I’d like to give a huge shout out to Costco, who now has the Novavax vaccine in stock in many of their pharmacies across the country. When I called their pharmacy yesterday, a live person answered their phone, and was happy to book a Novavax appointment for me even though I’m not a Costco member. I get jabbed this afternoon.
Compare this to the multiple phone calls I’ve made to Rite Aid, CVS and Walgreens where customers get stuck in an “automated customer service maze from hell” and often can’t speak to a real person. The few times I was lucky enough to reach the pharmacist, they either had never heard of Novavax, confused it with Moderna, and had no idea whether their company would be receiving it. And www.vaccines.gov is not up to date - the place to get real-time info, unfortunately, remains Twitter, or X, or whatever it’s now called, where there’s currently a #Novavax frenzy.
I have heard (although this isn’t confirmed) that Rite Aid and CVS will eventually get Novavax, but it could take a week or two. Perhaps it’s Costco’s superior internal distribution system that allows it to distribute fresh salmon to stores across the nation that enables it to be first at distributing Novavax.
After this exceedingly pleasant experience, I am planning to reinstate my Costco membership (even though I still have a huge box of unused, tissue-thin toilet paper in the garage from the early days of lockdown).
Also, Novavax plans to release the results of their Hummingbird (kids) study on October 17.
Thank you for this! One of my friends is pregnant and seeking Novavax. I let her know about your experience. (We live in the South Bay, fingers crossed that wherever you are in the bay, the costcos in the entire Bay Area are offering similar ease).
Awesome, confirmed my Costco has it too. I've never had bad reactions to the Pfizer/Moderna shots so now the question is, do I mix it up just to mix it up and help the 'demand' for Novavax, or do I stick with mRNA and leave the Novavax stock for those who really need it....
Novovax doesn't seem to have made it here yet and we didn't want to wait for our booster since we're off on a trip to South America in three weeks and wanted to get the flu and COVID updates a few weeks in advance.
I guess the good news is that things are, so far, better than a year ago.
P.S. I'd be pretty leery of anything on The Platform Formerly Known as Twitter unless I confirmed it somewhere else first.
Or put the mask on today. We have a chance to reduce community transmission of ILI. The area under the curve indicates cvd is all around us. If we wait to act, we create the surge.
No. Human beings are not responsible for waves of respiratory viruses. You are blaming people for something that is beyond our control. We don't control nature. It is incredibly arrogant to think otherwise.
We've had surges of respiratory viruses for all of human history. Only in the last few years have people been blamed for that.
I simply don't understand what he gets out of this. His comments suggest that he's accepted the risk of getting covid and giving it to others. I don't even judge anyone for that any more. But clearly this substack is for people who DO still give a s**t about that.
I don't much understand the chronic troll mindset as well. I have noticed a kind of religious fanaticism among the anti-vax/anti-mask crowd, so it could just be a matter of attacking the heathens.
Writing from Ohio: It has been hard to find the updated COVID booster for kids under 12. We made 2 appointments on September 22nd, then on September 29th: one at Walgreens and one at CVS. We got turned away after arrival because they "don't vaccine kids". The pharmacist at the CVS made it sound like it was based on his personal belief (he told us that the pharmacist who just ended their shift would have done it). Walgreens says they won't serve kids under 12 until date TBD. We found an appointment at a Kroger Little Clinic for yesterday: both my 6yo and 9yo received the double COVID + Flu shots. But boy, it took us 3 weeks and plenty of determination.
Meanwhile, as a school board member, I asked our superintendent to reach out to our county health department to set up an in-school vaccination campaign (we did that for the primary series when the FDA approved it for kids) and the county HD responded that they did not purchase any updated covid shots because it's not covered by the federal government.
Why does it have to be so hard to get shots in arms for those who want it, you know?!
Very hard to find them here in the Boston area as well. Seems like supply is improving this week, but as of last week I was still hearing versions of “it hasn’t been approved for kids yet” and “no idea” at every Walgreens and CVS I called. Frustrating!
Even my teens (13 & 17) can’t get the booster at my usual site (multiple CVS stores) because as Child Health + insurance holders, they “need New York State” to administer the shots. When I searched the state’s website for where they COULD get vaccinated, it pointed me back to our own CVS! The CVS pharmacy benefit line said they didn’t have a NDC (national drug code) for kids between 12 & 18. Under 12--has a code. Over 19--code. No code for my guys. I’m attempting vax at a Walgreens tomorrow ( so, outside of the CVS system), after 3 attempts elsewhere 🤞🏻.
