A consequential meeting took place at the FDA today. Their external scientific committee—called VRBPAC—met to discuss the national plan for COVID-19 boosters going forward. They essentially needed to answer one question: Do we simplify the COVID-19 vaccine approach in the U.S. and, if so, how?
I know doctors don’t think this way (I’m married to one), but unless there’s some significant risk associated with getting a second bivalent booster, why not get one six months after the first one for whatever good it might do? I’m one of the rapidly dwindling « never Covid » contingent, and I’d like to stay that way.
I absolutely agree with you - I would say get one 2 mos or even every month if it has no significant downside. And I never have heard any significant (except maybe rare) one mentioned in all I read. Those of us who want to do this are being denied - unless we ignore the “rules” - the right to try to protect ourselves.
Agreed. Others have the “right” to choose not to vax, not to mask, to expose themselves to COVID multiple times and strain the healthcare system, and to basically ignore the needs of the vulnerable. In this “you do you” era of the pandemic, shouldn’t we also have the right to protect ourselves and take on the risk of an additional vaccine every six months if we choose to?
It is so frustrating to hear the glacial pace of vaccine development and the lack of political will to do another round of “Warp Speed” for a virus that is killing 3,000 a week and disabling millions.
It is extremely disheartening to hear this inertia from the scientists and scientific bodies whose entire mission it is to be at the cutting edge of science for public health’s sake. If we cannot depend on them during a global pandemic (and it is crystal clear that we cannot), then why do they exist? To minimize and ignore the severe impact this vascular virus is having on entire generations?
I am entirely frustrated.
- signed, a mom in the US South, whose child is immune-compromised, so we have to continue to sit out on life
What I’d like to know is simple: I got the bivalent Moderna booster in September. Has it likely worn off by now? Is there anything to be gained by getting it again now?
I would like to know that too... Hence why I was a bit disappointed. You can be confident it's working against severe disease. It is probably working okay (?) against infection, but is likely waning by 6 months.
One way to think about the bi-valent is to consider that in fact you have gotten only ONE DOSE of Omicron focused vaccine. What we know from the original vaccine against the original virus was that you needed two shots to generate a significant immune response, and that the response was stronger and longer lasting if there was more time between shot #1 and shot #2. From that perspective, it would seem to me a second bivalent shot would be very advantageous in terms of stronger and longer immunity against infection, severe disease and death. But I guess we won't know that until folks are allowed their second shots.
I'm not sure I'd place much faith in the case of infection but I'm fairly confident in terms of severe disease/hospitalization/death. Although we got lucky with the original mRNA vaccines with regard to illness prevention against wild strain, subsequent variants have not behaved as nicely.
Why fairly confident somebody's still pretty well protected against hospitalization etc. after 6 mos? CDC's own study of booster protection against hospitalization shows it waning at rate of about 7% per month.
And of course even during period when post-booster protection against hospitalization is maximal, elderly and immunocompromised probably aren't as protected as younger and healthier people -- like maybe they start out at 85% protected against hospitalization, and decrease from there.
I'm thinking that 6 months out from a booster the average 70 year old is 40-50% protected against hospitalization. 11 months out? Almost completely unprotected.
Most of us, now, are employing hybrid immunity. There's evidence that hybrid immunity is more potent than infection-derived, or vaccine-derived immunity. The MMWR article you cite has a number of limitations they identify themselves. This study looked at emergency department visits and 2 vs 3 booster conditions with no visibility toward prior or concomitant infections. Thus, there was no evaluation for hybrid immunity's contribution to the condition.
Overall, we've done a pretty good job with vaccine development, and its longevity. Where we've done a poor job as a nation, and to a great extent as public health folks, is in providing a narrative that resonates with the public and encourages them to pursue an appropriate course, in this case, immunization and maintenance of the boosters as we currently know them until we've got something better. On the other hand, BECAUSE we did such a poor job communicating, and because we've also seen so many immune-evading variants, a large portion of the vaccinated public is also post-COVID.
The immune wall we've seen that's been preventing more death and hospitalization has occurred within the groups that have a naturally-acquired immunity secondary to infection as well as a vaccine plus booster acquired immunity. The two are complementary.
Actually the study didn’t just look at emergency dept. visits, it also looked at hospitalizations. Results for hospitalizations are shown in the lower part of Table 2.
Yes, it’s true that many people have hybrid immunity now, and no doubt the same study done now would show slower waning of immunity after boosting. Of course by the time the study was done a fair number of its subjects probably already had hybrid immunity. But more people have it now . However, quite a few people who are especially vulnerable due to age or health conditions have managed to avoid getting covid so far by being especially cautious. Those people also keep up with the news on covid, and I would guess that they are over-represented on this list. I am one of those people: I have a substantial unmodifiable risk factor. Those of us who made an extra effort to avoid covbid and have succeeded so far do NOT have hybrid immunity. If you ran that same study using our population we would probably do worse than the people in the study I cited, because not only do none of us have hybrid immunity, but also we are older and less healthy than the population in the study. I’ll bet our initial protection right after the booster would be lower than what was found for the subjects in this study. Older people generally have immune systems that are not working as well. That’s why some docs recommend older people get the “extra strength” flu vax. And it wouldn’t surprise me if older and more vulnerable people not only responded less well to the vax but also had their immunity wane faster.
It is regarding this group especially that I think a once yearly vaccine is inadequate.
So, there are several things to unpack here. The number of people with significant risk who have attempted to avoid COVID is dwindling simply because we've seen too many immune-evasive variants. That said, and while I don't EVEN want to sound like the virus is weakening (variant evolution doesn't indicate we're getting stable in that regard yet) several of the latest subvariants of Omicron have shown less virulence; it's possible you've been infected and did not have a bad result. Whether you have hybrid immunity requires clinical and lab evaluation unless you're vaccinated AND have had a documented (e.g., via PCR) or known (e.g., via home antigen testing) episode, in which case you can be pretty common that, if you're still breathing you have some degree of hybrid immunity.
Note: I fall into the technical high risk group as does my wife. And we've both been infected twice, despite following masking guidance and effectively hiding in place. While I know where I got my first case, and my wife got it from me, we have no clue what the vector was for our second bout. In both cases, my illness was trivial and in both cases, my wife had more significant disease than I did. What I'm saying is, being careful is no longer a guarantee you won't be infected.
We do know that most older patients do demonstrate a poorer immune response than younger patients. Thus, yes duration, in some older patients is not as robust as in most younger patients, Use of a higher potency flu vaccine has been a point of contention for awhile. I personally prefer a second dose in January or early February vs the higher dose single-shot vaccine.
For the record, I don't think we are ready to go to a single annual vaccine. I don't think we know enough about COVID, and I am concerned about immune evasion, and the potential for new recombinant variants that are not Omicron-derived but are, perhaps farther back the ancestral tree. Or a totally new variant. I don't think a pan-coronavirus vaccine is likely to become available for several years, although there appear to be several promising candidates in work.
