No. But alternative plans will take creativity and effort, and apparently, we're too tired. Nevertheless, lives are on the line. Timing Boosters: Part I.
Jeremy: Your argument is very effective and makes sense to time the boosters to an increase in the number of cases. I am over 65 and my husband is in his 80s. We received the bivalent booster in September because our son was being married in mid October and I felt that wedding related events would be a high risk situation. We made it through the wedding but 3 weeks later, we both tested positive for COVID. Fortunately it was mild, but it got me to thinking about what the CDC would recommend for 2023.
So I guess that the game plan for us will be to mask up and try to reduce risk as much as possible until the fall when I hope the new boosters are rolled out. I am a retired internist and have tried to time my annual flu shot for mid to late October in hopes that the immunity would carry over into the spring.
Thanks for your comments. They are greatly appreciated.
I always wait for my flu shot until the last possible week before the hospital threatens to de-activate my badge, for this exact reason. I want maximal protection and I assume that antibody titers wane fast.
Jeremy, why oh why have those who have dedicated their lives to public health not at the front of the line giving the science to those who will make this decision. I am tired, tired of not having smart science and health coming from our leadership. Thank you for continuing to inform us and I hope that you will still be headed to Washington from time to time.
That is consolation? Is there any sense of when or if the sides will align (not the far edges), but the true scientists and doctors on the front line. By aligning I mean distributing information of when we can take a breath as a collective society? I know there are many who are still so very compromised. I am not one of them( and I don't want this virus again) and yet I still feel unsure and scared as to how to go about daily life respectfully and carefully.
Booster rates will be very low, so the individual is forced to act prematurely because there is little community coherence and altruism.
Surges will happen, but there is more or less a constant grind. Inpatient census at our hospital system has plateaued around 150 hospitalized daily for months.
Hypercontagiousness variants, minimal masking, only 1-3 months of decent immunity before reinfection likely - its all a mess. We have to throw out old paradigms that worked for predictable flu seasons.
Maybe 65+ get booster q6 months until pan coronavirus vaccines available, with a serious push for a more practical fall booster campaign for everyone else - to head off or reduce a holiday wave, and blunt the back to school mess that converts children into efficient vectors.
I’ll be testifying to CDC on this later today. Ha.
I agree that more than annual for high risk makes sense. The question is when should they be? I was pretty unimpressed with the 4th dose being pushed in March and April of 2022...when we were seeing a fraction of the case load as we'd seen in Jan-Feb.
Great question. If imprinting is occurring--and I suspect on some level it is--then maximizing the benefit of boosters is of significant importance. This can be achieved in a few ways.
1. timing.
2. moving to monovalent Omicron-only boosters.
3. considering that some populations may not benefit as much from boosters *even with respect to effectiveness against infection* than many thought.
The WHO has stated that yearly boosters are not a good plan--do you think this will be approved for simplicity over science?
I am a retired primary care physician and have a moderate immune deficiency--I'm in the 65 group. I am already feeling so constrained by the "it's over" behavior, and this policy makes me even more concerned.
Does anyone know if Dr. Faust has posted an analysis of the Cleveland Clinic preprint article (posted 12/19/2022, https://www.medrxiv.org/content/10.1101/2022.12.17.22283625v1.full ) ostensibly showing a greater risk of a COVID-19 infection with an increasing number of vaccinations?
I have not looked at this study, but I would not be surprised if too many doses of Wuhan strain only would increase risk of reinfection during the Omicron era. That said, that risk may be worth it, if* the protection against severe disease is adequate. It's complicated and we/the research community is looking into this.
This would be a disaster for all the people (including so many grandparents) that wait all year now get together for the holidays in November and throughout December...
I'd rather the high risk get their dose in early-mid November than Sept or October. At least if we are going to do a 1-size fits all fall rollout, we should start it later and make it really easy to get.
We should study how often high-risk people can get boosted and still have more benefit than risk. I imagine it is more often than people think for older folks/those with very high risks. Especially if the new version of the vaccine is quite different from the previous one.
Yes, instead of older folks/those with very high risks getting a high-dose (or adjuvanted) influenza vaccination once a year, they could get a regular dose COVID-19 vaccination twice a year (or something like that).
Unfortunately the statistics that my state releases to the media are whitewashed. For instance the state refuses to release the statistics from all our 26 hospitals to the Feds. And will only release information on 15-22 hospitals. What if we don’t know if there’s a surge? What are our best individual practices?
We are working on better correlations between wastewater and cases/hospitalizations/deaths. Wastewater is good because it does not depend on testing resources/choices.
We will not know if there is a surge in Hawaii. wastewater testing is not at all a priority here. They have been “promising” testing for months, and months. What little wastewater testing is done is not statewide. Not even county-wide. Not even citywide.
We are working on better correlations between wastewater and cases/hospitalizations/deaths. Wastewater is good because it does not depend on testing resources/choices.
Jeremy: Your argument is very effective and makes sense to time the boosters to an increase in the number of cases. I am over 65 and my husband is in his 80s. We received the bivalent booster in September because our son was being married in mid October and I felt that wedding related events would be a high risk situation. We made it through the wedding but 3 weeks later, we both tested positive for COVID. Fortunately it was mild, but it got me to thinking about what the CDC would recommend for 2023.