That's bananas. In my area (Ohio), 12+ individuals can get vaccinated at a CVS. Why does it vary from a state to another? Are news reporting on the access to vaccines?
Yes! I’m in NY and I must have called 20 pharmacies this week. No one is carrying the vaccines for under 12. It is so frustrating. I didn’t have this issue for the last round.
The CDC report says “ fewer than one quarter had received the recommended COVID-19 bivalent vaccine.” I might be misreading but doesn’t that mean the majority of those hospitalized had NOT received the bivalent shot? I think there may be a simple typo in Katelyn’s post—it happens!
I'm sorry. It is *so* much easier to get Paxlovid now. I had it delivered the day after my first (EVER!!!!!!) positive test eight days ago.
In fact Paxlovid is so damn effective when administered early, and so dependent on liver and kidney functions, that I'm inclined to swear off alcohol for the rest of my life.
Dear Dr. Jetelina, Do you have any new statistics on the risk of Guillion-Barre (or afib) with the RSV vaccine? I know once the numbers of vaccines given goes up, the actual risk numbers will change. I also know the risk of significant disease with RSV for folks over 60 outweigh the risks so I am recommending it to my patients but just asking if you have newer info. So grateful for your work!
I caught the worst “cold” I’ve had in 20 years last month. Brutal! I (and my pcp) kept testing for Covid, but it wasn’t Covid or the flu (I’m fully vaccinated for both), but my pcp did say she was seeing a lot of patients with my symptoms. (I live in North Carolina.)
Also, we here in NC are still having a tough time finding a place that has the latest Covid vaccine. My husband had to drive yesterday to a Walgreens 20 miles away to get his. A friend made an appointment with the local CVS only to be told they didn’t have it when he got there.
According to a CDC study from April 2023, about 43% of people age 65 and older have received a bivalent booster shot. My mother-in-law is in a nursing home, and luckily, they held a flu and covid vaccine clinic last week. Hopefully this year more seniors will get the covid booster.
I'm curious about why respiratory viruses seem to start in the south in the fall? If it's about airborne transmission, then we would expect it to be where people are indoors. In the fall, the north has started to get cold and the south is fairly pleasant, so we would expect northerners to be indoors more than southerners. What else could be going on?
I know most of my friends’ kids in the south return to school about a month earlier than is common in the northeast. So maybe it takes about that long for the full impact of virus swapping to reach critical mass, and the northeast will get there in another month? Or something else? I’m curious to know!
We were all set for the full range of jabs for Oct 6, but got a call from our Walgreens to cancel because Walgreens pharmacy staff across the Portland, OR metro area are as good as on strike over working conditions. We're now scheduled for 10/31 at a Rite Aid further away. I hope that holds. Interesting about Costco. I might call them today and see what's up! Love this newsletter!
1. Does the mortality baseline now incorporate Covid deaths as part of the estimate since the pandemic has been going for 3+ years?
2. I have read about a “Harvesting Effect” where a waning pandemic is marked by a drop in excess mortality below the baseline. If my understanding is correct, this is due to the most vulnerable people having already died. Would you say this is an accurate interpretation?
1) No, they are still using projections based on previous years it appears, and that's consistent with how Human Mortality Database continues to project expected deaths. There are fair arguments to both viewpoints, but at some point we will have to incorporate the last 3 years into our projections for fidelity.
Unfortunately, the CDC stopped publishing dozens of weekly reports on Covid, but the most recent snapshot of mortality (published 9/27, but due to lag I would only trust ~week 32/Aug 12) showed 55,306 deaths (all cause), which is 3,557 more deaths than the same week pre-pandemic of 2019. If you compare week 32 of 2019 to the same time difference of 4 years (2015) the gap is the same - 3,555 more deaths between the 4 years. Make sense?
2) It's a viable theory (I've heard it under other names), and one I believed to be true early in the pandemic, but I haven't seen it supported by mortality data as strongly as I expected.
I also am not seeing it in historical data. Consider the Spanish Flu, in the US the number of deaths leading to it:
1915 - 815K
1916 - 925K
1917 - 981K
Now Spanish Flu hits and it jumps to 1,430,000 million deaths, a 50% increase
You would expect if the "Harvesting Effect" holds true, that once the Spanish Flu fades, you would see some year in the future - perhaps 1920 - drop under a million, even potentially dipping to 800K.