Vaccine response can only be judged on the aggregate. We will always have people whose immune system isn't activated by a particular vaccine, or the immune modulation process in general. Some of those will benefit from additional vaccine doses, something your doctor can prescribe in the case of COVID, if that's needed. If the FDA does get the green light to go to a single vaccine annually, there remains some leeway for your doc to support your specific condition.
I thought that I had read that it basically wore off in 4 months as far as providing immunity from infection was concerned. I got mine in September as fast as the pharmacy had it after approval and wish I could get another. Heck-I wish I could get one every month. Why not? I might feel like I could "have a life" again.
I believe by “sterilizing” vaccine you mean preventing actual infection. My understanding is that it does provide some protection (not sure what level - if anybody is) but that it wanes very quickly in its effectiveness at that. (virtually zero after 4 months - the stopping infection part). Is that contrary to what you understand from existing info/data? And what do data indicate about the duration of the prevention of serious cases and death? I’d appreciate your input since I know you are both smart and well informed. I follow your comments with great interest.
And isn’t there some protection against infection? As opposed to exposure. How much , if any and how long - if true. Some devotion issues here I think. Have been confused on these pints in much of what I’ve read
I'm wondering the same thing, I also got mine in September. As far as I understand it is unlikely it's worn off, but protection does start to drop after about 4 months. So I'm wondering, should I be looking at getting a booster in February or March? Can that even happen if the FDA punted on the question?
As someone who is high risk and has so far managed not to get COVID, I increasingly feel like government and corporate policy is no longer taking me into consideration. At this point in effect it's requiring me to go ahead and get COVID and see what happens.
Layperson here who is in the high risk category and just tries to stay informed. First and foremost, thank you so much for all that you do! From your post above, did you mean that you’re hoping for clarity after the ACIP meeting on whether those who want a second bivalent will have it available to them?
Hope this happens on that timeline - so long as determined "safe", I'll probably get another shot no later than early April, a couple of weeks before some planned travel. I'm not in any kind of high-risk group, just don't want to catch covid again (last August when primary + booster protection had clearly waned for me and before the new boosters were available - it sucked pretty bad even though it was a mild case by any kind of reasonable standard).
This is exactly my question. What is the guidance for those of us that got the bivalent shots when they were rolled out and who are willing to go get another one if it will be beneficial.
tl;dr I got a second bivalent booster with no push back, and my immune system is reacting just like September. I feel more at ease about upcoming travel and public events.
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I'll be traveling in February and attending a large conference in March. After finding no guidance or even mention of re-boosting, I booked an appt for a bivalent booster at the pharmacy where I got the September booster. I figured that if there was a reason to not be re-vaxxed, they'd decline. But they treated it as business as usual, and I got a second bivalent booster.
My arm got sore just like the first bivalent booster; I was low-energy and needed a nap the next day like the first bivalent booster. Seems like my immune system is responding appropriately to give me some renewed protection.
I'll still mask in public spaces, and I'll carry an Aranet 4 to measure CO2 & particulate levels so that I can remove myself from poor air quality spaces. But I feel like my risk/reward balance has gotten lighter on the risk side and tipped towards reward after getting a second bivalent booster.
That was written almost two years ago, and while it may not be perfect, it's still thought to be correlated to protection. And it's surely superior to cruder heuristics like age.
I'm concerned about that too - whether 'wearing off' is defined as getting asymptomatic infection (but with the capacity to transmit it unknowingly to others), the gamut of symptomatic infection, or the probability of acquiring long Covid. And optimally by age group etc. (not sure what the "etc" should include). Also what is 'wearing off?'- immunity to the variants included in the vaccine (I think yes) or to getting sick from a different variant? Has my immunity to other pathogens I was vaccinated against decades ago 'worn off?' How about to the measles infection I had as a child?
Allow me to offer a reassuring example. I had chickenpox when I was 8 - that's 40 years ago. I got an antibody test for varicella in addition to the covid antibody test. Still there!!
For those asking how likely it is that their bivalent booster has worn off by now: There is a CDC study of waning effectiveness against hospitalization of vaccines over time. Study did not look at bivalent booster, but was done using subjects who'd received original shot plus boosters, during the omicron period but prior to the time when the bivalent vaccine was available. The study's here: https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e2.htm#T1_down
Here's their finding about waning through 4 or 5 months: "During the period of Omicron predominance, vaccine effectivness against COVID-19–associated hospitalizations waned with time since vaccination: vaccine effectiveness after a second dose declined from 71% within 2 months of vaccination to 54% among those vaccinated ≥5 months earlier (p = 0.01). Among recipients of 3 doses, vaccine effectiveness against COVID-19–associated hospitalizations declined from 91% among those vaccinated within the past 2 months to 78% among those vaccinated ≥4 months earlier (p<0.001)."
So clearly effectiveness against hospitalizations wanes. looks like at something like 7% per month, at least over the first few months, which is the period this study looked at. Based on that result, I'm thinking that if people get only one shot per year, they're going to have almost no protection against covid by month 11. For the elderly and other vulnerable people giving shots only yearly seems dumb as hell to me.
Yup, it is definitely overdue for me to upgrade to a paid sub here. Your advice on Covid has been consistently invaluable. Right now, based on what you write here and from others I trust, like Eric Topol, as someone in a high risk group because of age, I am very worried that my cohort is once again going to be left in the dust without sufficient protection to have any semblance of a post-Covid normal life. My worries have been heightened because, despite taking all of your excellent advice and that of others to heart and following it closely, including all your pre-Thanksgiving advice, we were exposed to and contracted Covid from an 85 year old friend who had, as it turned out, a very incomplete understanding of the level of protection vaccines provide, did not realize the importance of same day testing pre-gathering, and on it goes. She turned out to be a superspreader, and everyone in our little new years gathering, all older women at higher risk, contracted Covid. Beyond that, the person next to her got hit really hard, including a whopping Pax rebound. It was very, very scary, only after 25 days has the fatigue lessened enough for her to resume something akin to pre Covid activity. At this point, we really have no idea how we can protect ourselves without locking ourselves in a closet, and what the FDA is contemplating does not appear to be even close to what we need to get past that.
PS: looking at the previous comments and questions re waning protection, both I and the person sitting next to our vector got our bivalent boosters 9/15/22. We are both in our 70s, unclear what any additional risk factors are, but likely some. We both contracted Covid after attending the small indoor gathering; neither of us required hospitalization, but the one of us sitting next to the vector had profound fatigue and other seriously problematic symptoms on and off for 3 weeks. As noted above, the Pax rebound was particularly frightening, and there was nowhere to turn to understand what was going on or when or whether the profound fatigue, in particular, would resolve.
I don’t mean to go on, and I know what I describe is anecdotal, but I have benefitted from learning of the experiences others have had who are fully boosted, higher risk, etc. so, in the case I have described, I have tried to learn from what occurred to see what I might do differently. Here are some takeaways:
1) I overestimated the knowledge base of the friends with whom we gathered; all were being careful within what they thought that entailed, but the knowledge base on which that rested, including the extent to which vax might prevent infection, how best to use rapid tests, etc. was varied and often wildly incomplete. One thing I did in the aftermath of our debacle was to send around Dr. Jetelina’s pre-Thanksgiving Substack, with advice for what to do when contemplating unmasked indoor visits with older people. Whether it will be followed in the future, I can’t know, but at least everyone has the information.
