It’s been close to 6 months since the initial rollout of the fall (bivalent) booster. A lot of people are wondering: Do I need a spring booster? The answer hinges on more questions: What is the purpose of vaccines? Does that purpose change depending on age or health status?
My husband and I are 78 and nearly-76 respectively. Last month we went to a pharmacy where we're unknown, handed them our original cards for just our first shots and boosters, and asked for--and got!!--our 2nd bivalent vaccinations. We feel tremendous relief, and just wish we hadn't to sneak around to get this basic protection that's being offered in countries that are actually civilized (and not as political as the US GOP makes everything) about public health for their elders.
It is difficult to understand the “down sides” to boosting. I have never seen this articulated anywhere. What, precisely, are the risks of boosting? Additionally, with bivalent booster uptake being so low in the US, it is doubly frustrating to see vaccine doses expiring rather than be given to people who desperately want them. Much of vaccine policy is not making much sense these days. The long delays and debates on boosting and reformulating are tough to watch while the world burns with COVID waves, over and over.
As the COVID task force is disbanded, the NYT has stopped collecting data, and Dr. Birx is quoted in the WaPo saying “the immune compromised are less protected than a year ago “, it’s time to allow the higher risk people to get a booster. I hope the approval comes soon. Just learned that Michael Osterholm, despite very thorough precautions has Covid--he has advocated for another booster. He tried to get a booster and was denied. Permission to boost high risk people seems overdue.
Thank you both for keeping your word on informing us about getting boosters earlier than this fall. I am worried for my frail 82-year-old parents, who are prime candidates. They NEED it. I am worried for myself: 57, healthful, active, fully vaxxed, still a “Novid”, and not wanting long Covid. I WANT it. I hear of people sneaking around the system to get boosted now if they’re not “due”. I hoped the decision-makers would approve another booster, so that this was not necessary. You both are my ears to the ground. I appreciate any intel you can offer!
Thank you so much. My friend and I were discussing this yesterday. As two immunocompromised over 65 year old women, we have worked hard to keep covid from putting us in the hospital. Your information is timely as always.
Lots of things worry me about our handling of Covid, but what troubles me most is the *absolute* lack of government and other messaging about the potential long-term effects of even a mild infection. Right now, it seems, we are at the point where most people seem to be thinking: getting Covid is no big deal, just like a cold, who cares? Never mind the 300-400 daily deaths from the disease. And never mind the growing body of papers that show long-term and possibility permanent increased risk of heart attacks and strokes (for just one reference, see Eric Topol's "Ground Truths" article "Heart attacks and strokes late after Covid", published recently). I guess this cuts close to the bone: my 27-year-old previously fit and healthy daughter got Covid quite early, and now has heart and neurological damage that may require coronary surgery and, at its worst, means she now has to use sticks to get around. So a question, Katelyn and Jeremy: why are you not writing about this? Perhaps if scientists started shouting from the rooftops about the increased MI and stroke risk, maybe people would start realizing that this disease is set to change the future of human life expectancy, and not for the better.
Thank you for this update! I would get my Bivalent booster today if I could. 61 with comorbidities. I really appreciate your Substack. Keep up this wonderful source of trusted information.
One group that wasn't included but should is caretakers of people at risk. Having them fully and doubly vaccinated can only help reduce the spread of infection.
May we please have a comment to indicate that if you have not had covid yet, it's important to do everything you can not to get it? May we have an analysis, from a public health/mental health perspective about how difficult it is for those of us in the minoriy, those of us who believe the government has lost the masking/vaccine culture wars, disinformation wars? The Feds threw up their hands and said, oh, we can't encourage people to be healthy, so let's just give up. Have you read this:
Just to contextualize the following question, I am happy either to never get another booster again or to get one every n months till I die—or anything in between. 🙂 Whatever is warranted—ie, is the best, most educated guess for my demographic profile.
So, given that, would I be correct in assuming that rare side effects aside, it seems like the only real downside to boosting is the risk of imprinting? That’d be a real risk: you don’t want to anchor your immune system to an extinct species. (General info on this for anyone curious here: https://en.m.wikipedia.org/wiki/Original_antigenic_sin)
Do we have any data yet on whether and how strongly imprinting occurs? Could we ever gather such data or are we stuck with biological common-sense guesses (we might be)?
I’m presuming no new consequential variant here, of course, and no new vax formulations.
Do we have a sense of inter-omicron cross-immunity? I know we have to use biological proxy measures in the lab, etc, that only model antibody reaction (I think!). But perhaps we can infer from populational data.
Finally, long Covid risk enters the calculus insofar as every infection either resets your chances or, worse, actually increases your chances. Do we have a bead on that yet? The magnitude of risk matters a lot of course.
Is there a MEDICAL downside to getting this booster if you are over 80 but have no comorbidities? Will it somehow have a negative effect on our immune systems such as being challenged too much?