You don't see that. 1919 was 1,072,000 deaths, then 1,118,000 in 1920, and 1,009,000 in 1921, and so forth. (even comparing in rates to factor in population growth you don't see reversal- they just stay elevated-flat)
We also don't see it with Covid so far. Sweden entered the pandemic with their lowest recorded deaths in 20 years for 2019, so you would expect a small bounce up in 2020 even without Covid, but in 2020 they saw a +10% increase in all cause mortality, the following years merely returned back to baseline - no dip to compensate for the earlier peak.
Same in South Korea, 2022 had a 17% increase in deaths, but so far in 2023 they are still +13% ahead of baseline - so not only didn't they see a decrease to compensate the 2022 large bounce, they are still highly elevated in death.
Fantastic, timely report! Thank you so much. In a future, pre-holiday installment, it would be great if you could also give your recommendations on use of rapid testing before gatherings.
Any advice on how often people in their 70s should get the newest vaccination? Our immune response is surely small compared to younger people. My husband and I had our first dose about 2 weeks ago, and are considering a re-vax every 4 or 5 months. (We did this for previous versions by going to different pharmacies and pretending each shot was our first.)
I don't think waning immunity is nearly as much of a threat as it was, it's just that the new variants have a punishingly short incubation period that the immune system can't catch in time. I'm just getting over my first case of Covid now - I got it on 10/5/23. I'd had my XBB shot on 9/16/23 and my spike antibody titer was >25,000 u/mL as recently as 9/6/23.
I was ready, though. I'd stocked up on rapid tests from the public library, and tested myself every other day for about a month and a half. As soon as I tested positive, I arranged to have Paxlovid delivered.
I was responding to her email about COVID-19 vaccinations when I wrote, "My husband and I had our first dose about 2 weeks ago, and are considering a re-vax every 4 or 5 months." But we did also get the flu and RSV vaccinations.
*If* you were referring to the COVID-10 vaccination, I think "get it ASAP" would be too soon, as I suspect the minimum time will turn out to be about 4 months, not 3 and a half months.
I love all your posts about the impact of the acute phase of Covid and other respiratory viruses. I'd like to read more about Long Covid/Post-acute sequelae of SARS-CoV-2. It is hard to sort out how much of a public health impact this is currently having and is projected to have over the next decades. There is a big difference between a couple months of coughing and the going on 4 years of complete disability that we are reading about.
Thank you for this exellent update. A question regarding vaccination status: How are you currently defining "up to date"? For example, say someone has been vaccinated five times, including the bivalent booster, but has not been vaccinated in the last six months? Are they "up to date"?
Thank you. This definition of "up to date" is, however, problematic, is it not? Most of the experts whom I look to on this particular question suggest that -- for anyone over 65, at least (which I am) -- you're *not* really "up to date" if you haven't had a vaccination (or an infection from which you've recovered) in the last 4 or 5 months. Indeed, Katelyn said, in mid September, "Over 65 or at risk for severe disease: Get vaccine 4 months after infection/previous vaccine. Don’t wait more than 6 months." I realize that in some formal/technical context, the meaning of "up to date" may be strictly defined in the way the CDC defines it, but when trusted experts make science-based recommendations that are contrary to that strict definition, it's confusing.
I think at this point you should assume your primary care physician is competent, and that you're up to date if they say you are based on what they know about you.
QUESTION: I am recovering from Covid, including a Paxlovid rebound. Should I hold off on the flu vaccine to give my body a break as well as time it closer to the holidays?
But - for what it's worth, when you schedule your vaccine they do ask a series of questions, and if you answer truthfully, that should give you some idea. I'm also in the throes of Paxlovid rebound right now.
My understanding is that it's good to wait a bit after any infection or live attenuated vaccine, because your innate immune system's been turbocharged and any vaccine you get within, say four weeks, won't be as effective doing what it's supposed to do for your adaptive immune system. But from your perspective I'm just a random chump on the internet, which brings me straight back to "Talk to your doctor"
Not that anyone is looking about now, but I’ll add this for “the record.” To avoid the online problems in obtaining accurate information and making an appointment (of the type that BayDog described in these comments), we opted to get our flu and Covid shots from a local independent pharmacy that does shots on a walk-in basis and which answers the phone with good information about their stock. Here’s what we encountered:
>for both the flu shot (for seniors) and the Covid shot, we encountered supply issues, so had to wait a bit on each. (To avoid side effects, we opted to do the shots separately, spaced about a week apart.)