2) Despite, at least in my case, trying to remain as informed and up to date as possible, we were all caught short by lack of information on the prevalence of XBB.1.5 in NYC (it was 75% or thereabouts New Years Day). Had we been aware, I suspect it likely the gathering would not have gone forward at all. I only subsequently learned of the high prevalence from . . . a Dr. Jetelina Substack! So, I sent that around, too. I also wrote my City Council person to ask for his assistance in pushing our local health department to do a better job of updating alerts, and specifically provision of information on things like the immune escape/high transmissibility of the XBB.1.5 variant, about which I could find nothing on the website, eg.
3) On learning that our vector, and perhaps others in the group, did not realize that vaccines/boosters do not by any means guarantee preventing infection, I explained what I know about that, and also about the issue of asymptomatic transmission.
Of course, I hope in all of this that what I conveyed was reasonably accurate information within what is known. I have high confidence in that regard if the information is from Dr. Jetelina; much less so when I am conveying my own understanding of things I have gleaned over time. And at this point I have very low confidence that an indoor gathering of more than 3-4 people can proceed safely at all, which is really sad to contemplate. I miss my friends, and none of us are getting any younger.
I agree with the well-stated concerns here for those of us who want more information! However, it is a stretch to conclude Paxlovid was 1. the cause of the rebound and then 2. that it amplified the rebound. "Whopping Rebounds" also occur when Paxlovid is not used. Remember that there is substantial consensus in the scientific community that Paxlovid is beneficial, since it reduces the severity of Covid as well as the incidence of PASC. Your better strategy is to be flexible about assumptions of when a case of Covid is completely over. The 5 and 10 day CDC guidelines come from statistical averages. Not all individuals are average; some will take less time; some more. I continue to be cautious around all recently infected people. I like your conclusion about doing the testing close to the time of gathering.
Hi, Kathan: these are very good points, and well taken. I absolutely agree that the consensus is that Paxlovid is generally beneficial and I would also say I am confident it was beneficial in both the case I describe and for others present who took Paxlovid. I didn’t mean to suggest, BTW, that Paxlovid caused the rebound, but rather that review of the CDC memo on rebound strongly indicated that rebound occurred in the case I described. My apologies if something got lost in translation there! Of course, with all of this, to borrow from the old hairdresser saying, only your local epidemiologist can know for sure--or at least closer to sure--what is, eg cause and effect, what is associated, and what is irrelevant. One of the great difficulties here, and why I am so grateful for Dr. Jetelina’s willingness to remain as a public facing communicator on all of this, and her clarity in so doing, is that all of us who do not have expertise have been forced to learn a lot of strange, new languages simply in order to do our best job of assessing personal risk and staying clear of infection (if that is what we choose). I joke sometimes that, to do this in the face of lack of clarity and/or information from our public health bodies, one must assemble a personal panel of private, trustworthy sources from which to gain understanding and determine what is best to do. In doing so, it’s always a good thing to retain humility about one’s own lack of expertise!
Well said. I have subscriptions to multiple newspapers. I follow the CDC and my local county health department. Since Fall 2022, Covid information has been harder to find. And when I do find reports, often the reporter doesn't have the expertise to accurately translate the science. The CDC/County HD messaging has switched to the mediocre, one-size-fits-all version in order to provide simple, static information. Unfortunately, Covid is neither simple nor static. I am also humble about my lack of expertise, but even more humbled and in awe of the complexities in the unfolding science of this virus. I sincerely appreciate Dr. Jetelina's expertise, concise writing, and her important brave advocacy.
Kathan, I have been thinking ever since about this perceptive comment you made regarding public-facing public health communication, particularly as it relates to those of us at higher risk because of age, immunocompromised status, and the like: “The CDC/County HD messaging has switched to the mediocre, one-size-fits-all version in order to provide simple, static information.” It took me back to this observation Dr. Jetelina made about the community levels map when the CDC changed its guidelines: “This map tells us when to take collective action so hospitals don’t surge. This does not tell us when to wear a mask for individual protection due to high transmission. If we are trying to prevent severe disease, those at most risk should know when they are at risk for infection.” Ironically, buried within the top level information on the CDC community levels maps page is a link to a section of guidelines for older people--but guess what, at least two links within that section, and the ones most pertinent to daily activities and mitigation strategies geared to older people, are broken. Sort of a metaphor for the overall problem!
"...often the reporter doesn't have the expertise to accurately translate the science.” Sadly so true. And it’s true on national news reporting as well. The ignorance of mass media on this subject is even more stupefying than the ignorance of basic economics and financial matters.
Sorry to hear about your experience Susan. Re same-day testing, we need more useful guidance. Probably false positives aren't common, but--depending on the Covid prevalence in the environment and how recently an asymptomatic testee was infected, the probability of a false negative rises. I would think that this is true to a lesser extent for home "PCR-like" (molecular) testing.
Hi, Iver: you are right about the limitations of same-day testing, which I believe is why Dr. Jetelina’s pre-Thanksgiving recommendation was for cadence testing, along with other pre-gathering mitigation measures. That is, it is only one strand in a multi-layered mitigation approach. In the case I describe, the person who turned out to be the vector believed that her vax/boost status rendered her immune from getting infected or infecting others, and, as a result, engaged, prior to our gathering, in high risk activities including a large, unmasked indoor party. Then, while she tested the day before our gathering, she was negative, so she thought she didn’t need to test the day of the gathering. Also, though I have not confirmed this with her, as she is already feeling absolutely horrible she visited this on everyone, she may well have had symptoms she didn’t recognize as possible Covid. Now, of course, it is still possible that she would have tested negative the day of the gathering, but I can only say I would have preferred those odds.
I believe false positives can happen with oral swabs if you've eaten acidic food. That's why I generally don't (and none of the manufacturers recommend swabbing orally anyway)
1) Dr. Offit conceding the data over his intuition and original sin (let's take the guilt out of that term somehow!)
2) mRNA technology still a wonder of the world
3) Cute toddler! Some flexibility to convert to remote work (for those fortunate enough to have the option) is such a valuable tool for family life. Disruptions have eased, but life is far from normal for those of us still being careful and conscientious. We should continue to promote that remote option, and employees should fight for it. I am.
4) FDA and CDC and everyone being proactive in January
Not happy about:
1) Over 75 data - I think that slide means that 1.8% of all >75 year olds in the US were admitted to the hospital with Covid between January 2022 to January 2023? Seems like a lot. Would be worse, I know.
2) Stroke data. I still think getting Covid is worse, and certainly a severe case increases stroke risk by 18 fold in a UK study (https://heart.bmj.com/content/109/2/119)
A lot of my savvy elderly patients who were boosted in September are asking about whether they should get another one soon. I reply that there is no recommendation on this yet. But I am troubled by the constant churn of Covid. I don't see waves, and our hospital system's inpatient census has been hovering at around 150 patients hospitalized with Covid for months now. Hoping for a spring reprieve.
