Update on COVID & the New COVID Booster
Your guide to the 2023-2024 fall/winter COVID season
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.
Q: What’s the deal with the new COVID variants?
A: The latest COVID sub-variant, called EG.5, is getting a lot of attention as it is becoming a dominant strain of COVID in the U.S. and seems to be a little more infectious than other strains. This means that a smaller number of virus particles are needed to infect a person when compared to previous Omicron sub-variants like the currently-dominant XBB.1.5 variant.
More recently, scientists are watching a new variant called BA.2.86, because it has 36 mutations that distinguish it from XBB.1.5. But so far EG.5 and BA.2.86 don't seem to be more contagious or cause more serious disease than prior variants. The symptoms are commonly those of a cold—runny nose, congestion, and cough. Of course some people can become very sick from COVID, especially people over age 65 and/or those who have underlying health issues or compromised immune systems. The new booster is expected to offer good coverage against severe COVID outcomes from EG.5 and BA.2.86, too. COVID antigen and PCR tests still work to detect the presence of both.
Q: How do the new COVID variants spread?
A: It spreads predominantly person-to-person and in the air. It is more likely to spread in crowded, indoor environments with poor ventilation.
Q: What’s the deal with the new COVID booster?
A: By the end of September/early October, the CDC is expected to recommend a newly-formulated Covid shot that targets the currently-circulating XBB.1.5 Omicron subvariant.
Q: Who will be eligible for the new shot?
A: We don’t know yet, but based on previous recommendations it’s safe to assume the CDC will suggest Pfizer and Moderna for anyone over 6 months and Novavax for anyone over 18.
Q: Who is at highest risk for COVID?
A: While anyone can get COVID (and the vast majority of Americans have had it), age over 65 continues to be the biggest risk factor for serious outcomes. Other risk factors include the presence of underlying health conditions like obesity, diabetes, kidney and heart disease and, of course, immunocompromised states.
Q: So, should I get the new booster shot?
Of course you should talk with your doctor, but based on the available data, I am more inclined to recommend the new booster shot when it comes out in late September if:
You are over age 65 and/or
Your immune system is compromised and/or
You have underlying health issues like obesity, diabetes, or heart disease and/or
You haven’t had COVID in the last 2 months and/or
You would like modest additional short-term protection against infection and additional protection against serious disease *and* if the benefits of the shot outweigh the potential downsides (i.e., short-term side effects, etc.)
Q: Should I still get the booster if I had COVID this year?
A: Again, this is up to you. Note that infection-acquired protection against hospitalization is approximately 90% through at least 10 months after contracting the virus.
Q: What if I already had the current bivalent booster?
A: The CDC suggests waiting at least four months after the last booster and the next (except for immunocompromised people, who might be able to receive them more frequently).
Q: When should I get the booster?
A: The vaccine’s ability to protect against infection is short-lived and not 100%: it lasts from approximately two weeks to two months after the shot. So, you might time the shot accordingly, with the understanding that you can still get COVID at any time. The vaccine’s ability to protect against serious disease in high-risk populations is its best feature. This protection lasts longer, so you can get the vaccine whenever it becomes available.
Q: Can I get the flu, COVID, and RSV shots on the same day? Or is it better to separate?
A: While it is technically safe to get the COVID, RSV and flu shots together, I suggest my patients separate them by at least one week to be uber cautious because the side effects can be more pronounced if they are taken together.
Q: If I am not in a high-risk group, should I get a booster anyway?
A: This is up to you. While you might want that temporary increase in antibodies to help reduce the risk of infection, there are two main reasons why you might decide not to get a booster:
If your risk for COVID hospitalization is already low, the benefits of another boost on your risk for serious outcomes 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, particularly for teen and young adult males who have the rare but real risk of vaccine-induced myocarditis. (Note the COVID itself also can cause myocarditis.) The COVID vaccines are generally very safe, but as with anything in medicine, more is not always more!
Q: Are there medicines available to treat COVID?
A: Paxlovid is the oral antiviral medication that I recommend to patients who are at higher risk for serious COVID outcomes when they get COVID. The above three medications work by halting replication of the virus and work best when started early on in the course of infection.
In general, we treat respiratory viruses with rest, aggressive hydration (with Pedialyte, for example), Ibuprofen or Acetaminophen for fever and aches, and, of course, time.
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