>no chance of Novovax in our area, so we decided to get whatever was going, which ended up being Moderna.
>the pharmacy does not get big stock of anything, as it is small and, post-emergency status, must pay upfront for supply. As a result, it runs out pretty fast.
>while there, we noticed one older person, but it seems not yet on Medicare, called to the desk to be told his insurance didn’t cover the Covid vax, so he would have to pay up front. They seemed to advise him that he could get reimbursed, but we couldn’t tell for sure. I thought no one should have to pay up front, so I wondered what happened there.
>we are in NYS, and the Qaire we had to fill out for the Covid shots asked whether we’d had a shot in the last five months. This worried us, as we thought we might be refused, and, as we are in our 70s, and following what Dr. Jetelina and others have recommended, we wanted to get the vax on or before four months had passed. Fortunately, this didn’t turn out to bar us, but I thought it weird NYS had this question on its form.
I appreciate your real-time record. I’m in NYS as well, and in trying to get my teens vaccinated, am running into the same issues as the other customer. Interesting. I’m glad you were able to be served!
I’d like to give a huge shout out to Costco, who now has the Novavax vaccine in stock in many of their pharmacies across the country. When I called their pharmacy yesterday, a live person answered their phone, and was happy to book a Novavax appointment for me even though I’m not a Costco member. I get jabbed this afternoon.
Compare this to the multiple phone calls I’ve made to Rite Aid, CVS and Walgreens where customers get stuck in an “automated customer service maze from hell” and often can’t speak to a real person. The few times I was lucky enough to reach the pharmacist, they either had never heard of Novavax, confused it with Moderna, and had no idea whether their company would be receiving it. And www.vaccines.gov is not up to date - the place to get real-time info, unfortunately, remains Twitter, or X, or whatever it’s now called, where there’s currently a #Novavax frenzy.
I have heard (although this isn’t confirmed) that Rite Aid and CVS will eventually get Novavax, but it could take a week or two. Perhaps it’s Costco’s superior internal distribution system that allows it to distribute fresh salmon to stores across the nation that enables it to be first at distributing Novavax.
After this exceedingly pleasant experience, I am planning to reinstate my Costco membership (even though I still have a huge box of unused, tissue-thin toilet paper in the garage from the early days of lockdown).
Also, Novavax plans to release the results of their Hummingbird (kids) study on October 17.
A Novovax, please, with a side of salmon. Love that!
Here’s a link for online Costco signup:
https://costco.web.medrefill.com/csweb/#/store
Did it; scheduled for tomorrow at 3:30pm.
Thank you for this! One of my friends is pregnant and seeking Novavax. I let her know about your experience. (We live in the South Bay, fingers crossed that wherever you are in the bay, the costcos in the entire Bay Area are offering similar ease).
Awesome, confirmed my Costco has it too. I've never had bad reactions to the Pfizer/Moderna shots so now the question is, do I mix it up just to mix it up and help the 'demand' for Novavax, or do I stick with mRNA and leave the Novavax stock for those who really need it....
I’ve had nothing but Moderna. A friend of mine who is a doctor told me this time to mix and match with Novavax.
Even without knowing anything about the underlying biology, "hedging" is part of Risk Mitigation 101. I'll do Novavax next year if it's fully approved
Novovax doesn't seem to have made it here yet and we didn't want to wait for our booster since we're off on a trip to South America in three weeks and wanted to get the flu and COVID updates a few weeks in advance.
I guess the good news is that things are, so far, better than a year ago.
P.S. I'd be pretty leery of anything on The Platform Formerly Known as Twitter unless I confirmed it somewhere else first.
Or put the mask on today. We have a chance to reduce community transmission of ILI. The area under the curve indicates cvd is all around us. If we wait to act, we create the surge.
Oh, that’s so 2020! We know better now: wait till things are past the point of prevention because freedom.
No. Human beings are not responsible for waves of respiratory viruses. You are blaming people for something that is beyond our control. We don't control nature. It is incredibly arrogant to think otherwise.
We've had surges of respiratory viruses for all of human history. Only in the last few years have people been blamed for that.
I blocked Paul. Why am I still seeing his garbage?
He's been on here forever. I'm sure he keeps making new accounts faster than Dr. Jetelina can block him.
Me too. Same question. Apparently blocking on Substack somehow doesn't mean what it means on social media. Makes it hard to filter out trolls.