I'm no Paul Offit, but if I were at the FDA meeting I might have floated this:
70+ can get booster q6 months until pan-coronavirus vaccines available. Younger generations collectively do little to protect them anymore. A more realistic, once-yearly, fall booster campaign for everyone else - to head off or reduce a holiday wave, and to blunt the back-to-school mess that converts children into efficient vectors.
Love your suggestion, but I'd say AT LEAST EVERY 3 months unless somebody can show a darn strong reason why not. As for Paul Offit, I have reached the point where I don't read his comments on these problems at all. So I am glad you're "no Paul Offit". With your attitude instead of his, many of us in our '70s and older might have a decent chance of avoiding and/or surviving Covid.
Dr. McCormick, very glad you weighed in on the booster timing, and I think Dr. Offit would do well to listen to you! I am interested, too, in how you arrived at 6 months, as opposed to say, as Mr. mcNiff does, 3 months. I perhaps there isn’t sufficient data to be clear enough on this, but I do often see indications that boosters start to wane in as few as three months. Anyway, would be interested in your thoughts.
I listen to Twiv when I can too 😊 these are really good links you’ve provided, and I will read through the longer one later. I’m also wondering if humans aren’t quite up to the task, and wonder what an artificial intelligence system would come up with if we tasked it with reviewing all the studies, epidemiology, and how to do boosters.
I think nuanced recommendations given with precision based on age and comorbidities would be best, but a public health communication nightmare!
I had read the STAT piece and reread it fast. I saw that Offit was apparently in favor of dropping the old “original” part of t he booster and just keep it with the “current strain”. I agree that it makes sense and I’ve heard him say it before, but the problem is that he is reluctant to give boosters of any kind to anybody and certainly not as often as they seem to need to protect us old folks well. I read the Lancet article in the Griffen post, but didn’t have time to watch the video now. It sounds like we all should get vaccinated and them get sick so we’ll have hybrid immunity. Good luck with that in the vulnerable part of the population.
Definitely agree on the comment about learning just how effective the vaccines are - of all kinds. But expecting a lot out of big pharma re research on the immune system seems unrealistic. Besides isn’t better understanding our immune systems the job of all the infectious disease experts that have been studying the issue for years and still haven’t done much, apparently, to alleviate our ignorance?
Thank you Dr. Jetelina. Your reporting is outstanding. You are very much appreciated.
FDA is taking a very high risk with many lives with their strategy. As a former senior government manager I do not think the government can manage their way out of a paper sack. What could go wrong - a lot! I have little confidence that this is going to work out well for the most vulnerable such as myself.
Thanks for all this information which is very helpful! Have you ever considered writing or co-writing a book about your experiences during the pandemic? It would make for riveting reading and I'd certainly buy a copy! As would a while lot of us!
Sounds as if because of waning bivalent booster and lack of further development chances will be very high I could be getting Covid soon after March. September to March. I mask, but almost no one does in my area. Many say, "I had covid and I'm fine, it was like a bad cold".
I'm blessed to live in a county where mask wearing is still reasonably common and accepted ("You Do You") but when someone says "it was like a bad cold" I'm happy for them, but hope they're not thinking they're reassuring me.
Agree. I am glad for them but also know there is no way for them to know how much it was or is affecting them. Now that we know it invades all kinds of cells throughout the body. We have no way to know if it is "over" or "gone".
This is somewhat knowable on an individual level, if you aren't too squeamish about the sight of your own blood. I just got another spike antibody test from Labcorp - I'm almost four months out from the bivalent, which I got in early September right before sitting on a grand jury in Brooklyn for four weeks. I'm fairly optimistic, because my last one, in the middle of December, clocked in at 25000 u/mL.
Basically, different people wane at different rates, and it's OK to know your own biometrics.
Let us know your results from the recent test, please. Also can you put some perspective on that figure of 25000 u/ml? what’s “typical”, low, very high? And does the test account for different “spikes” (from mutants/variants) being better able to evade antibodies (no matter how many antibodies they may face).
Results are back - as of yesterday, 146 days from my bivalent (my *seventh* overall, I jumped on it because I was about to serve on a grand jury for four weeks) I'm over 25000 u/mL on the Labcorp spike antibody test. I am quite confident there weren't any exposures in that period.
Some of my antibodies were likely able to neutralize Omicron subvariants even before my bivalent (thanks to affinity maturation)
But I still don't have any idea exactly how well this correlates to protection. It's possible that I've been blessed with genes that make vacc
If the administration's current Covid strategy is primarily vaccination, rather than NPI--as a high risk person (age and immune issues)--this proposed annual shot which feels like it is premature and not supported by robust data--leaves me feeling even more vulnerable and isolated.
I do understand that the current vaccine strategy is beyond confusing and there is low uptake/buy in at this point.
Recently my county went red, and absolutely no one changed their behavior.
As a high risk person, I'd like the CDC to authorize a 6 month booster--as mine is 6 months out.
Thank you for this very informative and timely post.
Thank you for covering Novavax!! I have had 2 Pfizer’s then a Moderna booster and then had to get a prescription to start Novavax (just had 2nd dose month ago).
Am I understanding you have had two NovaVax vaccines? What were your side effects like? I have had three Moderna with awful side effects and am feeling stuck because I was hoping a NovaVax bivalent would be an option.
Correct. Barely a sore arm for the first, nothing for the second. I didn’t have major reactions to the others either, just somewhat tired for a day or two. I did read somewhere to not exercise for 2 weeks following a vaccine so I stuck to that.
After my second Moderna and booster, I spent more than 48 hours vomiting with the worst headache of my life (and I suffer from migraines, so I am no stranger to headaches). That has stopped me from getting the bivalent booster because it was terrifying in the moment.
Maybe? I wish someone could explain it. Would the lower dose of Pfizer be better? Does mRNA technology not agree with me, and would NovaVax be better? Without an explanation, I feel stuck. And, it is disheartening to feel like those of us who are pro vaccine but had a bad experience are being ignored.
Thank you so much for this. Is there anything we can do to help the people in charge to make more progress in funding for studies as well as vaccines? It feels like we are underestimating this virus yet again.
I know doctors don’t think this way (I’m married to one), but unless there’s some significant risk associated with getting a second bivalent booster, why not get one six months after the first one for whatever good it might do? I’m one of the rapidly dwindling « never Covid » contingent, and I’d like to stay that way.
I absolutely agree with you - I would say get one 2 mos or even every month if it has no significant downside. And I never have heard any significant (except maybe rare) one mentioned in all I read. Those of us who want to do this are being denied - unless we ignore the “rules” - the right to try to protect ourselves.
Agreed. Others have the “right” to choose not to vax, not to mask, to expose themselves to COVID multiple times and strain the healthcare system, and to basically ignore the needs of the vulnerable. In this “you do you” era of the pandemic, shouldn’t we also have the right to protect ourselves and take on the risk of an additional vaccine every six months if we choose to?
