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I think Long Covid and other long-terms effects of infection (e.g., organ damage) need to be an important part determining whether or not we’re still in an emergency phase of the pandemic - or in a pandemic at all. It shouldn't be just about deaths, hospitalizations and healthcare capacity.

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Agree completely Meg. What I find of increasingly compelling concern on the personal and public levels is the increasing evidence of neurological sequelae in the long form of the infection. Fatigue, shortness of breath, gastric issues, one can adjust to and need not stress the public health system or even one's personal life; depending on severity, one simply scales back. But the neurological complications can be overwhelming and are likely a predictor of greatly increased suicide rates in the 65+ cohort in coming years. It's going to be a slow motion train wreck I'm afraid.

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I got the updated booster as soon as possible and am counting the 14 days. But now with the other variants rising, are we still vulnerable? I was going to be dancing in the streets and going to movies and restaurants again after living like a monk.

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My husband and I are just over 2 weeks past our bivalent booster. He tested positive today. 😞 But we're old, so more susceptible than many.

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I was reading about BF.7, which is another variant over 1% of the variant proportion share, but it’s actually a sublineage of BA.5. That’s actually good news as the bivalent booster covers BA.4 and BA.5.

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I mean nothing is 100%, and there will always be new variants, but unless you’re at extreme health risks, you should be pretty darn comfortable in being up to date.

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So, what's your best "guess" about optimum timing for the Influenza shot this year ? Lots of experts up here in this part of the USA are advising us to perhaps hold off until we see local "activity" in the Minnesota data regarding new flu diagnoses. As for the "new COVID vaccine", what's an optimum delay in your view? We the goobers, hicks, and rubes are hearing in local news that some HUA (High University Authorities) in Minneapolis are personally taking the choice of WAITING until the end of October for their bivalent boosting.

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Dr. Osterholm discussed this in some. Depth at about minute 30 of the 9/14 episode of The Osterholm update. Including discussion of the Stat New article and Kaiser study of waning immunity from flu vaccines.

Here are the links of your interested. I found it incredibly helpful and in line with things I had heard while working in family practice (not shared with patients, as it wasn't the official recommendations), but had not been able to find supporting data for.

https://www.statnews.com/2022/09/09/doubling-up-on-covid-booster-flu-shot-may-have-downside/

https://pca.st/episode/46adbb39-097e-43bc-81b9-587f8bac6325

I hope this is helpful. We are on the west coast, this combined with our personal experiences of the times we've had influenza hit our household (2 adults, kids currently aged 13, 8 and 8) it has been Jan/Feb and late March/April. We have decides for our household to delay our flu vaccine until late Oct/early Nov (definitely in time for holidays). Also considering the other measures we still take of masking, limiting indoor gatherings, no big gatherings, testing etc particularly to protect an immune compromised extended family member.

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I was very thankful to hear Dr. Osterholm’s thinking on the timing of flu vaccine, which was relatively concrete (end of Oct unless activity kick up). All advice seems so much fuzzier on timing of booster, and dependent on so many other factors. We went ahead and boosted one family member with risk-factors and with activities (though they are outdoors or masked) because it seems no one else is taking precautions. I’m holding a couple of weeks, though not past early October because I don’t want to miss the fair weather window for fall dining outdoors. I have little confidence that we’ll be back to indoor restaurant dining this winter (if we don’t want a side of COVID).

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Yes to all of that! We are right there with you on wanting to maximize our ability to more safely do certain things, and also prepare to be as protected by vaccines, while also adapting our habits where possible, going into the indoor activities months.

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My whole family got flu type A in January 2020, all vaccinated. I had taken to getting my flu shot really early then, end of August. I now usually time it at least late September/early October. We do already have flu cases in my state though.

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I've been saying for a few weeks now that households should consider staggering their flu shots throughout the year, and that a major reason we have these constant surges is that we all get vaccinated at the same time. Seasonality really may be a tragic self fulfilling prophecy.

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Hmmm, that's an interesting idea. To some degree our family does/has, just depending on scheduling and availability. I'll have to think more about that.

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Sep 20, 2022
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Good point. Thinking of immunity from antibodies and T-cell immunity which is not as possible to test for right?

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I read Katelyn article earlier that getting the flu shot with the bivalent was recommended.

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Great report as usual, curious as to your thoughts on Dr. Monica Gandhi at the University of California to her statement that Covid is on par with the flu, and Dr. Shira Doron at Tufts University argues that many hospitalizations being blamed on COVID are really people hospitalized with COVID, not because of COVID. Thank you.