I thought your description of my thymus as a "useless blob of fat" was unnecessarily cruel and thymusistic, but otherwise, I loved the column. As always. All our lives are based on risk-vs-benefit analysis, in which we don't have enough specific information. And political posturing compromises what information we do get. I'll get a booster after the six month wait from my last one.
Can only hope that there is still significant interest in the question of boosters being effective or not, useful or not, and then making them available if needed, especially in light of the news that there are at least two new variants (most notably in India) that are picking up steam.
We will have many disease vectors to cope with as climate change speeds up. Hope we stand firm on the need for enhanced public health funding and research.
Thanks for addressing this question. In the "land of the free" what a freakish irony that whereas vaccine mandates are compared to Nazi Germany’s persecution of the Jews, vaccine anti-mandates (you can’t get the vaccine booster even if you want one*) barely raises an eyebrow. (*Unless you have a doctor who will prescribe and a pharmacy that cooperates.)
Avoiding severe disease sounds good until you realize that Long COVID, even if it leaves you long-term disabled, is excluded from the FDA's and CDC's definition of severe disease. Boosting every 6 months, by reducing infection, would reduce Long COVID and with it severe Long COVID, which has not gone away to the degree that severe acute COVID has. Given the evidence that vaccination reduces the probability of Long COVID given infection, it probably does even better than that.
Restricting boosters to the elderly and immunocompromised excludes those at elevated risk of Long COVID. The official line is that there are no predictors of who will get Long COVID. This is nonsense. Of course people who have ALREADY had a post-viral syndrome (including past Long COVID, ME/CFS etc.), are at higher risk of having another one, just like people who have had one heart attack are at elevated risk of having a second. People with ME/CFS are also vulnerable to significant exacerbation with each subsequent infection.
Long COVID is the primary threat from COVID at this point, and yet it excluded from consideration when it comes to vaccination policy. It doesn't count as severe disease, no matter how severe. Evidence on risk factors is simply ignored, and high risk individuals qualify neither for boosters, nor for Paxlovid if infected.
Here’s my question: will we be *allowed* to get a second bivalent booster if we want one? I’m almost 71, my husband is 77. Because we both got COVID last September, we didn’t get this shot until December, so presumably we are still more or less protected, but I wouldn’t turn one down in June if it’s an option.
My husband and I are 78 and nearly-76 respectively. Last month we went to a pharmacy where we're unknown, handed them our original cards for just our first shots and boosters, and asked for--and got!!--our 2nd bivalent vaccinations. We feel tremendous relief, and just wish we hadn't to sneak around to get this basic protection that's being offered in countries that are actually civilized (and not as political as the US GOP makes everything) about public health for their elders.
It is difficult to understand the “down sides” to boosting. I have never seen this articulated anywhere. What, precisely, are the risks of boosting? Additionally, with bivalent booster uptake being so low in the US, it is doubly frustrating to see vaccine doses expiring rather than be given to people who desperately want them. Much of vaccine policy is not making much sense these days. The long delays and debates on boosting and reformulating are tough to watch while the world burns with COVID waves, over and over.
As the COVID task force is disbanded, the NYT has stopped collecting data, and Dr. Birx is quoted in the WaPo saying “the immune compromised are less protected than a year ago “, it’s time to allow the higher risk people to get a booster. I hope the approval comes soon. Just learned that Michael Osterholm, despite very thorough precautions has Covid--he has advocated for another booster. He tried to get a booster and was denied. Permission to boost high risk people seems overdue.
https://www.cidrap.umn.edu/covid-19/episode-127-tough-two-weeks
Thank you both for keeping your word on informing us about getting boosters earlier than this fall. I am worried for my frail 82-year-old parents, who are prime candidates. They NEED it. I am worried for myself: 57, healthful, active, fully vaxxed, still a “Novid”, and not wanting long Covid. I WANT it. I hear of people sneaking around the system to get boosted now if they’re not “due”. I hoped the decision-makers would approve another booster, so that this was not necessary. You both are my ears to the ground. I appreciate any intel you can offer!
Thank you so much. My friend and I were discussing this yesterday. As two immunocompromised over 65 year old women, we have worked hard to keep covid from putting us in the hospital. Your information is timely as always.
Lots of things worry me about our handling of Covid, but what troubles me most is the *absolute* lack of government and other messaging about the potential long-term effects of even a mild infection. Right now, it seems, we are at the point where most people seem to be thinking: getting Covid is no big deal, just like a cold, who cares? Never mind the 300-400 daily deaths from the disease. And never mind the growing body of papers that show long-term and possibility permanent increased risk of heart attacks and strokes (for just one reference, see Eric Topol's "Ground Truths" article "Heart attacks and strokes late after Covid", published recently). I guess this cuts close to the bone: my 27-year-old previously fit and healthy daughter got Covid quite early, and now has heart and neurological damage that may require coronary surgery and, at its worst, means she now has to use sticks to get around. So a question, Katelyn and Jeremy: why are you not writing about this? Perhaps if scientists started shouting from the rooftops about the increased MI and stroke risk, maybe people would start realizing that this disease is set to change the future of human life expectancy, and not for the better.