I simply don't understand what he gets out of this. His comments suggest that he's accepted the risk of getting covid and giving it to others. I don't even judge anyone for that any more. But clearly this substack is for people who DO still give a s**t about that.
I don't much understand the chronic troll mindset as well. I have noticed a kind of religious fanaticism among the anti-vax/anti-mask crowd, so it could just be a matter of attacking the heathens.
Or he could simply be a jerk. :-)
Writing from Ohio: It has been hard to find the updated COVID booster for kids under 12. We made 2 appointments on September 22nd, then on September 29th: one at Walgreens and one at CVS. We got turned away after arrival because they "don't vaccine kids". The pharmacist at the CVS made it sound like it was based on his personal belief (he told us that the pharmacist who just ended their shift would have done it). Walgreens says they won't serve kids under 12 until date TBD. We found an appointment at a Kroger Little Clinic for yesterday: both my 6yo and 9yo received the double COVID + Flu shots. But boy, it took us 3 weeks and plenty of determination.
Meanwhile, as a school board member, I asked our superintendent to reach out to our county health department to set up an in-school vaccination campaign (we did that for the primary series when the FDA approved it for kids) and the county HD responded that they did not purchase any updated covid shots because it's not covered by the federal government.
Why does it have to be so hard to get shots in arms for those who want it, you know?!
Very hard to find them here in the Boston area as well. Seems like supply is improving this week, but as of last week I was still hearing versions of “it hasn’t been approved for kids yet” and “no idea” at every Walgreens and CVS I called. Frustrating!
My local CVS doesn't vaccinate kids for anything, but maybe it is because we have a very strong Child Health Plus program?
Even my teens (13 & 17) can’t get the booster at my usual site (multiple CVS stores) because as Child Health + insurance holders, they “need New York State” to administer the shots. When I searched the state’s website for where they COULD get vaccinated, it pointed me back to our own CVS! The CVS pharmacy benefit line said they didn’t have a NDC (national drug code) for kids between 12 & 18. Under 12--has a code. Over 19--code. No code for my guys. I’m attempting vax at a Walgreens tomorrow ( so, outside of the CVS system), after 3 attempts elsewhere 🤞🏻.
That's bananas. In my area (Ohio), 12+ individuals can get vaccinated at a CVS. Why does it vary from a state to another? Are news reporting on the access to vaccines?
Yes! I’m in NY and I must have called 20 pharmacies this week. No one is carrying the vaccines for under 12. It is so frustrating. I didn’t have this issue for the last round.
"1 in 4 hospitalized are not up-to-date on Covid-19 vaccine" - This is not great support for covid vaccinations. It is very disheartening.
Yes, I hope Katelyn might expand on this statistic.
The CDC report says “ fewer than one quarter had received the recommended COVID-19 bivalent vaccine.” I might be misreading but doesn’t that mean the majority of those hospitalized had NOT received the bivalent shot? I think there may be a simple typo in Katelyn’s post—it happens!
ahh yes that is a mistake! i am
fixing now
I think Kate is correct. It should read 3 out of 4 hospitalizations had NOT received the Bivalent Vaccine.
This also indicate that antivirals are being underutilized too.
I had to beg to get mine in January.
I'm sorry. It is *so* much easier to get Paxlovid now. I had it delivered the day after my first (EVER!!!!!!) positive test eight days ago.
In fact Paxlovid is so damn effective when administered early, and so dependent on liver and kidney functions, that I'm inclined to swear off alcohol for the rest of my life.
Dear Dr. Jetelina, Do you have any new statistics on the risk of Guillion-Barre (or afib) with the RSV vaccine? I know once the numbers of vaccines given goes up, the actual risk numbers will change. I also know the risk of significant disease with RSV for folks over 60 outweigh the risks so I am recommending it to my patients but just asking if you have newer info. So grateful for your work!
I caught the worst “cold” I’ve had in 20 years last month. Brutal! I (and my pcp) kept testing for Covid, but it wasn’t Covid or the flu (I’m fully vaccinated for both), but my pcp did say she was seeing a lot of patients with my symptoms. (I live in North Carolina.)
Also, we here in NC are still having a tough time finding a place that has the latest Covid vaccine. My husband had to drive yesterday to a Walgreens 20 miles away to get his. A friend made an appointment with the local CVS only to be told they didn’t have it when he got there.
