Latest on COVID-19 Omicron Boosters

The Centers for Disease Control and Prevention (CDC) earlier this month approved two new booster vaccines specifically formulated to target the BA.4 and BA.5 omicron subvariants of the SARS-CoV-2 coronavirus, so our primary care concierge doctors in Jupiter want to bring you up to date on the latest information.

What’s different about this vaccine?

The COVID-19 vaccines that have been in use since they were first rolled out in 2021 were all designed to target the original strain. They also effectively reduced hospitalizations and deaths against the different variants that emerged in the following months, including the widespread delta variant.

As the newest omicron subvariants emerged and are now responsible for 90 percent of COVID-19 infections, vaccine makers Pfizer-BioNTech and Moderna developed new, more tailored versions to specifically target them.

The new formula is defined as “bivalent,” meaning it protects against both the original strain as well as the highly contagious BA.4 and BA.5 subvariants. They are the first updated COVID-19 vaccines to be cleared by the U.S. Food and Drug Administration (FDA).

“The updated COVID-19 boosters are formulated to better protect against the most recently circulating COVID-19 variant,” said CDC director Rochelle Walensky.

“They can help restore protection that has waned since previous vaccination and were designed to provide broader protection against newer variants,” she added. “This recommendation followed a comprehensive scientific evaluation and robust scientific discussion.”

Tests in mice have shown they produce a good immune system response to omicron’s BA.4 and BA.5 subvariants.

Are they safe?

Some have questioned the safety of the new versions of the shots because they haven’t been tested in humans, only in mice. But the new vaccines have merely been “tweaked” to “change the recipe,” as the University of Colorado’s UCHealth website explains.

The original Pfizer and Moderna vaccines have been fully tested in humans, and more than 600 million doses in the U.S. and millions more around the world have been given safely. The advisors and experts at both the FDA and the CDC have determined that the newly formulated booster shots are safe.

UCHealth infectious disease and COVID-19 expert Dr. Michelle Barron compared the new boosters to the flu shot, which is updated every fall as vaccine makers guess which strains of the flu will be circulating, and change the recipe to match. But the vaccine itself is not entirely new, she explained.

“We don’t test the flu shot each year. We just change it slightly,” Barron said.

“This new COVID-19 booster just tweaks the formula. The technology is the same. The safety of the vaccines will be exactly the same because it’s not a new vaccine,” she explained.

Who can get them?

The Pfizer vaccine is authorized for anyone ages 12 and older; the Moderna vaccine is authorized for adults 18 and older.

Like the previous coronavirus vaccines, the new boosters are free to the public. They will be available to anyone who has already had their primary vaccine series from any authorized U.S.-approved company regardless of how many boosters they’ve already received.

Public health officials recommend that those who are pregnant or have been pregnant recently should also get the updated boosters because they are at a slightly increased risk of more severe illness and death from COVID-19.

For those who recently received a booster of the previous vaccines, the FDA has set a minimum waiting period at two months, but advisers to the CDC recommend waiting longer: at least three months for those at high risk, or as long as six months for everyone else.

It’s also recommended that anyone who has recently recovered from a COVID-19 infection should wait at least three months to be vaccinated, not only to boost the effects of the vaccine but also to avoid the possibility of a rare side effect, heart inflammation, that sometimes affects teen boys and young men.

“If you wait a little more time, you get a better immunologic response,” CDC adviser Dr. Sarah Long of Drexel University told CBS News.

According to the CDC, side effects are expected to be similar to those associated with the current vaccine, including headache and muscle soreness, occasional fatigue, and redness and swelling at the injection site.

What about other vaccines?

As we head into the fall flu season, several of our clients have asked whether they can get a coronavirus vaccine along with a flu vaccine. The answer is yes, one in each arm.

In fact, health officials have recommended this protocol, and the government is preparing to launch a campaign that will urge Americans to do just this, due to the possibility of the high spread of flu and COVID-19 this season.

As for the Jynneos monkeypox vaccine, the CDC suggests that adolescent and young adult men consider waiting four weeks after receiving the monkeypox vaccine before receiving a Moderna, Novavax, or Pfizer COVID-19 vaccine, because of the risk of inflammation of the heart muscle (myocarditis) or inflammation of the tissue surrounding the heart (pericarditis).

However, the agency adds that the monkeypox vaccination “should not be delayed” due to recently receiving a coronavirus vaccine.

If you have any questions about whether or not to get the new booster, don’t hesitate to contact us for advice.