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That would be this Dr. Monica Gandhi, yes? https://sciencebasedmedicine.org/contrarian-doctors-the-pandemic-is-over-again-again/

'Dr. Monica Gandhi renewed her annual tradition of minimizing the virus on Dr. Zubin Damania’s (AKA ZDogg) podcast. In 2020 they recorded “How to Stop Living in Fear of COVID” in which Dr. Damania said “the fear that’s driving this pandemic has been heartbreaking to see.” In 2021 they recorded “The End of the Pandemic” where listeners heard that “A UCSF infectious disease doctor is convinced this pandemic is ending, and sooner than you think.” Drs. Gandhi and Damania shared a belly laugh then, mocking variants by saying “variants shmariants“. Their 2022 installment was titled “Living with COVID“.'

Just a reminder that having a "Dr." in front of you name doesn't make you an expert on epidemiology. Or on anything. It doesn't even guarantee that you aren't a politically motivated quack. Just saying.

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Good reminder…

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Well said

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P.S. From now on, posts link to sources for claims like this. It makes it easier for the rest of us to find out whether they're bullpucky or not. Fortunately, I saw the SBM article just a few days ago.

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Sep 19, 2022
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Interestingly all of the people I have seen on line who keep talking about the allegedly large numbers of people diagnosed with COVID who die for totally unreleased reasons never seem to have any data to back it up. And never come up with any when asked.

Just a coincidence, I'm sure. :-)

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Agreed. Since 2010 in the United States, the greatest number of deaths from influenza has been estimated to have been 61,000 during the 2017–2018 season. Since significant influenza activity typically lasts about 6 months (October through March), that would result in an average of 335 deaths/day having occurred during the 2017–2018 season.

The current 7-day average of daily deaths from COVID-19 in the US is 391 (and rising over the previous 4 days), an almost 17% greater number of daily deaths from COVID-19 relative to the worst season of influenza in the US in the past 12 years.

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Gandhi is a liar and a quack who has been saying the pandemic is over since it started. Your average TV psychic has a better track record of predicting its course than she has. She's just another attention-seeking hack.

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I'll say this until I'm blue in the face, but we really need to be channeling our activism to the US Preventive Services Taskforce to ensure that immunocompromised people have access to necessary mitigations.

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Thank you, Dr Jetelina, for always so nicely summarizing what we should be focused on.

If BA.2.75.2 has the likelihood of immunity escape, is this just for people who have natural immunity, or does it also apply to the new bivalent booster? Do we have any real-world data on the new bivalent booster (i.e., people, not lab mice)? I'm planning to get the bivalent booster and flu shot at the beginning of November, hopefully a few weeks ahead of any possible winter surge, and to maximize protection during holiday travel and gatherings with my elderly loved ones.

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The study she linked to used 18 blood samples from Stockholm. The authors didn’t say, and probably didn’t know, the infection/vaccination history of the donors.

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As usual, your summary is extremely helpful and very much appreciated. Thank you!

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If BA.2.75.2 is substantially different enough to cause concern, why not whip up a trivalent mRNA vaccine that contains in addition to what's in the current bivalent? Is it not that easy?

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I had the same question. This is why we need better therapeutics that work against any variant! The vaccines will never match the variant-of-concern du jour.

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Sep 19, 2022
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The question really has two parts:

(1) ease of creating a vaccine for any given mutation/variant

(2) predicting which observed variant has the best chance to take hold

There's been enough writing here that I feel like (2) has been semi-addressed, at least in terms of past. The TL;DR is that evolution hasn't yet settled enough to be fully predictive. However, observationally, the variants that had been flagged of rising concern turned out to actually cause waves (Delta, BA.1, BA.5). At the moment I'm assuming that the similar red flags earned this new variant a mention.

Which brings us back to (1)--how hard is it, given the identification of a particular variant--to create a mRNA vaccine for it?

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Sep 19, 2022Edited
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Trials aren't relevant to the question I asked. And if the concern is that it will drive the winter wave, then there's certainly enough time to at least start a mouse trial.

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Sep 19, 2022
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I'm aware that trials are part of the entire process, but they're still not relevant to part (1) of what I asked.

According to point 4 in https://theconversation.com/how-can-scientists-update-coronavirus-vaccines-for-omicron-a-microbiologist-answers-5-questions-about-how-moderna-and-pfizer-could-rapidly-adjust-mrna-vaccines-172943 a new mRNA vaccine can be available for clinical trial 52 days from having the spike protein genetic sequence available. Since the writing mentions how it's different from other variants, I'll assume that it's already been sequenced.

So, what's to prevent us from having a trivalent vaccine available for mouse-testing 52 days from now?

None of BA.4.6/7, BA.5.9 and now BF.1 are mentioned as something folks are watching for a winter surge, so at the moment those don't seem relevant to the discussion. Should that outlook change, then substitute <new variant> for BA2.75.2 in all prior writing.