So I guess that the game plan for us will be to mask up and try to reduce risk as much as possible until the fall when I hope the new boosters are rolled out. I am a retired internist and have tried to time my annual flu shot for mid to late October in hopes that the immunity would carry over into the spring.
Thanks for your comments. They are greatly appreciated.
I always wait for my flu shot until the last possible week before the hospital threatens to de-activate my badge, for this exact reason. I want maximal protection and I assume that antibody titers wane fast.
Jeremy, why oh why have those who have dedicated their lives to public health not at the front of the line giving the science to those who will make this decision. I am tired, tired of not having smart science and health coming from our leadership. Thank you for continuing to inform us and I hope that you will still be headed to Washington from time to time.
Thank you. If it's any consolation, some in government are listening. Whether they'll be able to act is another story.
That is consolation? Is there any sense of when or if the sides will align (not the far edges), but the true scientists and doctors on the front line. By aligning I mean distributing information of when we can take a breath as a collective society? I know there are many who are still so very compromised. I am not one of them( and I don't want this virus again) and yet I still feel unsure and scared as to how to go about daily life respectfully and carefully.
no question mark after consolation-typing on my break :)
So many variables to consider
Booster rates will be very low, so the individual is forced to act prematurely because there is little community coherence and altruism.
Surges will happen, but there is more or less a constant grind. Inpatient census at our hospital system has plateaued around 150 hospitalized daily for months.
Hypercontagiousness variants, minimal masking, only 1-3 months of decent immunity before reinfection likely - its all a mess. We have to throw out old paradigms that worked for predictable flu seasons.
Maybe 65+ get booster q6 months until pan coronavirus vaccines available, with a serious push for a more practical fall booster campaign for everyone else - to head off or reduce a holiday wave, and blunt the back to school mess that converts children into efficient vectors.
I’ll be testifying to CDC on this later today. Ha.
I agree that more than annual for high risk makes sense. The question is when should they be? I was pretty unimpressed with the 4th dose being pushed in March and April of 2022...when we were seeing a fraction of the case load as we'd seen in Jan-Feb.
I wish you were testifying. It all makes so much sense!
We are no where near a durable vaccine or a predictable virus. Simplification just feels like wishful/magical thinking--at best.
What are your thoughts about "immune imprinting" and booster timing?
Great question. If imprinting is occurring--and I suspect on some level it is--then maximizing the benefit of boosters is of significant importance. This can be achieved in a few ways.
1. timing.
2. moving to monovalent Omicron-only boosters.
3. considering that some populations may not benefit as much from boosters *even with respect to effectiveness against infection* than many thought.
The WHO has stated that yearly boosters are not a good plan--do you think this will be approved for simplicity over science?
I am a retired primary care physician and have a moderate immune deficiency--I'm in the 65 group. I am already feeling so constrained by the "it's over" behavior, and this policy makes me even more concerned.
We are in the same club!
Does anyone know if Dr. Faust has posted an analysis of the Cleveland Clinic preprint article (posted 12/19/2022, https://www.medrxiv.org/content/10.1101/2022.12.17.22283625v1.full ) ostensibly showing a greater risk of a COVID-19 infection with an increasing number of vaccinations?
I have not looked at this study, but I would not be surprised if too many doses of Wuhan strain only would increase risk of reinfection during the Omicron era. That said, that risk may be worth it, if* the protection against severe disease is adequate. It's complicated and we/the research community is looking into this.
This would be a disaster for all the people (including so many grandparents) that wait all year now get together for the holidays in November and throughout December...
I'd rather the high risk get their dose in early-mid November than Sept or October. At least if we are going to do a 1-size fits all fall rollout, we should start it later and make it really easy to get.
And what if there is more than one surge a year, which very well may be the case?
We should study how often high-risk people can get boosted and still have more benefit than risk. I imagine it is more often than people think for older folks/those with very high risks. Especially if the new version of the vaccine is quite different from the previous one.
Yes, instead of older folks/those with very high risks getting a high-dose (or adjuvanted) influenza vaccination once a year, they could get a regular dose COVID-19 vaccination twice a year (or something like that).
The current approach is vaccination, with no other mitigation— how will this reduction and simplification improve the public health?
Dr Faust
Unfortunately the statistics that my state releases to the media are whitewashed. For instance the state refuses to release the statistics from all our 26 hospitals to the Feds. And will only release information on 15-22 hospitals. What if we don’t know if there’s a surge? What are our best individual practices?
Thanks
We are working on better correlations between wastewater and cases/hospitalizations/deaths. Wastewater is good because it does not depend on testing resources/choices.
We will not know if there is a surge in Hawaii. wastewater testing is not at all a priority here. They have been “promising” testing for months, and months. What little wastewater testing is done is not statewide. Not even county-wide. Not even citywide.
We are working on better correlations between wastewater and cases/hospitalizations/deaths. Wastewater is good because it does not depend on testing resources/choices.