A COVID Q&A: booster timing; testing; contagiousness; & the Novavax shot
It’s virus season all over again
ICYMI 👉
This week, the first two questions (on booster timing and testing) are free for all subscribers. Questions 3-4 (on contagiousness and the Novavax shot) are for paid subscribers only. If you would like a paid subscription but it’s not in your budget, please message me directly.
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
QUESTION #1: BOOSTER TIMING
I had Covid in October—when should I get a booster (if I need a booster)? Do not want to get so sick again if I can prevent!
-Anne
Dear Anne,
Thank you for the question. I discussed much of this with Dr. Shira Doron, Professor of Medicine and Hospital Epidemiologist at Tufts School of Medicine, this week! (Watch here.) The upshot: Recall that the main benefit of COVID shots in 2024 is to reduce the risk of hospitalization from COVID for people who are most likely to need hospital care. So, if you're at high risk for needing hospital care due to COVID (e.g., you have diabetes, underlying heart or lung issues, or a compromised immune system) then YES - you should get another shot, ideally 6 months after your last bout of COVID. But if you’re not at high risk for needing hospital care and you’ve taken the original set of vaccine doses, which you have, the marginal benefit of another booster is probably small.
What about the vaccine’s ability to prevent infection? Ever since the Delta variant arrived in spring 2021, the COVID shots no longer efficiently prevent infection. In other words, you can still get COVID even after multiple booster shots. Getting another shot may help reduce the risk of infection for 2 weeks to 2 months after the shot, but that reduction in risk may be offset by other factors, such as inhaling a larger “dose” of virus or the absence of past infection-acquired immunity in the nose.
The upshot: I am a big fan of the COVID shots, however it’s important to understand the benefits and limitations of additional vaccine doses. My best advice this winter is to take care of your underlying health: to see your primary care doctor for a checkup; to limit your intake of alcohol and caffeine; to prioritize sleep, exercise, and nutritious eating; and to manage your chronic conditions.
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QUESTION #2: TESTING
I’m a little traumatized (and maybe burned out) from all the covid tests I’ve taken for 3 yrs. How important is it to test myself or bring myself to urgent care for every fever or runny nose?
-PG
Dear PG,
Great question. Testing is most important for the cohort of patients for whom a positive test would change medical management. In other words, as a physician, I ask myself before testing someone with a PCR test, “Would knowing what virus this patient has change the way I manage their care?” For example, I need to know if my 80-year-old patient’s cough and body aches are due to COVID, flu, RSV, or something else in order to direct care, for example considering prescribing Tamiflu for the flu or Paxlovid for COVID to help reduce the risk of needing hospital care.
However, for a healthy young person, testing isn’t as critical because the risk-benefit ratio of prescribing antiviral medications is different when compared to someone who is at higher risk. That said, knowing you have COVID and not rhinovirus, for example, might change your behaviors and cause you to isolate yourself from other people for longer.
Note that the symptoms of RSV, COVID and flu overlap. All can cause congestion, cough, fever, and body aches, among other symptoms. PCR tests exist for all three viruses, but we don’t necessarily need to test every person every time they have symptoms. When in doubt, call your doctor for advice!
QUESTION #3: CONTAGIOUSNESS
Hi Dr. McBride! Is it possible/common for people in the same household to have Covid symptoms but only some people testing positive on home tests? My husband and I have been sick more than a week. We are both up to date on our vaccinations. But only his home tests are positive—mine are always negative. Does this mean that I’m just not contagious? Just curious what it’s all about!
-Tamara
Dear Tamara,
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