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Many thanks Katelyn for a great update on four viruses first thing on a West Coast Monday! Regarding the new bivalent booster, last week's New England J published a study suggesting the bivalent (/BA.1 was tested, not /BA.5) we might not get as much protection from this booster as we did from earlier shots. BA.5 efficacy data in humans is still a few months away I'm guessing. Do you think this illustrates 'immune imprinting' (the body remains 'more interested' in responding to the ancestral strain)? How should this figure in to a decision on getting the bivalent booster (vs. continuing to be super-careful and waiting for human results)? Hopefully at the absolute minimum the bivalent will reduce chances of long Covid and extend protection from severe Covid. (likely the decision depends on several factors e.g. whether previously infected, risk factors, prior side-effects to Covid vaccines....). NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2208343.

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I'm curious about your thinking about the "downside" of receiving the bivalent vaccine being significant enough to consider delaying it. Versus a different approach of seeking a booster of the monovalent vaccine, or receiving the bivalent knowing it may not perform as hoped/expected, but will still provide increased protection as opposed to not. Thank you for further explaining your thoughts on this.

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If I am reading it correctly, the chart in the Flu section shows that the flu season was earlier than usual in Australia. I wonder if this correlates to an early flu season in the U.S.? I've only seen one chart, and it didn't have enough data points to draw any conclusions other than "Maybe".

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Thank you as always for your dedication in reporting of the latest scientific news and facts. If you were infected in August (B.A. 5) are you protected against B.A. 4.6? I had my fourth shot in July and become infected for a second time. Clearly I am not due for the Bivalent yet, but would love to know if anyone knows if we are protected against B.A. 4.6.

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It would make sense that as we start to vaccinate the highest risk groups for MPX, those at elevated risk but not yet vaccinated would start to show up as an increasing percentage of total cases. We saw this happen with COVID, as older folks were overwhelmingly vaccinated, the average age of hospitalized and fatal cases dropped. In France, total MPX cases are dropping but women make up a whopping 12.9% of cases. This means there probably is some escape from social networks of MSM, but some escape to non-MSM but close contacts, possibly female roommates of MSM or close female friends who may attend dance parties or crowded bars with close physical contact for possible exposure. This isn't to say this is happening more than it did before, but unless those close contacts are vaccinated, and under many places they aren't eligible for vaccination, they will represent an increasing percentage of cases, even as the total number of cases fall.

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Is there any difference between Pfizer and Moderna bivalent boosters?

I had Pfizer for my original vaccine series. Then Pfizer for the first booster and Moderna for my second booster. Any thoughts on which would be better to do for the bivalent booster?

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Moderna is also harder to find in my area ,and I’ve read a few reports that Moderna is still ramping up supply, and so it will be become increasingly available. Moderna rolled out some good data on their BA1 bivalent binding better and improving protection in the lungs during the CDC meeting (see Katelyn’s write up and/or slides at CDC website https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-09-01/08-covid-oliver-508.pdf )and it’s typically seemed to have lasted a bit longer? Our household is Team Moderna based on this, but I agree with you, Rachel, would love to hear more about comparisons.

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Sep 21, 2022
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I saw this ,too! Helps explain the difficulty finding a Moderna dose.I was able to book a Moderna appointment, but it took some searching.

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You should check in your area, but I work as a vaccinator and Moderna is currently not able to be ordered. We’ve been told it may only be a few more weeks but for now, Pfizer is all we are able to give.

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This is totally anecdotal, but it seems like Moderna is being allocated to the higher density cities that are more likely to experience hospital strain. Pfizer is available everywhere else. I'm basing this on 5 data points, but I don't think it's just a coincidence.

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Sep 19, 2022
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How can you be certain it has nothing to do with effectiveness? If one booster was only 5% better than the other one, that could save many lives in a place like NYC.

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My husband has COVID19, positive test today. I took my first test just now--negative. But I told our doctor it was positive so we can pick up both Paxlovid doses now. We're 75 and 77, and I don't dare leave him to pick up a dose for myself if/when I need it.

I'll test myself every day or two. Curious how long my own Paxlovid will be OK to use if I don't need it right away. (I *expect* to need it, since our home is small and we're always together. )

Does it have some sort of "best if used by" date?

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Re: Bivalent booster: I understand it takes about 2 weeks to become effective. I'm wondering if there's any data on when protection peaks and how fast it drops off after that. Any info would be very useful. Thanks!!

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I’d be interested in some useful stats to share with commenters in Yahoo comment sections who say - vaccines don’t work. And, “I’ve had COVID 3 times, no big deal and my elderly in-laws too.” I tend to point people to the Texas DSHS Covid cases and deaths by vaccination status dashboard, but they cannot believe that for July the risk of dying of Covid was 31x higher for unvaxxed Texans. Maybe if we compared it to flu deaths per year?

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