It is so frustrating to hear the glacial pace of vaccine development and the lack of political will to do another round of “Warp Speed” for a virus that is killing 3,000 a week and disabling millions.
It is extremely disheartening to hear this inertia from the scientists and scientific bodies whose entire mission it is to be at the cutting edge of science for public health’s sake. If we cannot depend on them during a global pandemic (and it is crystal clear that we cannot), then why do they exist? To minimize and ignore the severe impact this vascular virus is having on entire generations?
I am entirely frustrated.
- signed, a mom in the US South, whose child is immune-compromised, so we have to continue to sit out on life
What I’d like to know is simple: I got the bivalent Moderna booster in September. Has it likely worn off by now? Is there anything to be gained by getting it again now?
I would like to know that too... Hence why I was a bit disappointed. You can be confident it's working against severe disease. It is probably working okay (?) against infection, but is likely waning by 6 months.
One way to think about the bi-valent is to consider that in fact you have gotten only ONE DOSE of Omicron focused vaccine. What we know from the original vaccine against the original virus was that you needed two shots to generate a significant immune response, and that the response was stronger and longer lasting if there was more time between shot #1 and shot #2. From that perspective, it would seem to me a second bivalent shot would be very advantageous in terms of stronger and longer immunity against infection, severe disease and death. But I guess we won't know that until folks are allowed their second shots.
I'm not sure I'd place much faith in the case of infection but I'm fairly confident in terms of severe disease/hospitalization/death. Although we got lucky with the original mRNA vaccines with regard to illness prevention against wild strain, subsequent variants have not behaved as nicely.
Why fairly confident somebody's still pretty well protected against hospitalization etc. after 6 mos? CDC's own study of booster protection against hospitalization shows it waning at rate of about 7% per month.
https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e2.htm#T1_down
And of course even during period when post-booster protection against hospitalization is maximal, elderly and immunocompromised probably aren't as protected as younger and healthier people -- like maybe they start out at 85% protected against hospitalization, and decrease from there.
I'm thinking that 6 months out from a booster the average 70 year old is 40-50% protected against hospitalization. 11 months out? Almost completely unprotected.
Most of us, now, are employing hybrid immunity. There's evidence that hybrid immunity is more potent than infection-derived, or vaccine-derived immunity. The MMWR article you cite has a number of limitations they identify themselves. This study looked at emergency department visits and 2 vs 3 booster conditions with no visibility toward prior or concomitant infections. Thus, there was no evaluation for hybrid immunity's contribution to the condition.
Overall, we've done a pretty good job with vaccine development, and its longevity. Where we've done a poor job as a nation, and to a great extent as public health folks, is in providing a narrative that resonates with the public and encourages them to pursue an appropriate course, in this case, immunization and maintenance of the boosters as we currently know them until we've got something better. On the other hand, BECAUSE we did such a poor job communicating, and because we've also seen so many immune-evading variants, a large portion of the vaccinated public is also post-COVID.
The immune wall we've seen that's been preventing more death and hospitalization has occurred within the groups that have a naturally-acquired immunity secondary to infection as well as a vaccine plus booster acquired immunity. The two are complementary.
Actually the study didn’t just look at emergency dept. visits, it also looked at hospitalizations. Results for hospitalizations are shown in the lower part of Table 2.
Yes, it’s true that many people have hybrid immunity now, and no doubt the same study done now would show slower waning of immunity after boosting. Of course by the time the study was done a fair number of its subjects probably already had hybrid immunity. But more people have it now . However, quite a few people who are especially vulnerable due to age or health conditions have managed to avoid getting covid so far by being especially cautious. Those people also keep up with the news on covid, and I would guess that they are over-represented on this list. I am one of those people: I have a substantial unmodifiable risk factor. Those of us who made an extra effort to avoid covbid and have succeeded so far do NOT have hybrid immunity. If you ran that same study using our population we would probably do worse than the people in the study I cited, because not only do none of us have hybrid immunity, but also we are older and less healthy than the population in the study. I’ll bet our initial protection right after the booster would be lower than what was found for the subjects in this study. Older people generally have immune systems that are not working as well. That’s why some docs recommend older people get the “extra strength” flu vax. And it wouldn’t surprise me if older and more vulnerable people not only responded less well to the vax but also had their immunity wane faster.
It is regarding this group especially that I think a once yearly vaccine is inadequate.
So, there are several things to unpack here. The number of people with significant risk who have attempted to avoid COVID is dwindling simply because we've seen too many immune-evasive variants. That said, and while I don't EVEN want to sound like the virus is weakening (variant evolution doesn't indicate we're getting stable in that regard yet) several of the latest subvariants of Omicron have shown less virulence; it's possible you've been infected and did not have a bad result. Whether you have hybrid immunity requires clinical and lab evaluation unless you're vaccinated AND have had a documented (e.g., via PCR) or known (e.g., via home antigen testing) episode, in which case you can be pretty common that, if you're still breathing you have some degree of hybrid immunity.
Note: I fall into the technical high risk group as does my wife. And we've both been infected twice, despite following masking guidance and effectively hiding in place. While I know where I got my first case, and my wife got it from me, we have no clue what the vector was for our second bout. In both cases, my illness was trivial and in both cases, my wife had more significant disease than I did. What I'm saying is, being careful is no longer a guarantee you won't be infected.
We do know that most older patients do demonstrate a poorer immune response than younger patients. Thus, yes duration, in some older patients is not as robust as in most younger patients, Use of a higher potency flu vaccine has been a point of contention for awhile. I personally prefer a second dose in January or early February vs the higher dose single-shot vaccine.
For the record, I don't think we are ready to go to a single annual vaccine. I don't think we know enough about COVID, and I am concerned about immune evasion, and the potential for new recombinant variants that are not Omicron-derived but are, perhaps farther back the ancestral tree. Or a totally new variant. I don't think a pan-coronavirus vaccine is likely to become available for several years, although there appear to be several promising candidates in work.
Vaccine response can only be judged on the aggregate. We will always have people whose immune system isn't activated by a particular vaccine, or the immune modulation process in general. Some of those will benefit from additional vaccine doses, something your doctor can prescribe in the case of COVID, if that's needed. If the FDA does get the green light to go to a single vaccine annually, there remains some leeway for your doc to support your specific condition.
I thought that I had read that it basically wore off in 4 months as far as providing immunity from infection was concerned. I got mine in September as fast as the pharmacy had it after approval and wish I could get another. Heck-I wish I could get one every month. Why not? I might feel like I could "have a life" again.
On average - but everyone is different.
I made a point to get my last few shots in the morning, and to exercise immediately after.
I believe by “sterilizing” vaccine you mean preventing actual infection. My understanding is that it does provide some protection (not sure what level - if anybody is) but that it wanes very quickly in its effectiveness at that. (virtually zero after 4 months - the stopping infection part). Is that contrary to what you understand from existing info/data? And what do data indicate about the duration of the prevention of serious cases and death? I’d appreciate your input since I know you are both smart and well informed. I follow your comments with great interest.
