Welcome to COVID week!
Today’s newsletter is about interpreting the new CDC guidance re: COVID boosters.
Ask me anything about COVID for Friday’s Q&A here. I’ve already received great questions about long COVID, potential new COVID treatments, and the joyfully uncontroversial (😭) subject of masking—giddy up!
Hoo boy! Questions about booster shots are rolling in as the CDC’s new guidance generates next-level confusion from even the most savvy consumer.
So, what should YOU do when facing another barrage of information and mixed messaging about booster shots? Here is my take:
Bottom line up front
According to the new guidelines from the FDA, CDC and ACIP, people aged 65+ and those who are immune-compromised may now get a second bivalent booster. Specifically:
People over 65 are eligible for a single dose at least 4 months after their last dose.
People who are immune-compromised are eligible for a single dose at least 2 months after their last dose.
Healthy adults under age 65 who have been fully vaccinated or had COVID within the last year can put booster dose decisions on pause until the fall (at least).
So, should you get another booster shot if you’re 65 and over?
Based on the available data, I am more inclined to recommend a second booster shot for 65+ under these circumstances:
If you have managed expectations for what another boost can and cannot do.
Recall that the bivalent booster offers additional protection against hospitalization. No amount of booster shots will block infection. You can get 100 shots (please don’t) and still get COVID.
If your last dose was > 11 months ago.
Why 11 months? The additional protection against hospitalization actually seems to increase the longer it’s been since your last dose. The CDC’s own data showed this time-dependent effect, with the highest vaccine efficacy among people whose last dose was at least 11 months prior to their booster. (I cannot explain why the CDC picked a 4-month interval between two bivalent boosters when waiting a bit seems just fine, and probably better!)
What about the CDC’s recent data showing waning protection of the bivalent booster against hospitalization from 64% to 39%?! Before we freak out, it’s critical to remember that these data are observational only, i.e., they are most certainly confounded by other variables. In other words, when we compare hospitalization rates between cohorts of people who had a bivalent booster with cohorts of patients who did not receive a booster, there will be differences between these groups beyond simply having had an extra shot. This is not to discourage you from getting another boost if you’re eligible; it’s simply to contextualize the scary headlines.
If your last COVID infection was > 10 months ago.
For people who have had COVID itself, a Lancet meta-analysis found that the infection-acquired protection against hospitalization is very high (90%!) through at least 10 months after contracting the virus.
Taken together, if you are an adult > 65 years with a normal immune system, you may want to wait until the fall when flu and COVID are predicted to surge again to get your booster.
Is it a bad idea to re-boost after 4 months? Probably not, but it’s always best to use data to guide medical decisions.
Are you Okay? For more on how the stories we tell ourselves impact our everyday health, join our conversation!
Should you get a fresh boost if you have an immune-compromising condition?
The answer is probably yes. Several studies have found that the ability to mount an immune response does improve with additional doses. Immunocompromised adults generally mount a less robust immune response to the COVID shots when compared to healthy adults, though I’m including this chart (also here to spare your eyeballs) in order to reassure those of you who are immunocompromised that vaccine-induced protection against COVID is NOT zero!
If I am *not* in either of those groups, should I get a booster anyway?
No, for now. There are two main reasons why not:
If your risk for hospitalization already is low (because you are young and healthy and/or because you already have been fully vaccinated and/or had COVID), the benefits of another boost will be tiny. For context, the COVID death rate among 18 to 49-year-olds was 1 in a million for the unvaccinated during BA.4/5 (September-December 2022).
The potential harms of the vaccine are not zero. While these vaccines are generally very safe, as with anything in medicine, we cannot assume that more is more.
We are at the point now with widespread population immunity that COVID presents a similar threat as the flu. The people at highest risk are elderly individuals with multiple health conditions which put them at risk for any respiratory infection.
What about during pregnancy and for children aged 6 months to 4 years?
The FDA excluded these groups from the spring booster option due to lack of data. Here is the CDC’s (confusing) new flowchart for kids 6 months to 4 years:
What about kids age 6 and up? Should they get the first bivalent booster if they never had it?
The CDC recommends that everyone over age 6 years should have a single bivalent booster at least 2 months after their last dose, even if they completed a full monovalent series. Do clinicians have a different opinion? Yes! If you have a healthy, immunocompetent child, the answer is likely, no, they don’t need a bivalent boost. You should always talk to your pediatrician for specific advice, but my take on the data is this:
Nearly all children have already had COVID by now.
Infection-derived immunity offers strong (3 year-olds are 5x better than adults!) and durable (18+ months) protection.
The bivalent booster trials were not powered to detect rare adverse events.
How safe is the bivalent booster for kids?
A recent CDC study of safety data for children 5-11 following a bivalent booster found that 99.8% of adverse effects were non-serious. You will recall, however, that the primary vaccine series (particularly dose 2) was associated with a rare but real risk of vaccine-induced myocarditis in teen and young adult males.
What will be the schedule for COVID shots moving forward – one shot a year?
The CDC’s overall goal is to simplify the schedule, so yes, I expect to see a push for flu and COVID boosters in the fall.
What is the best way to protect myself and my family from COVID in spring/summer 2023?
The best way to protect yourself against any infectious disease is take care of your underlying health. So schedule your check-up, get outside in nature, work on stress management, nourish your body in healthy ways, connect with loved ones, prioritize sleep, and move your body!
It turns out that exercise reduces the risk of infection, serious disease, hospitalization and death due to COVID. So get out there!
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What did you think of today’s newsletter? I’d love to hear your thoughts!
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.
Thank you for answering the questions I have before I’ve even formulated how to ask them! Very helpful info here and your Q/As also. I appreciate it!
Thank you for this. I’m a healthy 40 year old, fully vaccinated, and had COVID last summer. I haven’t gotten a booster and I think, based on this, I’ll hold off. Appreciate the straightforward approach - my own doctor just repeated the CDC recommendation when I asked her whether I should get a booster and I didn’t find that super helpful.