COVID bivalent boosters

As you may recall, spouse B, daughter T, and I were all participants in the Phase III clinical trial for the COVID-19 vaccine from Pfizer/BioNTech. We then all participated in a follow-on third dose trial. B and I left the trial this spring because we were eligible to receive a fourth dose and wanted the extra protection before travelling. T stayed in the trial until its end earlier this summer.

Here in the United States, a new booster was recently approved which combines the original formulation with a new one designed to better combat the Omicron BA.4 and BA.5 variants. BA.5 is the dominant variant currently in the US, accounting for about 88% of cases. About 11% are caused by BA.4. The new booster is expected to strengthen protection against serious illness/death and, one hopes, cut down on symptomatic infection somewhat, as well.

Given that I am still trying to remain COVID-free and that I have several trips coming this fall, I decided to receive one of the new boosters at my local pharmacy. I chose to receive the Pfizer formulation because all my others have been theirs, although there is a Moderna version which is also a fine choice. This was my first time receiving the vaccine in a pharmacy setting. My prior doses had all been in a medical office or a state vaccination site. I made an appointment online and everything was very fast and efficient.

Dr. Ashish Jha, who is the White House COVID-19 response coordinator, and Dr. Anthony Fauci, the long-time director of the National Institute of Allergy and Infectious Diseases, have said that it is possible that we may have reached a point where an annual booster will be enough to protect the vast majority of Americans from serious illness/death from COVID, similar to annual flu shots. Some people who are especially vulnerable due to age or medical condition might need more frequent boosters. The wild card, though, would be the emergence of a new strain that could evade our antibodies and current vaccines.

So, my message is to receive one of these new boosters as soon as they become available wherever you are. The US has been first to authorize them, but it seems they will become more widely available globally soon. Remember, though, that these are booster doses given to people who have already completed an initial vaccine series. If you haven’t completed an initial vaccine series, start NOW!

Meanwhile, here in Broome County, our community risk level is still medium. While I wait for the new booster to take full effect, I will still mask for indoor gatherings and shopping. I’ll be evaluating what to do after that, although these boosters are so new that data may be hard to come by.

I hope to stay well and hope that you do, too.

still COVID

I’m sad to report that the total death toll in the United States from COVID-19 is now over 1.04 million with over 93 million confirmed cases. The actual case count is no doubt higher, as some states have stopped reporting and many cases that are detected by at-home testing are not reported to health agencies at all. New cases are still occurring at a rate of 93,000 a day with 457 deaths (7-day rolling average on August 22, 2022).

It’s still heart-breaking.

And still considered by most experts a pandemic, although perhaps heading in the direction of being considered endemic in the United States soon, as influenza is.

Most cases in the US now are Omicron variants BA.4 or BA.5. There is some hope that new boosters that contain components targeted at Omicron variants might give some additional protection going into the fall and winter, especially against hospitalizations and deaths, but we will have to see if a) people actually get vaccinated and b) the vaccines do boost protection for any length of time.

And/or c) a new strain could develop that evades all prior immunity, is even more wildly contagious, doesn’t respond to current treatments, and/or causes more severe illness.

At home, B, T, and I all still remain uninfected to the best of our knowledge. It’s possible that one or more of us have had an asymptomatic case but there is no real way to know. Any time that we have had symptoms, we have tested, as we have also for travel and after known exposures. We also have had extra tests as part of our participation in the Pfizer/BioNTech vaccine trials. T remains a participant in the third shot trial; B and I exited the trial in order to receive a fourth dose before travelling to the UK this spring. I believe that our vaccination status has helped us to avoid infection and plan to receive one of the new booster shots this fall, if I’m eligible for what will be my fifth dose. T may be eligible for a booster after she finishes with her trial participation this fall if those boosters are available to people under 50.

Broome County, New York, managed to have only a few weeks in the Centers for Disease Control category of low community risk for transmission before going back up to medium. I’ve gone back to masking with a KF94 while shopping or in other indoor public places. I’m making determinations on small gatherings on a case by case basis. Other than church services, I’m avoiding large gatherings.

Some people think I’m being overly cautious at this point but I am still trying to avoid infection, if I can. At the very least, if I do become infected, I will know that I was doing everything I could to keep myself healthy so that I don’t suffer guilt on top of COVID. I am well aware that, even with multiple vaccine doses, masking, avoiding crowds, etc., Omicron, especially BA.5, has been quite successful at evading immunity and protections. I know from what the public health experts are saying and also anecdotally among my friends. There are very few left who have managed to stay COVID-free in recent months.