And isn’t there some protection against infection? As opposed to exposure. How much , if any and how long - if true. Some devotion issues here I think. Have been confused on these pints in much of what I’ve read
But if not infected then can’t get disease, right? What are NAbs? NAbs contraction?
I'm wondering the same thing, I also got mine in September. As far as I understand it is unlikely it's worn off, but protection does start to drop after about 4 months. So I'm wondering, should I be looking at getting a booster in February or March? Can that even happen if the FDA punted on the question?
As someone who is high risk and has so far managed not to get COVID, I increasingly feel like government and corporate policy is no longer taking me into consideration. At this point in effect it's requiring me to go ahead and get COVID and see what happens.
I think the next ACIP meeting will be in mid-Feb. So we would hopefully get some clarity by then. But in the meantime, I wouldn't expect it.
Layperson here who is in the high risk category and just tries to stay informed. First and foremost, thank you so much for all that you do! From your post above, did you mean that you’re hoping for clarity after the ACIP meeting on whether those who want a second bivalent will have it available to them?
Hope this happens on that timeline - so long as determined "safe", I'll probably get another shot no later than early April, a couple of weeks before some planned travel. I'm not in any kind of high-risk group, just don't want to catch covid again (last August when primary + booster protection had clearly waned for me and before the new boosters were available - it sucked pretty bad even though it was a mild case by any kind of reasonable standard).
Concur.
Good reason for people to make sure they've got health insurance!!
This is exactly my question. What is the guidance for those of us that got the bivalent shots when they were rolled out and who are willing to go get another one if it will be beneficial.
tl;dr I got a second bivalent booster with no push back, and my immune system is reacting just like September. I feel more at ease about upcoming travel and public events.
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I'll be traveling in February and attending a large conference in March. After finding no guidance or even mention of re-boosting, I booked an appt for a bivalent booster at the pharmacy where I got the September booster. I figured that if there was a reason to not be re-vaxxed, they'd decline. But they treated it as business as usual, and I got a second bivalent booster.
My arm got sore just like the first bivalent booster; I was low-energy and needed a nap the next day like the first bivalent booster. Seems like my immune system is responding appropriately to give me some renewed protection.
I'll still mask in public spaces, and I'll carry an Aranet 4 to measure CO2 & particulate levels so that I can remove myself from poor air quality spaces. But I feel like my risk/reward balance has gotten lighter on the risk side and tipped towards reward after getting a second bivalent booster.
I'll get a second bivalent if an antibody test shows evidence of waning. So far so good
Who would I ask to get an antibody test?
Any Labcorp. Don't need to ask anyone
"Antibody testing is not currently recommended to assess for immunity to SARS-CoV-2 following COVID-19 vaccination or to assess the need for vaccination in an unvaccinated person." https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing/antibody-tests-guidelines.html
That was written almost two years ago, and while it may not be perfect, it's still thought to be correlated to protection. And it's surely superior to cruder heuristics like age.
I'm concerned about that too - whether 'wearing off' is defined as getting asymptomatic infection (but with the capacity to transmit it unknowingly to others), the gamut of symptomatic infection, or the probability of acquiring long Covid. And optimally by age group etc. (not sure what the "etc" should include). Also what is 'wearing off?'- immunity to the variants included in the vaccine (I think yes) or to getting sick from a different variant? Has my immunity to other pathogens I was vaccinated against decades ago 'worn off?' How about to the measles infection I had as a child?
Allow me to offer a reassuring example. I had chickenpox when I was 8 - that's 40 years ago. I got an antibody test for varicella in addition to the covid antibody test. Still there!!
Thanks for this summary. That's a cute photo in your kitchen of the Helper at work too.
For those asking how likely it is that their bivalent booster has worn off by now: There is a CDC study of waning effectiveness against hospitalization of vaccines over time. Study did not look at bivalent booster, but was done using subjects who'd received original shot plus boosters, during the omicron period but prior to the time when the bivalent vaccine was available. The study's here: https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e2.htm#T1_down
Here's their finding about waning through 4 or 5 months: "During the period of Omicron predominance, vaccine effectivness against COVID-19–associated hospitalizations waned with time since vaccination: vaccine effectiveness after a second dose declined from 71% within 2 months of vaccination to 54% among those vaccinated ≥5 months earlier (p = 0.01). Among recipients of 3 doses, vaccine effectiveness against COVID-19–associated hospitalizations declined from 91% among those vaccinated within the past 2 months to 78% among those vaccinated ≥4 months earlier (p<0.001)."
So clearly effectiveness against hospitalizations wanes. looks like at something like 7% per month, at least over the first few months, which is the period this study looked at. Based on that result, I'm thinking that if people get only one shot per year, they're going to have almost no protection against covid by month 11. For the elderly and other vulnerable people giving shots only yearly seems dumb as hell to me.
"For the elderly and other vulnerable people giving shots only yearly seems dumb as hell to me.” Yep.
There’s been talk about giving the vulnerable two shots a year, but even that seems unnecessarily limited. And I think we’ll be lucky to get one.
Yup, it is definitely overdue for me to upgrade to a paid sub here. Your advice on Covid has been consistently invaluable. Right now, based on what you write here and from others I trust, like Eric Topol, as someone in a high risk group because of age, I am very worried that my cohort is once again going to be left in the dust without sufficient protection to have any semblance of a post-Covid normal life. My worries have been heightened because, despite taking all of your excellent advice and that of others to heart and following it closely, including all your pre-Thanksgiving advice, we were exposed to and contracted Covid from an 85 year old friend who had, as it turned out, a very incomplete understanding of the level of protection vaccines provide, did not realize the importance of same day testing pre-gathering, and on it goes. She turned out to be a superspreader, and everyone in our little new years gathering, all older women at higher risk, contracted Covid. Beyond that, the person next to her got hit really hard, including a whopping Pax rebound. It was very, very scary, only after 25 days has the fatigue lessened enough for her to resume something akin to pre Covid activity. At this point, we really have no idea how we can protect ourselves without locking ourselves in a closet, and what the FDA is contemplating does not appear to be even close to what we need to get past that.
PS: looking at the previous comments and questions re waning protection, both I and the person sitting next to our vector got our bivalent boosters 9/15/22. We are both in our 70s, unclear what any additional risk factors are, but likely some. We both contracted Covid after attending the small indoor gathering; neither of us required hospitalization, but the one of us sitting next to the vector had profound fatigue and other seriously problematic symptoms on and off for 3 weeks. As noted above, the Pax rebound was particularly frightening, and there was nowhere to turn to understand what was going on or when or whether the profound fatigue, in particular, would resolve.
I don’t mean to go on, and I know what I describe is anecdotal, but I have benefitted from learning of the experiences others have had who are fully boosted, higher risk, etc. so, in the case I have described, I have tried to learn from what occurred to see what I might do differently. Here are some takeaways:
1) I overestimated the knowledge base of the friends with whom we gathered; all were being careful within what they thought that entailed, but the knowledge base on which that rested, including the extent to which vax might prevent infection, how best to use rapid tests, etc. was varied and often wildly incomplete. One thing I did in the aftermath of our debacle was to send around Dr. Jetelina’s pre-Thanksgiving Substack, with advice for what to do when contemplating unmasked indoor visits with older people. Whether it will be followed in the future, I can’t know, but at least everyone has the information.