According to a CDC study from April 2023, about 43% of people age 65 and older have received a bivalent booster shot. My mother-in-law is in a nursing home, and luckily, they held a flu and covid vaccine clinic last week. Hopefully this year more seniors will get the covid booster.
In response to a similar question, Katelyn said this was a typo. It should be 3 out of 4 were NOT up to date on their vaccines.
Thanks!
I'm curious about why respiratory viruses seem to start in the south in the fall? If it's about airborne transmission, then we would expect it to be where people are indoors. In the fall, the north has started to get cold and the south is fairly pleasant, so we would expect northerners to be indoors more than southerners. What else could be going on?
I know most of my friends’ kids in the south return to school about a month earlier than is common in the northeast. So maybe it takes about that long for the full impact of virus swapping to reach critical mass, and the northeast will get there in another month? Or something else? I’m curious to know!
Kids are indoors in school etc.
Maybe hurricanes? That could seed outbreaks because they cause people to move around, pack into shelters, huddle inside, etc
We were all set for the full range of jabs for Oct 6, but got a call from our Walgreens to cancel because Walgreens pharmacy staff across the Portland, OR metro area are as good as on strike over working conditions. We're now scheduled for 10/31 at a Rite Aid further away. I hope that holds. Interesting about Costco. I might call them today and see what's up! Love this newsletter!
Two Questions Regarding Excess Mortality:
1. Does the mortality baseline now incorporate Covid deaths as part of the estimate since the pandemic has been going for 3+ years?
2. I have read about a “Harvesting Effect” where a waning pandemic is marked by a drop in excess mortality below the baseline. If my understanding is correct, this is due to the most vulnerable people having already died. Would you say this is an accurate interpretation?
1) No, they are still using projections based on previous years it appears, and that's consistent with how Human Mortality Database continues to project expected deaths. There are fair arguments to both viewpoints, but at some point we will have to incorporate the last 3 years into our projections for fidelity.
Unfortunately, the CDC stopped publishing dozens of weekly reports on Covid, but the most recent snapshot of mortality (published 9/27, but due to lag I would only trust ~week 32/Aug 12) showed 55,306 deaths (all cause), which is 3,557 more deaths than the same week pre-pandemic of 2019. If you compare week 32 of 2019 to the same time difference of 4 years (2015) the gap is the same - 3,555 more deaths between the 4 years. Make sense?
2) It's a viable theory (I've heard it under other names), and one I believed to be true early in the pandemic, but I haven't seen it supported by mortality data as strongly as I expected.
I also am not seeing it in historical data. Consider the Spanish Flu, in the US the number of deaths leading to it:
1915 - 815K
1916 - 925K
1917 - 981K
Now Spanish Flu hits and it jumps to 1,430,000 million deaths, a 50% increase
You would expect if the "Harvesting Effect" holds true, that once the Spanish Flu fades, you would see some year in the future - perhaps 1920 - drop under a million, even potentially dipping to 800K.
You don't see that. 1919 was 1,072,000 deaths, then 1,118,000 in 1920, and 1,009,000 in 1921, and so forth. (even comparing in rates to factor in population growth you don't see reversal- they just stay elevated-flat)
We also don't see it with Covid so far. Sweden entered the pandemic with their lowest recorded deaths in 20 years for 2019, so you would expect a small bounce up in 2020 even without Covid, but in 2020 they saw a +10% increase in all cause mortality, the following years merely returned back to baseline - no dip to compensate for the earlier peak.
Same in South Korea, 2022 had a 17% increase in deaths, but so far in 2023 they are still +13% ahead of baseline - so not only didn't they see a decrease to compensate the 2022 large bounce, they are still highly elevated in death.
Fantastic, timely report! Thank you so much. In a future, pre-holiday installment, it would be great if you could also give your recommendations on use of rapid testing before gatherings.
Any advice on how often people in their 70s should get the newest vaccination? Our immune response is surely small compared to younger people. My husband and I had our first dose about 2 weeks ago, and are considering a re-vax every 4 or 5 months. (We did this for previous versions by going to different pharmacies and pretending each shot was our first.)
I don't think waning immunity is nearly as much of a threat as it was, it's just that the new variants have a punishingly short incubation period that the immune system can't catch in time. I'm just getting over my first case of Covid now - I got it on 10/5/23. I'd had my XBB shot on 9/16/23 and my spike antibody titer was >25,000 u/mL as recently as 9/6/23.