New Guidance on COVID-19 Can Be Confusing

Sometimes it seems as though we need a spreadsheet to keep track of all the changing information and recommendations on COVID-19.

  • Masks/no masks?
  • Boosters? Maybe not, maybe now, maybe later.
  • Quarantine? Yes, no, who, and how long?

Our primary care concierge doctors in Jupiter don’t mean to criticize the researchers and public officials who are responsible for keeping us healthy. The SARS-CoV-2 coronavirus is, after all, a disease we’d never seen until early in 2019. No one knew how to deal with it.

And thanks to the combined efforts of scientists around the world, we’ve made tremendous strides in the effort to combat it.

But one thing few counted on was “pandemic fatigue,” which meant many people rapidly grew tired of taking precautions and radically altering their lifestyles to help stem the spread of COVID-19.

Which may be what’s behind the latest guidance from the Centers for Disease Control and Prevention (CDC). (https://www.cdc.gov/media/releases/2022/p0811-covid-guidance.html

A new approach

This month the CDC relaxed many of its coronavirus recommendations, leaving measures to battle to limit viral spread largely up to individuals.

According to The Washington Post:

  • “No longer do schools and other institutions need to screen apparently healthy students and employees as a matter of course.
  • “The agency is putting less emphasis on social distancing—and the new guidance has dropped the ‘six-foot’ standard.
  • “The agency’s focus now is on highly vulnerable populations and how to protect them—not on the vast majority of people who at this point have some immunity against the virus and are unlikely to become severely ill.”

In releasing the new guidance, the CDC cited improved tools like vaccination, boosters, and treatments to better protect ourselves from the virus.

“We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation,” Greta Massetti, a CDC epidemiologist, said in a statement.

“This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives,” she added.

Isolation changes

In one fairly substantial shift, for example, the CDC no longer recommends quarantine if you’re up to date with your vaccines and have been exposed to COVID-19. Instead, you should mask for 10 days and get tested on Day Five.

Additional CDC guidance on isolation includes the following:

  • If you’ve tested positive and have a healthy immune system, regardless of your vaccination status, you should isolate yourself for five days. On Day Six, you can end isolation if you no longer have symptoms or have not had a fever for 24 hours and your symptoms have improved.
  • Once isolation has ended, you should wear a high-quality mask through Day 10. If you test negative on two rapid antigen tests, however, you can stop wearing your mask sooner.
  • Until Day 11 at least, you should avoid visiting or being around anyone who is more likely to have severe outcomes from COVID-19, including the elderly and people with weakened immune systems.

These changes stem from a new statistic, according to Massetti: 95 percent of the U.S. population has at least some level of immunity against the virus, either from vaccination or previous infection.

What about boosters?

As for booster shots, the U.S. Food and Drug Administration (FDA) finally decided last month against allowing adults younger than 50 to become eligible for a second booster vaccine (for a total of four mRNA shots).

Currently, only those age 50 and older and children at least 12 years old with impaired immune systems can get a second booster.

This is because the agency expects to have reformulated mRNA boosters available by next month that will contain components from both the original virus and its variants, as well as from the currently circulating (and highly contagious) omicron subvariants BA.4 and BA.5.

Meanwhile, the FDA still recommends that anyone under age 50 receive a single booster shot, and people older than 50 or those with weakened immune systems receive a second mRNA booster.

The mask question

No one likes wearing masks, especially in the heat. However, our primary care concierge doctors believe it’s better to err on the side of caution, especially if you’re immunocompromised or older than 65.

Especially given the new CDC guidance revisions, there’s no harm in wearing a mask in crowded indoor situations with poor ventilation.

It’s true that we now have effective treatments for COVID-19, but given the risk of long COVID—one recent study found that as many as one in every eight people who contracted it had lingering symptoms—what’s the point in taking unnecessary chances?

It’s up to you, of course, but in a recent interview with The Post, Ziyad Al-Aly, an epidemiologist at Washington University in St. Louis, compared the current state of the country to “the Wild West.”

“There are no public health measures at all,” he told the paper.

“We’re in a very peculiar spot, where the risk is vivid and it’s out there, but we’ve let our guard down and we’ve chosen, deliberately, to expose ourselves and make ourselves vulnerable.”

long-covid

Living with Long COVID

The post-COVID syndrome commonly known as “long COVID” or “long-haul COVID” can be debilitating.