2) Despite, at least in my case, trying to remain as informed and up to date as possible, we were all caught short by lack of information on the prevalence of XBB.1.5 in NYC (it was 75% or thereabouts New Years Day). Had we been aware, I suspect it likely the gathering would not have gone forward at all. I only subsequently learned of the high prevalence from . . . a Dr. Jetelina Substack! So, I sent that around, too. I also wrote my City Council person to ask for his assistance in pushing our local health department to do a better job of updating alerts, and specifically provision of information on things like the immune escape/high transmissibility of the XBB.1.5 variant, about which I could find nothing on the website, eg.
3) On learning that our vector, and perhaps others in the group, did not realize that vaccines/boosters do not by any means guarantee preventing infection, I explained what I know about that, and also about the issue of asymptomatic transmission.
Of course, I hope in all of this that what I conveyed was reasonably accurate information within what is known. I have high confidence in that regard if the information is from Dr. Jetelina; much less so when I am conveying my own understanding of things I have gleaned over time. And at this point I have very low confidence that an indoor gathering of more than 3-4 people can proceed safely at all, which is really sad to contemplate. I miss my friends, and none of us are getting any younger.
I agree with the well-stated concerns here for those of us who want more information! However, it is a stretch to conclude Paxlovid was 1. the cause of the rebound and then 2. that it amplified the rebound. "Whopping Rebounds" also occur when Paxlovid is not used. Remember that there is substantial consensus in the scientific community that Paxlovid is beneficial, since it reduces the severity of Covid as well as the incidence of PASC. Your better strategy is to be flexible about assumptions of when a case of Covid is completely over. The 5 and 10 day CDC guidelines come from statistical averages. Not all individuals are average; some will take less time; some more. I continue to be cautious around all recently infected people. I like your conclusion about doing the testing close to the time of gathering.
Hi, Kathan: these are very good points, and well taken. I absolutely agree that the consensus is that Paxlovid is generally beneficial and I would also say I am confident it was beneficial in both the case I describe and for others present who took Paxlovid. I didn’t mean to suggest, BTW, that Paxlovid caused the rebound, but rather that review of the CDC memo on rebound strongly indicated that rebound occurred in the case I described. My apologies if something got lost in translation there! Of course, with all of this, to borrow from the old hairdresser saying, only your local epidemiologist can know for sure--or at least closer to sure--what is, eg cause and effect, what is associated, and what is irrelevant. One of the great difficulties here, and why I am so grateful for Dr. Jetelina’s willingness to remain as a public facing communicator on all of this, and her clarity in so doing, is that all of us who do not have expertise have been forced to learn a lot of strange, new languages simply in order to do our best job of assessing personal risk and staying clear of infection (if that is what we choose). I joke sometimes that, to do this in the face of lack of clarity and/or information from our public health bodies, one must assemble a personal panel of private, trustworthy sources from which to gain understanding and determine what is best to do. In doing so, it’s always a good thing to retain humility about one’s own lack of expertise!
Well said. I have subscriptions to multiple newspapers. I follow the CDC and my local county health department. Since Fall 2022, Covid information has been harder to find. And when I do find reports, often the reporter doesn't have the expertise to accurately translate the science. The CDC/County HD messaging has switched to the mediocre, one-size-fits-all version in order to provide simple, static information. Unfortunately, Covid is neither simple nor static. I am also humble about my lack of expertise, but even more humbled and in awe of the complexities in the unfolding science of this virus. I sincerely appreciate Dr. Jetelina's expertise, concise writing, and her important brave advocacy.
Kathan, I have been thinking ever since about this perceptive comment you made regarding public-facing public health communication, particularly as it relates to those of us at higher risk because of age, immunocompromised status, and the like: “The CDC/County HD messaging has switched to the mediocre, one-size-fits-all version in order to provide simple, static information.” It took me back to this observation Dr. Jetelina made about the community levels map when the CDC changed its guidelines: “This map tells us when to take collective action so hospitals don’t surge. This does not tell us when to wear a mask for individual protection due to high transmission. If we are trying to prevent severe disease, those at most risk should know when they are at risk for infection.” Ironically, buried within the top level information on the CDC community levels maps page is a link to a section of guidelines for older people--but guess what, at least two links within that section, and the ones most pertinent to daily activities and mitigation strategies geared to older people, are broken. Sort of a metaphor for the overall problem!
"...often the reporter doesn't have the expertise to accurately translate the science.” Sadly so true. And it’s true on national news reporting as well. The ignorance of mass media on this subject is even more stupefying than the ignorance of basic economics and financial matters.
Sorry I have googled but what is Pax rebound? Is this the same as Paxlovid rebound as per Joe Biden?
yes
Sorry to hear about your experience Susan. Re same-day testing, we need more useful guidance. Probably false positives aren't common, but--depending on the Covid prevalence in the environment and how recently an asymptomatic testee was infected, the probability of a false negative rises. I would think that this is true to a lesser extent for home "PCR-like" (molecular) testing.
Hi, Iver: you are right about the limitations of same-day testing, which I believe is why Dr. Jetelina’s pre-Thanksgiving recommendation was for cadence testing, along with other pre-gathering mitigation measures. That is, it is only one strand in a multi-layered mitigation approach. In the case I describe, the person who turned out to be the vector believed that her vax/boost status rendered her immune from getting infected or infecting others, and, as a result, engaged, prior to our gathering, in high risk activities including a large, unmasked indoor party. Then, while she tested the day before our gathering, she was negative, so she thought she didn’t need to test the day of the gathering. Also, though I have not confirmed this with her, as she is already feeling absolutely horrible she visited this on everyone, she may well have had symptoms she didn’t recognize as possible Covid. Now, of course, it is still possible that she would have tested negative the day of the gathering, but I can only say I would have preferred those odds.
I believe false positives can happen with oral swabs if you've eaten acidic food. That's why I generally don't (and none of the manufacturers recommend swabbing orally anyway)
Excellent synopsis - thank you.
Happy about:
1) Dr. Offit conceding the data over his intuition and original sin (let's take the guilt out of that term somehow!)
2) mRNA technology still a wonder of the world
3) Cute toddler! Some flexibility to convert to remote work (for those fortunate enough to have the option) is such a valuable tool for family life. Disruptions have eased, but life is far from normal for those of us still being careful and conscientious. We should continue to promote that remote option, and employees should fight for it. I am.
4) FDA and CDC and everyone being proactive in January
Not happy about:
1) Over 75 data - I think that slide means that 1.8% of all >75 year olds in the US were admitted to the hospital with Covid between January 2022 to January 2023? Seems like a lot. Would be worse, I know.
2) Stroke data. I still think getting Covid is worse, and certainly a severe case increases stroke risk by 18 fold in a UK study (https://heart.bmj.com/content/109/2/119)
A lot of my savvy elderly patients who were boosted in September are asking about whether they should get another one soon. I reply that there is no recommendation on this yet. But I am troubled by the constant churn of Covid. I don't see waves, and our hospital system's inpatient census has been hovering at around 150 patients hospitalized with Covid for months now. Hoping for a spring reprieve.