A large part of my motivation to keep from getting infected is fear of long COVID. While SARS-CoV -2 is too new a virus for researchers to fully understand, it’s possible that I may have some genetic risk factors that could come into play regarding long COVID. None of this is helped by the fact that the underlying medical conditions I have are themselves not well understood.

So, I’ll keep on doing the best I can to stay as healthy as possible.

Wish me luck.

I’m going to need it.

COVID update

Remember the COVID-19 pandemic?

It’s still going on, even though most people here in the US are ignoring it. We crossed the one million death threshold in mid-May, although it is likely that the true number is higher as not all deaths caused by COVID are listed as such.

The good news in the US is that both the Moderna and Pfizer/BioNTech vaccines have been approved for children beginning at six months. It remains to be seen how many parents/caregivers decide to vaccinate their babies/toddlers/preschoolers. If it were me, I’d be first in line, but I expect we won’t see very high numbers. Only about 30% of 5-11-year-olds are fully vaccinated, despite availability since November, 2021. This boggles my mind, given that these same parents have vaccinated their children against a host of other serious diseases, yet have chosen to leave them unprotected against a disease that has sickened and killed so many here and around the world. It’s true that the vaccines are not a guarantee against infection but they prevent some infections and usually keep those that do occur from causing hospitalizations or deaths. From a public health standpoint, the more people who are vaccinated, the more likely it is that the pandemic will end and COVID-19 becomes endemic.

We are still far from that point, especially as new variants and subvariants are better at evading immunity, whether from vaccination or infection. The US right now is still dealing with Omicron subvariants. BA.2.12.1 is still responsible for the majority of cases here at about 56% but BA.4 and BA.5 are up to 35% of cases which is a large increase and a sign that they may out-compete the already wildly contagious BA.2.12.1.

Our county, which has been struggling with high infection rates for months, mostly due to BA.2 sub-variants that originated in central New York before causing misery more widely, is finally back in the “medium” risk category according to the CDC. It’s a bit discouraging in that Broome and our neighbor Tioga are the only two counties in all of upstate New York that haven’t dropped down into the “low” category. Maybe soon. Meanwhile, I’m continuing to avoid crowds and mask in public places like stores and church.

As you may recall, spouse B and I left the Pfizer/BioNTech COVID vaccine trial this spring in order to receive a fourth shot to boost our immunity before we travelled, but daughter T is still participating. Next month will be the one-year anniversary of her third dose, so she will be having an in-person visit for blood tests and such.

Pfizer and Moderna have both developed newer forms of their vaccines to better battle Omicron. The Food and Drug Administration scientists are meeting today to begin consideration of a new round of booster shots this fall to try to increase protection. It would be great if we can do so. I will definitely get another booster if it is offered, as I am still trying to keep from getting infected because I don’t want to be sick, especially with long COVID.

In the UK, where our daughter E and her family live, BA.4 and 5 are causing another spike in cases. Last week, it is estimated that 1 in 40 people in England and 1 in 20 in Scotland were currently infected. While the UK was initially slow to immunize children, earlier this year they began routine availability for COVID vaccination at age five. ABC’s recent fifth birthday came with the opportunity for her first Pfizer dose, for which we are grateful in the midst of the current wave. While it remains true that children have much lower rates of severe illness than adults, by not immunizing them you are allowing a large pool of little people to congregate, pass around germs, and spread them to their homes and communities. It’s one thing when we are talking about colds or even flu, but COVID-19 is a much more serious public health threat.

As usual, I renew my plea. Vaccinate if you are eligible and have access. Pay attention to infection rates in your area. Mask in indoor public places unless transmission rates are low. Avoid large crowds. Increase ventilation. Stay home if you are sick. Test and talk to your health care provider if you have symptoms. The SARS-CoV-2 virus has already caused immense suffering. Do everything you can to keep it from affecting you, your loved ones, and your community.

Pfizer study exit

As you many recall, spouse B, daughter T, and I have all been participants in the Pfizer/BioNTech COVID-19 vaccine Phase III clinical trial since summer of 2020. B and T received the vaccine while I was in the placebo group, although I received the vaccine through the trial after the emergency use authorization came through. All three of us continued in the study of third doses.

I had hoped that Pfizer would extend our study to include fourth doses but they have decided not to do so. After researching and discussion with family and medical practitioners, I have chosen to end my participation in the trial early in order to receive a fourth shot, which I did on Saturday.

