COVID Vaccine Boosters

Don't let perfect be the enemy of the good.

I have to admit, I’m tired of the whole issue of COVID vaccines.  That does not mean I’ve not had mine – I have.  I had my two shot initial series and BOTH boosters. 

But it’s hard to keep up with all the recommendations.  And it’s frustrating the vaccine doesn’t give us long term immunity.  But it’s all we have right now.  So… Is it better to go without because it’s not a perfect vaccine?  NO – don’t let PERFECT be the enemy of GOOD!

Our current COVID vaccines (Pfizer and Moderna) are very good vaccines – they reduce serious illness, hospitalization and death by around 90%.  And they’re still effective against the latest variants.  But they’re not perfect:

  • Can cause flu like symptoms for few days after administration
  • Don’t stop you from getting COVID
  • Immunity only lasts 4-6 months

Pharmaceutical companies are working diligently on a vaccine that will solve these issues, but we’re not there yet.

  1.  What Happened to Johnson & Johnson Vaccine?

It wasn’t as effective as Pfizer or Moderna so isn’t being given anymore in the US.

  • Who Can Get A First Booster? 

Everyone ages 12 and up can get 1 booster 5 months after completing the primary series with either Pfizer or Moderna.  If your primary shot was with Johnson and Johnson, you’re eligible for a booster after 2 months.

  •  Who Is Eligible For A 2nd Booster?
    • Adults aged 50 and over. 
    • People aged 12 and older who are moderately or severely immunocompromised – active cancer treatment, organ transplant recipients, stem cell transplant in last 2 years, primary immunodeficiency syndromes, HIV infection, high dose oral steroids or other immunosuppressive medications
    • People who got 2 doses of Johnson & Johnson vaccine
  •  When should I get the 2nd booster?

At least 4 months after the first booster.  This is my opinion:  you might want to wait until cases are rising or you’re planning air travel.

  •  Do I need a booster if I’ve had COVID?

Yes.  We know natural immunity lasts at least 90 days.  But after that, it varies significantly by individual.  We’ve seen re-infections at 90 days in some but 6-9 months in others.  Appears we have little natural immunity after 1 year.

  •  Should I “Mix and Match” the vaccine boosters?

There is some data that shows benefit from getting a booster that is DIFFERENT than your original vaccine series.  For example, I had 3 Moderna vaccines (2 initial and 1 booster), so for my 2nd booster I got Pfizer.  It’s a harder question to answer if you had Pfizer as your primary series….that’s because the Moderna booster is only a half dose and I worry it may not provide enough protection.

  •  Where can I get a booster?

I am no longer giving vaccine in my office, but it’s readily available at many pharmacies and some County locations.  You can find locations and schedule appointments or see if they talk walks ins here.

Omicron: What’s In A Name?

OMICRON was named as a concerning variant of COVID-19 in November 2021.

Because it’s so new, we don’t know very much at this point.

· Is it more infectious/transmissible?

· Does it cause less severe disease?

· Can you be asymptomatic like the other variants?

· Will the vaccines be effective against Omicron?

Since we don’t know very much, I thought we should look at where the name Omicron came from.

In May 2021, the World Health Organization announced a simple method for naming COVID variants. They would name them after letters of the Greek alphabet. This system makes public communication about variants easier and less confusing. The older naming convention was unfair to the people where the virus emerged. The agency called the practice of describing variants by the places they were detected “stigmatizing and discriminatory.” (https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/)

We better get familiar with the Greek alphabet: alpha, beta, gamma, delta, epsilon, zeta, eta, theta, iota, kappa, lambda, mu, nu1, xi, omicron, pi1, rho, sigma, tau, upsilon, phi, chi1, psi1, omega.

Omicron, the 15th letter of the Greek Alphabet, was assigned to the 13th strain of COVID. Wait….13th? Not the 15th strain? Yes. The W.H.O. skipped two letters just before Omicron — “Nu” and “Xi”. “‘Nu’ is too easily confounded with ‘new,’” Tarik Jasarevic, a W.H.O. spokesman, said. “And ‘Xi’ was not used because it is a common last name.”

You may be thinking “I didn’t know there were 13 strains of COVID? That’s because we generally only hear about strains of “interest” or “concern”. There were some strains assigned a letter from the Greek alphabet that didn’t reach that classification level. For more information, check out this article in the New York Times.

Home COVID Tests FAQ

I frequently get questions about the home COVID tests that are now available at local pharmacies. I’ll answer the most common questions below.

PCR tests are the “gold standard” for COVID testing, typically are run through a lab, and produce results in 1-3 days. One is now available for home testing!!