I'm no Paul Offit, but if I were at the FDA meeting I might have floated this:
70+ can get booster q6 months until pan-coronavirus vaccines available. Younger generations collectively do little to protect them anymore. A more realistic, once-yearly, fall booster campaign for everyone else - to head off or reduce a holiday wave, and to blunt the back-to-school mess that converts children into efficient vectors.
Love your suggestion, but I'd say AT LEAST EVERY 3 months unless somebody can show a darn strong reason why not. As for Paul Offit, I have reached the point where I don't read his comments on these problems at all. So I am glad you're "no Paul Offit". With your attitude instead of his, many of us in our '70s and older might have a decent chance of avoiding and/or surviving Covid.
Dr. McCormick, very glad you weighed in on the booster timing, and I think Dr. Offit would do well to listen to you! I am interested, too, in how you arrived at 6 months, as opposed to say, as Mr. mcNiff does, 3 months. I perhaps there isn’t sufficient data to be clear enough on this, but I do often see indications that boosters start to wane in as few as three months. Anyway, would be interested in your thoughts.
I listen to Twiv when I can too 😊 these are really good links you’ve provided, and I will read through the longer one later. I’m also wondering if humans aren’t quite up to the task, and wonder what an artificial intelligence system would come up with if we tasked it with reviewing all the studies, epidemiology, and how to do boosters.
I think nuanced recommendations given with precision based on age and comorbidities would be best, but a public health communication nightmare!
I'd say social security mortality tables taking age and sex into account would be a good start
I had read the STAT piece and reread it fast. I saw that Offit was apparently in favor of dropping the old “original” part of t he booster and just keep it with the “current strain”. I agree that it makes sense and I’ve heard him say it before, but the problem is that he is reluctant to give boosters of any kind to anybody and certainly not as often as they seem to need to protect us old folks well. I read the Lancet article in the Griffen post, but didn’t have time to watch the video now. It sounds like we all should get vaccinated and them get sick so we’ll have hybrid immunity. Good luck with that in the vulnerable part of the population.
Definitely agree on the comment about learning just how effective the vaccines are - of all kinds. But expecting a lot out of big pharma re research on the immune system seems unrealistic. Besides isn’t better understanding our immune systems the job of all the infectious disease experts that have been studying the issue for years and still haven’t done much, apparently, to alleviate our ignorance?
Thank you Dr. Jetelina. Your reporting is outstanding. You are very much appreciated.
FDA is taking a very high risk with many lives with their strategy. As a former senior government manager I do not think the government can manage their way out of a paper sack. What could go wrong - a lot! I have little confidence that this is going to work out well for the most vulnerable such as myself.
Thanks for all this information which is very helpful! Have you ever considered writing or co-writing a book about your experiences during the pandemic? It would make for riveting reading and I'd certainly buy a copy! As would a while lot of us!
I have a few options with publishers, just need to find the time :) I’m hoping once the response calms down, I can find a cozy cabin and just write
Ahmmm
Two little ones are a project of their own....
I've appreciated all of your informational posts, but this was exemplary in the amount of relevant information provided. A sincere thanks.
Sounds as if because of waning bivalent booster and lack of further development chances will be very high I could be getting Covid soon after March. September to March. I mask, but almost no one does in my area. Many say, "I had covid and I'm fine, it was like a bad cold".
I'm blessed to live in a county where mask wearing is still reasonably common and accepted ("You Do You") but when someone says "it was like a bad cold" I'm happy for them, but hope they're not thinking they're reassuring me.
Agree. I am glad for them but also know there is no way for them to know how much it was or is affecting them. Now that we know it invades all kinds of cells throughout the body. We have no way to know if it is "over" or "gone".
This is somewhat knowable on an individual level, if you aren't too squeamish about the sight of your own blood. I just got another spike antibody test from Labcorp - I'm almost four months out from the bivalent, which I got in early September right before sitting on a grand jury in Brooklyn for four weeks. I'm fairly optimistic, because my last one, in the middle of December, clocked in at 25000 u/mL.
Basically, different people wane at different rates, and it's OK to know your own biometrics.
Let us know your results from the recent test, please. Also can you put some perspective on that figure of 25000 u/ml? what’s “typical”, low, very high? And does the test account for different “spikes” (from mutants/variants) being better able to evade antibodies (no matter how many antibodies they may face).
So - no, the test doesn't check individual variants, but it's widely believed that boosters broaden one's antibodies.
Results are back - as of yesterday, 146 days from my bivalent (my *seventh* overall, I jumped on it because I was about to serve on a grand jury for four weeks) I'm over 25000 u/mL on the Labcorp spike antibody test. I am quite confident there weren't any exposures in that period.
Some of my antibodies were likely able to neutralize Omicron subvariants even before my bivalent (thanks to affinity maturation)
But I still don't have any idea exactly how well this correlates to protection. It's possible that I've been blessed with genes that make vacc
If the administration's current Covid strategy is primarily vaccination, rather than NPI--as a high risk person (age and immune issues)--this proposed annual shot which feels like it is premature and not supported by robust data--leaves me feeling even more vulnerable and isolated.
I do understand that the current vaccine strategy is beyond confusing and there is low uptake/buy in at this point.
Recently my county went red, and absolutely no one changed their behavior.
As a high risk person, I'd like the CDC to authorize a 6 month booster--as mine is 6 months out.
Thank you for this very informative and timely post.
I've appreciated all of your informational posts, but this was exemplary in the amount of relevant information provided. A sincere thanks.
Thank you for covering Novavax!! I have had 2 Pfizer’s then a Moderna booster and then had to get a prescription to start Novavax (just had 2nd dose month ago).
After the third shot of Novavax they have detected sterilizing (mucosal) immunity. Hopefully the new version is out when I’m due for my booster. More info here: https://donford.substack.com/p/the-benefits-of-novavax-explained
Am I understanding you have had two NovaVax vaccines? What were your side effects like? I have had three Moderna with awful side effects and am feeling stuck because I was hoping a NovaVax bivalent would be an option.
Correct. Barely a sore arm for the first, nothing for the second. I didn’t have major reactions to the others either, just somewhat tired for a day or two. I did read somewhere to not exercise for 2 weeks following a vaccine so I stuck to that.
After my second Moderna and booster, I spent more than 48 hours vomiting with the worst headache of my life (and I suffer from migraines, so I am no stranger to headaches). That has stopped me from getting the bivalent booster because it was terrifying in the moment.
Maybe? I wish someone could explain it. Would the lower dose of Pfizer be better? Does mRNA technology not agree with me, and would NovaVax be better? Without an explanation, I feel stuck. And, it is disheartening to feel like those of us who are pro vaccine but had a bad experience are being ignored.
Thank you so much for this. Is there anything we can do to help the people in charge to make more progress in funding for studies as well as vaccines? It feels like we are underestimating this virus yet again.