In the US at this point, government and public health officials are not making COVID policy as much as providing information for individual decision-making. I admit that this is frustrating as community behavior is so important with pandemics in general and the increasingly contagious omicron variants in particular. Emphasis has also shifted away from individual infection rates and toward making sure there aren’t enough serious infections to cause the health system to collapse.

My priority is still to try to avert infection. I don’t want to be sick if I can help it. While rates of hospitalization and death are low among those vaxxed and boosted, serious cases are still possible. While some are lucky to have no or mild symptoms, many still feel like they are suffering the worst flu/virus ever, being out of commission for at last a week. I am also concerned about the risk of long COVID, estimated to affect as much as thirty percent to over forty percent of total cases. Vaccination is estimated to halve the risk. (Please note that definitions of long COVID and the risk factors are currently in flux. As more data are collected and analyzed, these estimates will likely change.) Due to some factors in my family history, I may be at increased risk for developing long COVID. I also know that COVID infection can cause severe flares in people with interstitial cystitis, which I have.

I am very concerned about the possibility of inadvertently infecting others, including my family. I also have several immunocompromised friends who I want to protect.

Infection rates are high in my county now. I am continuing to mask in public and am back to avoiding crowds, including church services, concerts, and plays. Even with the high case counts here, most people are not taking precautions so I am being extra careful.

The boost to resistance to infection is likely to be short-lived, only a few weeks, but this is a critical time for me to have that extra protection. In mid-May, I am travelling to Northampton, Massachusetts to attend my 40th reunion at Smith College. The protocols there are strict, including mandatory vaccination and boosters, indoor masking, and many outdoor activities, so I feel relatively safe attending.

Ten days after my return, B, T, and I will travel to London, UK to visit daughter E and her family. Again, we will be very cautious with our behavior to avoid infection. We also want to protect our family, especially granddaughters ABC and JG who are too young to be vaccinated. JG is even too young to mask.

I’m happy to report that my side effects from my fourth shot have been mild, mostly a sore arm and a bit of tiredness.

I am grateful to Meridian Clinical Research who handled the trial locally and to Pfizer and BioNTech for developing the vaccine and getting it out to so many people so quickly. I am happy to have been of service by participating in the trial and stand ready to participate in additional clinical trials as they become available.

I will close with my accustomed plea for people to do all they can to end the pandemic with whatever means are available to them – vaccines, distancing, masking, avoiding crowds, increasing ventilation, etc. The pandemic is not over and our lack of attention only increases the possibility of new variants and extends the length of time before SARS-CoV-2 becomes endemic.

Covid red again

Like many places around the world, COVID cases are rising here in Broome County, New York (USA), so much so that we are once again in the highest risk category from the Centers for Disease Control and Prevention. Technically, the high risk category is now orange, not red, but I used red in the title of this post because it seems to be yet another “code red” to me.

Broome County is in one of the red zones with the Covid Act Now site that I use regularly. Our current rating is “very high,” the fourth of five levels. Our seven day average is 50.2 daily cases per 100,000 residents. This figure is likely an undercount, as not all people who test positive with a home test are contacting the health department or a medical professional to report the case or seek advice and treatment. UPDATE 4/19/22: The Covid Act Now site is now using the (much less useful) CDC rating system. Fortunately, the more granular data by neighborhood is still available, as are statistics like percentage of population with booster shots.

There are a number of factors involved in the current rise in cases. Our vaccinated and boosted rate is only 35.5% so we have many vulnerable people. (While it’s true that boosted people are still vulnerable to infection, they are much less likely to fall seriously ill with COVID.) It is also likely that we have cases of two new omicron subvariants that have recently emerged in central New York. While information is still being gathered, these may be even more wildly contagious than the previous versions of omicron.

You would think that our government officials would be re-instituting indoor mask mandates, but they have yet to do so. This is what I feared would happen. When the mandates were lifted, politicians and public health experts said they were doing it to give people a break while cases were relatively low so that they could bring mandates back if we had another surge, but only a few jurisdictions, like the city of Philadelphia, are actually following through.

Instead, government officials are relying on individuals to make their own decisions. The problem is that the majority of people in the US are not seeking out credible information about the risks in their localities. As a participant in the Pfizer/BioNTech COVID vaccine trial, I have been following the science closely. Discussions with my personal medical team have reinforced the wisdom of trying to avoid or, at least, continue to postpone infection. Nearly all the public health goals at this point are aimed at reducing serious infection, hospitalization, and mortality, but I also want to avoid illness, infecting others, experiencing long-COVID, and developing complications. I had continued to wear a KF94 mask in public and avoid crowds as much as possible, including singing masked for this performance and this video. With our current infection levels, we will most likely return to take-out dining only.

