Getting a boost, predicting the future and other things you need to know about the COVID-19 vaccine

To borrow from one of the great literary minds of our time, the Fresh Prince, it’s summertime. And in order to maximize your and your family’s ability to have fun while school is out (“and it’s sort of a buzz”), we’re here to help you to untangle and make sense of all the different guidance floating around when it comes to COVID vaccines. That way you can take time to sit back and unwind – safely.

But first, just to point out how maddeningly confusing it can be as to who should be getting boosted – and when – this week we’ll start things off with a little quiz. 

HYPOTHETICAL QUESTION: You are 48 years old. Your spouse, who just turned 46, has an underlying health condition that necessitated her getting a second COVID vaccine booster. Your kids, one of whom is 12 and the other, who is 16 and suffers with asthma, have both been vaccinated – and boosted. The older one recently contracted the virus and was prescribed Paxlovid by the family doctor. Your mother, who lives in Canada and you plan on visiting in two weeks, is currently going through chemotherapy, but she’s been vaccinated and boosted as well. Are you eligible for a second booster? Solve for x. 

Right. So, it’s a tad complicated. 

 

To answer tough questions like these – and plenty of others – we chatted with Danielle Scheurer, M.D., MUSC Health System chief quality officer, who oversees all things COVID for the hospital system. 

Q. If you’re under 50 and it’s been more than five months since your first booster, should you be getting another one, even if the Centers for Disease Control and Prevention is only recommending it for those 50 and older? I ask because I imagine there aren’t lines out the door these days.

A. It’s a good question, and you make a fair point. As far as “should you,” the CDC has released no new guidance for those age 49 and younger. And you’re right; a lot of those folks are hitting their six-, seven-, eight-month windows, so they’re wondering what they should do. To be honest, we always ask people if they’re eligible for the booster, but if they come in seeking a vaccine, we don’t pester them or over-screen. We never turn away people wanting to get a vaccine. It’s an honor system. 

Q. Same scenario, but let’s turn the question on its head: are the boosters even that effective against the latest strains of COVID anyway?

A. For the most part the mindset has changed quite a bit on vaccines and boosters – it’s less about can we prevent you from altogether getting COVID, and it’s shifted more to a focus on reducing how sick you get if you happen to get COVID. The boosters are still very good, but there’s a lot we just don’t know. The bottom line is – and this gets back to some of the old boring and tiresome public health messaging – if you want to prevent getting COVID, you need to social distance, wash hands frequently, wear a mask. That sort of thing.

Q. I keep reading about how the Food and Drug Administration says the next round of boosters should focus on the Omicron subvariants. How are scientists supposed to make a vaccine for variations that haven’t even happened yet?

A. You’re right. There is some work being done – and I don’t know how far they’ve gotten with it – to produce an Omicron-specific booster with some projection of what may happen based on the pattern of behavior. Just like with the flu, COVID is constantly changing. How flu vaccines are made from season to season is based on historical data and projections. Basically, it’s our best scientific guess, for lack of a better way of putting it. Some years we nail it, and flu numbers are low. Sometimes we don’t, and it’s maybe 30% effective, and a lot more people get sick. So yes, it is possible for the vaccine makers to get a future COVID booster right, but it’s still based on their best guess, which is usually pretty good. My only concern is that this new round of boosters is only going to be good if the variants quit mutating. And the more time the virus has the luxury of hanging around, the more likely it is to keep mutating and varying. Every iteration of these variants, the vaccine becomes less and less of a shield against transmission. But it’s still very good at preventing hospitalization and death. 

Q. Kids age 5 and younger were recently approved to get the vaccine. What kind of numbers are we seeing at MUSC Health’s vaccine sites for kids in that age range?

A. The turnout has been pretty low for little kids. Maybe some of it has to do with it being so early in the approval process. Maybe parents are just overly cautious. Either way, there’s not a high uptake yet. 

Q. Basic question, but one that I know most people still care about: Regardless of age, does getting a COVID vaccine/booster at any of the MUSC Health sites cost anything?

A. We have chosen not to charge people for the vaccine. And that applies to everybody. 

Q. Why does my pediatrician’s office charge for it?

A. I’m not 100% sure, but my guess is they’re not charging you for the vaccine but rather an administration fee, like a payment for their time. 

Q. Why isn’t everybody who gets a positive COVID test prescribed Paxlovid?

A. The CDC has guidelines for prescribers, and just like with the vaccine, it’s all about the risk-benefit ratio. In other words, it comes down to the patient’s age, health history and timing: it needs to be started within five days of coming down with the virus. But that doesn’t mean there’s a hard and fast rule as to who can get it and who can’t. Just like any prescription, it boils down to the expertise of the prescriber as to whether it’s a good fit for the patient. That said, getting Paxlovid is much easier than ever. More drugstores have it, and now pharmacists themselves are able to prescribe it, saving the patient the headache of having to scramble to find a prescriber and then a location that actually has the pills. 

Q. Last one. We’re in a weird time where we’re in a spike, but nobody really seems to be behaving like we have in the past: i.e., social distancing, masking, etc. To what do you attribute infection numbers being medium to high but hospitalizations and deaths so low? Is it because the strains are less severe or maybe we’re approaching some sort of herd immunity?

A. I think it might be both. There is pretty good evidence that we’re pretty close to, if not already at, herd immunity. Most Americans have evidence of antibodies in their systems, whether it’s from vaccine or natural antibodies. So, combine that with the fact that Omicron seems to be a little less severe, and that’s my best guess as to why things haven’t spiraled out of control.