Although not everyone experiences aftereffects from infection, some of the most common symptoms include lingering fatigue, shortness of breath after even mild exertion, trouble sleeping, “brain fog,” and symptoms that worsen after physical or mental activity. Others can include rapid heartbeat, chronic pain, dizziness, muscle weakness, and erectile dysfunction.

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What to Know About Infant Vaccines

The Centers for Disease Control and Prevention (CDC) has designated this week National Infant Immunization Week (April 25-May 2) to raise awareness of the importance of childhood vaccines. This annual observance highlights the importance of protecting children two years and younger from vaccine-preventable diseases.

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omicron variant

Omicron Variant Still Largely a Mystery

There’s still much we don’t know about the new COVID-19 omicron variant. The SARS-CoV-2 coronavirus was first detected just over a month ago. Our concierge primary care doctors at MD 2.0 in Jupiter have gotten questions from so many of our patients. We wanted to bring you up to date on what we know at the moment.

Health officials are conducting laboratory tests and reviewing real-world data as the variant spreads. However, it will be several weeks before we know precisely what we’re dealing with. There are some early indications, however, that can allow us to make a few assumptions.

How different is omicron?

The new variant originally caught the world’s attention in South Africa. Researchers there detected as many as 30 mutations on the shell of the coronavirus. 

In the intervening weeks, we’ve learned that omicron is highly contagious, even more so than delta. While delta’s transmissibility has been compared to that of chicken pox, omicron has been spreading much more rapidly.

The World Health Organization (WHO) released an update in mid-December. It noted the omicron variant is spreading faster than any previously detected strain of the coronavirus.

More benign?

There’s some possible good news. So far as real-world data have been able to determine, the omicron variant appears to trigger slightly less severe cases than delta. This information is very preliminary and is based on a study in South Africa where the infection and vaccination rates differ from that in the U.S.

Another small study this month by the CDC examined 43 people infected with the omicron variant. Three-quarters of the group received vaccinations, and a third of those also had booster shots. One person from the group was hospitalized for two days. The rest experienced cough, fatigue, congestion, or a runny nose.

While noting the report was “encouraging,” John Moore, a professor of microbiology and immunology at the Weill Cornell Medical College, told NBC News that, “We’re not out of the woods yet.”

“Only four cases [in the study] were aged over 65, while 29 were under 40. Young people generally have milder infections, whatever the variant,” he added. “So we don’t yet know what omicron might do in much older and more vulnerable populations.”

The variant is not benign, however. In the middle of the month, Britain reported its first death from the omicron variant. Since then, reports of possible omicron-related deaths grew.

Omicron now surpassed delta as the dominant variant due its rapid spread.

What about the vaccines?

The question of vaccine effectiveness against omicron is a case of good news/bad news, or perhaps vice versa. The bad news, according to the South African study, the two-dose Pfizer-BioNTech vaccine’s effectiveness at preventing illness dropped from around 93 percent to about 30 percent against the omicron variant. It still provided about 70 percent protection against hospitalization, though.

The good news is, the study found that the vaccine still offers as much as 70 percent effectiveness against hospitalization with any current variant of COVID-19, including omicron. Boosters increase this protection.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said recently that boosters will be enough protection against the omicron variant. He didn’t see a need for a new vaccine specifically designed to fight omicron.

“Our booster vaccine regimens work against omicron,” he said at a White House coronavirus briefing. “At this point, there is no need for a variant-specific booster.”

Vaccines necessary

At the same time, he warned those unvaccinated are still at high risk of contracting COVID-19. This includes the delta and omicron variant.

“If you are unvaccinated, you are very vulnerable—not only to the existing delta surge we are experiencing, but also to omicron,” he said.

Vaccines continue to offer the best protection against severe illness and death against any variant of the coronavirus, including omicron.

“[Omicron] may be a more mild variant but we just don’t know yet. It’s too soon,” Dr. Isaac Bogoch, an infectious disease specialist at the University of Toronto, told NBC News. For now, “if you’re vaccinated, chances are you’re going to have a milder course,” he added.

Do we still need masks?

One question we often get from our patients is whether they need to keep wearing masks once they’ve been vaccinated.

Here’s what the CDC says: “If you are fully vaccinated, to maximize protection and prevent possibly spreading COVID-19 to others, wear a mask indoors in public if you are in an area of substantial or high transmission.”

We would add that it’s also a good idea to wear one if you are indoors in a public place where you’re not sure how many there have been vaccinated, especially if few others are wearing masks. Until we know more about the omicron variant, wearing a mask for now offers added protection against breakthrough cases.