnerable members can result in an unprecedented amount of pain, suffering and death from this virus. So with North Korea, we’re really talking about dropping the sports car version of the virus into a population of 25 million with no previous exposure through prior infection or vaccine, a considerable amount of risk factors, including severe malnutrition and virtually no access to extensive healthcare.”

“From a global perspective, it seems like we’ve reached a point these past several weeks where cases are no longer declining, but are rather staying fairly steady. And of course, I always preface any of these comments about, how complete is a report in any one country? And what does that mean in terms of interpreting the numbers? If you look at this current level of overall stability of cases reported worldwide, it hasn’t existed at this level since basically November of last year. Otherwise, since then, we saw them shoot up from 4 million cases reported a week to 23 million cases reported a week in a span of just a couple of months from the initial Omicron surge. Then they dropped to around 10 and a half million cases by late February, before bouncing back up to 12.8 million by mid-March, and then dropping yet again to just under 3.7 by early May, which was just a few weeks ago. In two weeks, since then, the weekly cases have stuck around 3.8 million, which is largely due to rises in the Americas and Western Pacific offsetting case declines in other regions.”

“Deaths have only continued to decline, which is a trend that really began in mid-February. In that span of time we’ve seen weekly deaths go from over 77,000 to less than 10,000 as of last week. So from a mortality standpoint, the global situation with COVID is continuing to improve. But of course, as this pandemic has reminded us, things are subject to change. And while that’s always exhausting to hear, it’s the reality we need to acknowledge. So that being said, there are just those select locations that stand out for one reason or another, which I continue to monitor a little more closely.”

“Again, at no surprise, China is still up there on my list of concerns and despite their reports so slow but steady case declines overall, I continue to believe that they’re in a very precarious position. I hate to sound like a broken record, but the constant cropping up of cases there all across numerous cities and provinces is a reminder of the ever present threat that exists to that zero COVID approach. As of right now, they claim that cases are continuing to shrink in Shanghai, which has been under lockdown for two months. And although they’ve announced some plans for reopening, which will reportedly take place throughout the month of June, they’re fairly opaque from what I’m seeing and it could be a slow going process. Of course, the reason they’ve taken this very careful approach stems from the idea that the city is still highly vulnerable to the virus. So it’s not as if this is the end all or be all for outbreaks there. It could be days, weeks, or months before they uncover more cases. In fact, that’s what’s happening in the city of Tianjin right now. Back in January, the city had an outbreak that led to restrictions in which the ripple effect impacted supply chains for companies like Toyota and Volkswagen. Eventually that outbreak was controlled. However, they’re now seeing cases again and have locked down a central district of the city as a response.”

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“Another country we’ve been keeping an eye on is South Africa, which has had a wave of cases linked to the BA.4 and BA.5 subvariants of Omicron. As a quick recap, they saw cases grow from 1,200 a day in mid-April to 7,700 cases a day in mid-March. Since May 11th cases have dropped to 5,400, so it appears that the potential BA.4/BA.5 peak that I mentioned in last week’s episode was authentic. And the good news is that the hospitalizations and deaths in the country have remained low so far, even compared to previous waves with Omicron. At the same time, we might be seeing another BA.4/BA.5 driven surge in Portugal. Cases there have gone from under 9,000 a day to more than 18,000 a day in just a couple of weeks, which has coincided with the rising frequency of these subvariants, particularly BA.5, although publicly available sequencing that I’ve seen to date is somewhat sparse.”

“With the average daily reported U.S. cases above 100,000 per day and the true number of daily cases obviously being much higher, there is no question that this virus is everywhere. Just as I said last week, and I emphasize again this week, I know more people who have developed COVID infections over this last several week period than I have at any several week period through the entire pandemic. According to the CDC’s community transmission map we discussed last week, 60% of counties in the U.S. have high levels of community transmission, 16% have substantial, 17% moderate, and only 7% low. This compared to 52% of the counties having a high level of transmission last week. So we’ve gone up 8%. I also want to note that the Omicron subvariant BA 2.12.1 is now the dominant strain in the U.S., making up around 59% of the new cases last week. Now, despite the rise in cases in community transmission levels, hospitalizations, ICU, admissions, and deaths remain comparatively low.”

“The virus is very rare, which is why this current outbreak is making so many headlines. As of Tuesday, there have been over 130 confirmed cases and over a hundred additional suspect cases in over a dozen countries outside of Africa, including the United States, most of the cases have been in the UK, Spain and Portugal, but case numbers in other countries are quickly increasing. So far there have not been any reported fatalities in the outbreak. Cases in this outbreak have mostly, but not exclusively, occurred in men who have sex with men, particularly under the age of 50 with transmission often occurring between sexual partners. It is possible that the virus is transmitted through fluids during sexual contact. It was also possible that the virus may just be spreading due to close contact and not specifically sexual contact. I want to acknowledge that for many people, this could be causing a lot of fear, frustration, and anxiety, given how quickly COVID took over our lives. A few years ago. I know many may be listening to this, wondering if monkeypox is going to do the same as I previously noted. The good news is that there are many aspects of monkeypox that make it very, very different from COVID. And I believe therefore it will not cause anywhere close to the same amount of death and disruption across the world as COVID did.”

Follow the public health fundamentals and help end this pandemic, no matter where you live—get vaccinated or boosted ASAP; if you live in an area with low vaccination rates, wear an N95 face mask, don’t travel, social distance, avoid large crowds, don’t go indoors with people you’re not sheltering with (especially in bars), practice good hand hygiene, and to protect your life and the lives of others, don’t visit any of these 35 Places You’re Most Likely to Catch COVID.