Q&A: Dr. Ali Mokdad on COVID, the holidays and vaccines


Aaron Kunkler


Dr. Ali Mokdad is the chief strategy officer for Population Health at the University of Washington, and a professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME). The IHME has consistently produced world-class modeling of the COVID-19 pandemic. We spoke with Dr. Mokdad about the likely course of the pandemic over the coming months, vaccine boosters, and ways to stay safe during the holidays. 


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Aaron Kunkler: What course are you expecting the pandemic to take in the coming months? 

Dr. Ali Mokdad: So for the United States, what we are expecting is we’re going to level, at this level, and we’ll stay there all the way till maybe towards the end of January, and the cases will start coming down. The recent cases will level because they are peaking in certain states, and declining in some states right now. The reverse will happen later on, they will start declining in the states that are peaking right now, and go up in the states that are declining right now. The reason for that is, of course, seasonality and the waning of the vaccine, and the fact that many Americans right now are moving more. Mask wearing is very low in the US, in general. So all of this put together will contribute to a surge.”

AK: Let’s talk about masks. Even with vaccines, they’re still one of the most important parts of fighting COVID. 

AM: We are projecting 881,000 deaths cumulative by March 1 in our projections from Nov. 15. That’s about 121,000 additional deaths in the United States. If 95% of Americans wear a mask when we are outside our home, we are projecting out of this 121,000, there will be 65,000 fewer deaths. So masks are very important. Now, vaccines are our best defense, of course, and boosters. But masks start working immediately whereas a vaccine right now, even a booster, will take a week or two to have full impact.”

AK: What should people know about the current research on vaccine efficacy as they’re thinking about boosters moving into the holiday season?

AM: On the vaccine, we have a lot of data right now. After five to six months, immunities start coming down very fast, more so for Pfizer than for Moderna, but in general, even for six months after receiving your second dose, immunity comes down rapidly. It starts declining very fast. It reaches about 20% protection against infection, which is very important. So definitely a booster is needed for everybody. It took forever in the U.S. to authorize a booster for everybody, and even when they did it the language wasn’t that clear. But waning immunity is here. 

The big question mark that we don’t know much about is waning immunity from a natural infection. Somebody got COVID-19 delta variant, how long? So we’re assuming right now it’s about the same as the vaccine. One thing we know is that cross-variant immunity is not high. So basically somebody who got the alpha variant doesn’t mean he or she will have good protection against delta.” 

AK: So the message to everyone reading this is go get your booster. That brings me to another question, which is how long will we be getting additional shots?

AM: This COVID-19 is not gonna disappear. The endpoint is it becomes like the flu. You know, you may need a shot before winter. Then you should be okay, depending on what’s circulating and then that could be combined with a flu vaccine. So I get one shot for all of them. So yeah, we should plan for it. Hopefully, it doesn’t come true. Hopefully, we don’t need it anymore. But many countries right now, the UK already started planning for a yearly vaccination for COVID-19. Whether they’ll add it to flu, or make it separately, that’s a big question mark. But yes, I see, for the coming two, three years that we need a yearly shot for COVID-19.”

AK: I’ve been reading articles tossing around the idea of deaths and hospitalizations being a more accurate metric of the pandemic that just case counts. What are your thoughts on that?

AM: Your cases in a pandemic are very important, because you want to know how much the virus is circulating, and you need to keep an eye on cases. Remember, with the vaccines right now that not all cases are detected. In the U.S., we detect about 49% of cases, so 50% of them are because of testing, and most people get infection, it’s asymptomatic. No, we need to keep an eye on testing, and we need to keep an eye on cases. And yes, mortality is going to be lower than before, simply because the vaccines are highly effective against hospitalization. So it will come down in terms of infection fatality rate out of 100 people that have been infected, less people will die now compared to before we had the vaccine, which is good for us. Hospitalization is another indicator with the three of them that are important. Hospitalization is an indicator that we need to keep an eye on, because we don’t want to overwhelm our hospitals.”

AK: On the testing side, do we still have enough capacity? Especially as people head back into the office and school, and as other respiratory diseases are spreading like flu or a cold? 

AM: Right now, the concern is people assuming it’s not COVID, that it’s flu, and not testing. So we need to keep the testing, that you could do at home… There are many free sites still in our city that are doing free testing so you could use that. But the recommendation here should be the following: if you have any symptoms irrespective of what it is, stay at home.” 

AK: The holiday season is upon us. What are you expecting to see in terms of COVID this holiday season, and what should people be thinking about?

AM: We can celebrate our holidays safely if we are behaving. So basically make sure you’re vaccinated before you head to your family. And if you’re traveling to see your family make sure if you’re by plane, have a very good mask and N95, a KN95, not a cloth mask. Once you arrive there, make sure you know you wear a mask. I mean you have to do the common sense. We can have our holiday, we deserve our holidays, but we have to be responsible. 

Most of the problem with the holidays is the following. In my case, I have a daughter who will come here during the holiday, and usually when she comes here it’s not spending time with us. She’s going to see her friends because she wants to. She’s going to see her friends from high school so that’s activities around the holidays, in addition to the holiday itself. If we are careful, and then we pay attention to the circulation of the virus where we are coming from and where we are arriving, we could do it. But the key issue here is if you’re not feeling good, any symptoms, stay home, stay away from your loved ones.”

This interview has been lightly edited for length and clarity.