Thank you for this update! I would get my Bivalent booster today if I could. 61 with comorbidities. I really appreciate your Substack. Keep up this wonderful source of trusted information.
One group that wasn't included but should is caretakers of people at risk. Having them fully and doubly vaccinated can only help reduce the spread of infection.
May we please have a comment to indicate that if you have not had covid yet, it's important to do everything you can not to get it? May we have an analysis, from a public health/mental health perspective about how difficult it is for those of us in the minoriy, those of us who believe the government has lost the masking/vaccine culture wars, disinformation wars? The Feds threw up their hands and said, oh, we can't encourage people to be healthy, so let's just give up. Have you read this:
https://www.pestemag.com/lost-to-follow-up/broken-sociality? And, please explain why those of us who know better don't have an option other than having a more isolated life.
Thanks!
Just to contextualize the following question, I am happy either to never get another booster again or to get one every n months till I die—or anything in between. 🙂 Whatever is warranted—ie, is the best, most educated guess for my demographic profile.
So, given that, would I be correct in assuming that rare side effects aside, it seems like the only real downside to boosting is the risk of imprinting? That’d be a real risk: you don’t want to anchor your immune system to an extinct species. (General info on this for anyone curious here: https://en.m.wikipedia.org/wiki/Original_antigenic_sin)
Do we have any data yet on whether and how strongly imprinting occurs? Could we ever gather such data or are we stuck with biological common-sense guesses (we might be)?
I’m presuming no new consequential variant here, of course, and no new vax formulations.
Do we have a sense of inter-omicron cross-immunity? I know we have to use biological proxy measures in the lab, etc, that only model antibody reaction (I think!). But perhaps we can infer from populational data.
Finally, long Covid risk enters the calculus insofar as every infection either resets your chances or, worse, actually increases your chances. Do we have a bead on that yet? The magnitude of risk matters a lot of course.
Thanks, again!
Is there a MEDICAL downside to getting this booster if you are over 80 but have no comorbidities? Will it somehow have a negative effect on our immune systems such as being challenged too much?
I thought your description of my thymus as a "useless blob of fat" was unnecessarily cruel and thymusistic, but otherwise, I loved the column. As always. All our lives are based on risk-vs-benefit analysis, in which we don't have enough specific information. And political posturing compromises what information we do get. I'll get a booster after the six month wait from my last one.
Can only hope that there is still significant interest in the question of boosters being effective or not, useful or not, and then making them available if needed, especially in light of the news that there are at least two new variants (most notably in India) that are picking up steam.
We will have many disease vectors to cope with as climate change speeds up. Hope we stand firm on the need for enhanced public health funding and research.
Thanks for addressing this question. In the "land of the free" what a freakish irony that whereas vaccine mandates are compared to Nazi Germany’s persecution of the Jews, vaccine anti-mandates (you can’t get the vaccine booster even if you want one*) barely raises an eyebrow. (*Unless you have a doctor who will prescribe and a pharmacy that cooperates.)
Avoiding severe disease sounds good until you realize that Long COVID, even if it leaves you long-term disabled, is excluded from the FDA's and CDC's definition of severe disease. Boosting every 6 months, by reducing infection, would reduce Long COVID and with it severe Long COVID, which has not gone away to the degree that severe acute COVID has. Given the evidence that vaccination reduces the probability of Long COVID given infection, it probably does even better than that.
Restricting boosters to the elderly and immunocompromised excludes those at elevated risk of Long COVID. The official line is that there are no predictors of who will get Long COVID. This is nonsense. Of course people who have ALREADY had a post-viral syndrome (including past Long COVID, ME/CFS etc.), are at higher risk of having another one, just like people who have had one heart attack are at elevated risk of having a second. People with ME/CFS are also vulnerable to significant exacerbation with each subsequent infection.
Beyond that, Long COVID is clearly related to dysautonomia, so those who already have a dysautonomia diagnosis should be considered high risk. Also the hypermobile https://www.rcpjournals.org/content/clinmedicine/21/1/53.
Long COVID is the primary threat from COVID at this point, and yet it excluded from consideration when it comes to vaccination policy. It doesn't count as severe disease, no matter how severe. Evidence on risk factors is simply ignored, and high risk individuals qualify neither for boosters, nor for Paxlovid if infected.
Here’s my question: will we be *allowed* to get a second bivalent booster if we want one? I’m almost 71, my husband is 77. Because we both got COVID last September, we didn’t get this shot until December, so presumably we are still more or less protected, but I wouldn’t turn one down in June if it’s an option.