I was ready, though. I'd stocked up on rapid tests from the public library, and tested myself every other day for about a month and a half. As soon as I tested positive, I arranged to have Paxlovid delivered.
This didn't age well. I'm experiencing Paxlovid rebound.
GET IT ASAP - parents 77 & 76 with little health issues got that and flu at the same time.
I was responding to her email about COVID-19 vaccinations when I wrote, "My husband and I had our first dose about 2 weeks ago, and are considering a re-vax every 4 or 5 months." But we did also get the flu and RSV vaccinations.
*If* you were referring to the COVID-10 vaccination, I think "get it ASAP" would be too soon, as I suspect the minimum time will turn out to be about 4 months, not 3 and a half months.
I love all your posts about the impact of the acute phase of Covid and other respiratory viruses. I'd like to read more about Long Covid/Post-acute sequelae of SARS-CoV-2. It is hard to sort out how much of a public health impact this is currently having and is projected to have over the next decades. There is a big difference between a couple months of coughing and the going on 4 years of complete disability that we are reading about.
Thank you for this exellent update. A question regarding vaccination status: How are you currently defining "up to date"? For example, say someone has been vaccinated five times, including the bivalent booster, but has not been vaccinated in the last six months? Are they "up to date"?
Katelyn is referencing the CDC report that uses having received the Bivalent Vaccine as being “up to date”.
“fewer than one quarter (23.5%; 95% CI = 19.5%–27.7%) had received the recommended COVID-19 bivalent vaccine.”
Thank you. This definition of "up to date" is, however, problematic, is it not? Most of the experts whom I look to on this particular question suggest that -- for anyone over 65, at least (which I am) -- you're *not* really "up to date" if you haven't had a vaccination (or an infection from which you've recovered) in the last 4 or 5 months. Indeed, Katelyn said, in mid September, "Over 65 or at risk for severe disease: Get vaccine 4 months after infection/previous vaccine. Don’t wait more than 6 months." I realize that in some formal/technical context, the meaning of "up to date" may be strictly defined in the way the CDC defines it, but when trusted experts make science-based recommendations that are contrary to that strict definition, it's confusing.
I think at this point you should assume your primary care physician is competent, and that you're up to date if they say you are based on what they know about you.
QUESTION: I am recovering from Covid, including a Paxlovid rebound. Should I hold off on the flu vaccine to give my body a break as well as time it closer to the holidays?
Talk to your doctor
But - for what it's worth, when you schedule your vaccine they do ask a series of questions, and if you answer truthfully, that should give you some idea. I'm also in the throes of Paxlovid rebound right now.
My understanding is that it's good to wait a bit after any infection or live attenuated vaccine, because your innate immune system's been turbocharged and any vaccine you get within, say four weeks, won't be as effective doing what it's supposed to do for your adaptive immune system. But from your perspective I'm just a random chump on the internet, which brings me straight back to "Talk to your doctor"
No that's apples to oranges - your immune system is also low
Not that anyone is looking about now, but I’ll add this for “the record.” To avoid the online problems in obtaining accurate information and making an appointment (of the type that BayDog described in these comments), we opted to get our flu and Covid shots from a local independent pharmacy that does shots on a walk-in basis and which answers the phone with good information about their stock. Here’s what we encountered:
>for both the flu shot (for seniors) and the Covid shot, we encountered supply issues, so had to wait a bit on each. (To avoid side effects, we opted to do the shots separately, spaced about a week apart.)
>no chance of Novovax in our area, so we decided to get whatever was going, which ended up being Moderna.
>the pharmacy does not get big stock of anything, as it is small and, post-emergency status, must pay upfront for supply. As a result, it runs out pretty fast.
>while there, we noticed one older person, but it seems not yet on Medicare, called to the desk to be told his insurance didn’t cover the Covid vax, so he would have to pay up front. They seemed to advise him that he could get reimbursed, but we couldn’t tell for sure. I thought no one should have to pay up front, so I wondered what happened there.
>we are in NYS, and the Qaire we had to fill out for the Covid shots asked whether we’d had a shot in the last five months. This worried us, as we thought we might be refused, and, as we are in our 70s, and following what Dr. Jetelina and others have recommended, we wanted to get the vax on or before four months had passed. Fortunately, this didn’t turn out to bar us, but I thought it weird NYS had this question on its form.
I appreciate your real-time record. I’m in NYS as well, and in trying to get my teens vaccinated, am running into the same issues as the other customer. Interesting. I’m glad you were able to be served!