Lucira Check It COVID-19 Test Kit, which uses PCR, gives results in 15-30 minutes. According to the manufacturer website, it is 98% sensitive. It can be purchased directly from Lucira’s website for $75. The test is able to detect alpha, beta, delta, gamma, lambda, mu and omicron variants of the virus

** THESE QUESTIONS REFER TO ANTIGEN TESTS WHICH ARE THE MOST COMMON **

· Are they any good? They are about 85-90% sensitive, meaning they will pick up COVID infection 85% of the time. That also means they’ll miss COVID infection 15% of the time. These tests are sold in boxes of two tests because if you take 2 tests, 24 hours apart, the sensitivity improves to about 95%.

· If they’re only 85-90% sensitive, are they even worth doing? Yes. Because they are readily available and inexpensive, it allows easy testing in many situations. For example, if everyone tests prior to arriving at your home for Christmas Dinner, you’ll pick up 85-95% of asymptomatic infected people. That’s better than picking up none!

· If I test positive, do I really have COVID? YES. False positive tests, (a test that’s positive when you actually don’t have COVID) are extremely rare. So, if you test positive, you have COVID and should isolate yourself.

· If I test negative, am I sure I don’t have COVID? NO. Remember, the tests are not perfect. A single test misses 15% of cases. 2 tests taken 24 hours apart miss around 5% of COVID cases. If you test negative, still use common sense and wear a mask in high-risk situations, practice social distancing, and wash hands frequently.

· When should I take a home COVID test? They’re useful in several situations: In the first 6 days of symptoms they are very good at picking up COVID in symptomatic people. If you’ve been exposed to someone with COVID – 3 to 5 days after exposure. If you’re going to a gathering with several people who are not in your household, the testing will provide some reassurance that infected people are not at the event. Personally, I am asking all 21 people coming to my house for Christmas to take a test prior to coming for dinner.

· Which test is best? ConsumerLab has reviewed many of the currently available tests:

Recommended

BinaxNow Self Test

QuickVue

Flowflex

NOT Recommended

iHealth – more false negatives than most of the others

BD Veritor – somewhat pricey, slightly more false negatives, requires an App

On/Go – the most false negatives of any test. Expensive.

AccessBio CareStart – same as On/Go, sold through Target at lower cost.

InteliSwab – least expensive but least accurate. Hard to find in local stores

Ellume – no longer seems to be on the market since it had a massive recall in October.

· Will these tests pick up Omicron? Yes. All these home tests focus on the nucleocapsid antigen, so they should be able to pick up the Omicron variant.

· Are they expensive? CVS currently has BinaxNow box of 2 tests for $14 if you sign up for their frequent shopper program (free). Walmart also sells this test for around $14.

· Will insurance pay for home tests? Maybe. Currently, it’s hit or miss. However, President Biden has mandated that insurance cover the cost of home testing starting January 1.

· Will being vaccinated change the results of a home test? No. Being vaccinated gives you antibodies. These tests are NOT testing for antibodies. They’re testing for antigen – a piece of the virus itself.

Influenza is here – will it be more severe?

The first flu cases are arriving, and Influenza A (H3N2) is the dominant strain so far. Although flu symptoms are similar no matter the strain, Influenza A (H3N2) seasons tend to be more severe. See What You Should Know About H3N2 Flu – https://www.verywellhealth.com/what-you-should-know-about-h3n2-flu-770301

The early flu activity is currently most common in young adults and in college and universities. As they come home for the holidays, they will likely spread it to older friends and family members.

If you or someone you know is not vaccinated against flu this year, I strongly encourage you to get the flu shot. It’s not too late!

There are also other things you can do to reduce your risk of getting the flu:

· Wear a mask in high risk settings – indoors, lots of people

· Stay home when sick for at least 24 hours after symptoms resolve

· Cough or sneeze into your elbow, arm or tissue

· Wash hands frequently or use alcohol-based hand sanitizer

· Avoid touching your eyes, nose and mouth

See Tips for Protecting Yourself and Others This Holiday Season – https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Tips-for-Protecting-Yourself-and-Others-This-Holiday-Season.aspx

Healthcare Worker Burnout from COVID-19

Healthcare worker burnout

Healthcare workers on the front lines have had a front row seat for the worst pandemic in 100 years.  Although I’m not on the front lines in the hospital anymore, I can tell you it’s taking its toll.  Healthcare workers are compassionate and empathetic people by nature.  Each death hits us hard, regardless of the cause or age. 

But with COVID-19, it’s different.  Death of this magnitude is unthinkable with modern medicine.  Because of COVID visitor restrictions, patients are often very sick and separated from their families.  Healthcare workers are trying to fill the void.  We’re trying to be there for those who are alone in the hospital and help them talk to loved ones on the phone or have a video chat by FaceTime or Zoom.  

Doctors are retiring, nurses are quitting, and hospitals and clinics are struggling to hire more staff.  What makes this wave of the coronavirus even more tragic is that the severe illness and deaths it’s causing are preventable. Public health officials say nearly 100% of mortalities since January could have been avoided with covid-19 vaccinations.

COVID-19 is a real disease and real people are getting sick, it’s stressing our healthcare system.  Healthcare workers are a limited precious resource.  Please do all you can to avoid getting COVID.