Cases up. Booster up?

An informal review of the current Covid landscape

As you almost certainly know by now, the new Covid boosters were approved last week in the U.S. for people over the age of 6 months. These updated shots from Moderna and Pfizer against the XBB variant are increasingly available at pharmacies and doctors’ offices. We should have Moderna shots in our office any day now. I started a detailed post with graphs and figures, but the sense I’m getting from people in the office is that most have already read about this stuff, know the general score, and have pretty much decided whether they are going to get the new booster or not. So I’m going to skip the technical deep dive here and instead share some office anecdotes from the past week, some professional experience, and conclude with an endorsement of the booster. It’s also been a really long day.

What’s going down in the community/office

I practice in Jersey and live in Philly. Over the past 2 weeks we have seen a real “swell” in Covid cases in our patients. I’ll reserve the term “surge” for when hospitals start feeling the stress. Today I saw three people in the office (wearing masks) who came in for chronic condition check ups, but with coincident respiratory symptoms. They had performed Covid tests at home that were reportedly negative, but rapid antigen tests are maybe 70-80% accurate these days, and can be falsely negative early on. All three tested positive in the office. I offered and prescribed Paxlovid. I also reviewed and treated 3 more people on the phone after-hours with Covid. This is a much higher number than usual, and it has been gaining momentum over the past couple weeks.

It would be a good idea to mask up (KN or N95) in doctors’ offices, crowded indoor places, planes, Lyfts, etc. if you want to reduce your risk.

Most people are experiencing “bad colds” and “flu-like symptoms.” We have not sent anyone to the hospital these past 2-3 weeks, which is great.

My daughter has multiple classmates and teachers out with Covid this week. Schools remain a nexus point.

Professional experience/commentary

I think it’s important to keep countering the narrative that Covid is nothing to worry about. Most of the time people do indeed recover well, but some struggle mightily, especially the older generation. A significant number of people (about 5-10%) absolutely go on to experience post-Covid conditions that can last for weeks, months, or permanently. People in their mid-30’s to mid-50’s develop long Covid at the highest rates. And each time we get Covid it’s a new roll of the dice. Repeat infections are no guarantee of milder illness, either. I am definitely seeing weird things happen in terms of fatigue, cognitive fogginess, autonomic dysfunction (disruptions in heart rate, blood pressure, and sweating), muscle pain, and even shortness of breath persisting weeks to many months after infections.

The CDC states that you can get a booster if it has been more than 2 months since your last booster, and suggests waiting 3 months since your last infection.

The boosters do work better with more time in between your most recent boost or illness. If Covid were not still circulating and rising as previously noted, waiting at least 6-12 months would be ideal.

But gaming the timing of this booster has become predictably tricky. Cases are high right now, but will likely be higher around the holidays, too. The highest protection against infection occurs during the 1-3 months after the booster pumps up our antibody levels. Dr.

Katelyn Jetelina

flattens it out nicely: “…if this feels too much like gymnastics, get your shot before Halloween. It will help you and those around you.”

We will have to look back at the data in a couple months for the actual vaccine effectiveness of this new booster, but assume maybe a 50% reduction in your risk for month #1 at best, decreasing to ~35-40% by month #2, and then maybe 25-35% by month #3. Rough numbers and guesses here.

The XBB booster is also capable of neutralizing other variants like EG.5.1 and BA.2.86 better than anticipated.

Assuming I don’t get Covid in the next 10 days, which is iffy given all that’s swirling around in my community and in my daughter’s school, I’m thinking 9/29 for my mRNA boost.

Novavax is not available yet. They just can’t seem to keep up with the mRNA well-oiled machines. But when available and approved, it seems to provide a good boost too, with potentially less side effects for some.

A nudge

I like expertise. Despite failings and imperfections, the CDC and ACIP really are stacked with expertise. Instead of reading some random deep dive from a single medical professional, or celebrity, or conspiracy-minded ranter, consider diving into the actual CDC slides from their meeting on these boosters. If nothing else it will convince you that a lot of smart people have been weighing the risks and benefits of boosters, and the consensus is to go for it. A recent study also showed that vaccine uptake has been quickest and most extensive by those at the head of the class, so I think there is power in the intellectual hive mind.

We count on boosters to further reduce the risk of severe disease, hospitalization, and death in the most vulnerable, high risk, and older populations. Some experts stop there.

But others expect boosters to further reduce infections in high prevalence time periods for everyone, which can have positive ripple effects on community transmission, fewer rolls of the dice for long Covid, and less bodies for mutating viruses to keep mutating in.

And I personally like XBB booster. It has a ring to it. Kind of X-Men crossed with Star Wars BB-8.

Good luck, take good care, and consider being a bit more careful out there right now, regardless of booster timing. The same techniques still help.

So…