I did attend Easter Vigil last night, as I knew that it would not be very crowded, unlike the services today. I was masked but the majority of attendees were not. I admit that I cringed when I heard some very loud coughing jags near the back of the church. I was sitting near the front, so I was very far away from them, but I realize that many people are infected without knowingly being in close contact.

The ease of the spread of COVID was brought home to us over the last couple of weeks. B had gone into the office for the first time in over two years because they were having a new product launch. There was only a fraction of the workforce there, all of whom were vaxxed and boosted. Despite that, B got a message three days later that a co-worker with whom he had been conversing had developed symptoms and tested positive. B immediately masked at home and kept his distance from T and I. He did not go out in public and did self-testing. I am happy to report that we are now over ten days from his exposure with no symptoms or positive test, so he is in the clear, but the story illustrates how easily one can be exposed and risk unwittingly infecting others.

I’m not sure what additional actions I may need to take for my and my family’s protection. If the numbers stay this high, I may forgo attending mass in person and return to televised or recorded services until the numbers are better. I will probably try to speak to the local researchers in charge of the Pfizer vaccine trial to see if they are planning to offer a fourth shot to those fifty and older. The CDC has opened the option for our age group to receive a fourth dose but we need to follow the study protocols to remain enrolled in the study which is still ongoing with weekly symptom checks and periodic blood draws to check antibody levels, etc. B and daughter T received their third dose last July, while I received mine in October. We are all well beyond the four-month interval to be eligible for a fourth shot, although T is not old enough to qualify. At this point, we probably have decent protection against hospitalization but not not much against infection. It’s hard to say for sure, though, because B and T are part of the data set on which such findings are based. (I’m a bit behind them because I was part of the placebo group in the initial phase of the study, so I was vaccinated and boosted later than they were.)

I am hoping that this wave in the Northeast will pass quickly. I always hope for surges to pass quickly to reduce suffering but I have an additional personal reason this time. I am scheduled to attend my 40th reunion at Smith College beginning on May 12th. It’s the first time since 2019 the event will be held in person. It’s planned in a cautious way, with all participants required to be vaxxed and boosted, many events being held outdoors, and indoor masking requirements in place except while eating or drinking. Even with a surge, we should be okay to go ahead but it will be less stressful if the surge has passed by then.

So, once again, fingers crossed. I’m doing what I can to keep myself, my family, and my community safe. I urge all of you to stay informed from credible sources in your area and take whatever steps you can with vaccination, masks, testing, medications, etc. to get the virus levels down and protect public health and your own.

We know what can happen if we don’t pay attention and act. The United States is closing in on a million known COVID-19 deaths. It’s already a stunning level of tragedy here and around the world. Please do all you can.

over COVID?

Over the last few weeks, many people here in the United States have said publicly that they are “over COVID” or “through with the pandemic” and are going to “go back to normal” which means living like they did before SARS-CoV-2 appeared.

Guess what? Pandemics don’t disappear just because we are tired or frustrated or in denial. There were 3,622 COVID deaths reported in the US yesterday, adding to the almost 900,000 deaths in the US since the start of the pandemic and 5.7 million deaths worldwide. These staggering totals are almost certainly undercounted, as some regions don’t have the will or capacity to track and report. Also, some deaths result from lasting heart, lung, or neurological damage from COVID rather than from the active infection itself and so may not be identified as COVID related.

Some people are saying we just have to live with COVID, as we do with flu and other viruses. Thus, they are saying that it is now endemic, but here is the problem. There is a specific definition of pandemic, “(of a disease) prevalent over a whole country or the world” (Oxford Languages). Looking at case numbers in the US and around the world, it’s obvious this is still a pandemic. We will get to a point where it is endemic, someday, through a mix of vaccination and immunity from having been infected, although no one yet knows how long immunity acquired through either route will last. Dictionary.com has a handy non-epidemiologist explainer of pandemic, epidemic, and endemic.

The subtext of being “over COVID” seems to be more along the lines of I’m tired of masking and distancing and avoiding crowds, so I’m just going to get back out there because a) I’m vaccinated/boosted so I don’t think I’ll get sick or at least not seriously so; b) I am young/strong/take vitamins/exercise so I’m not going to get sick; c) I don’t believe there is such a thing as this virus; d) you can’t tell me what to do; or e) we have to ease up on restrictions now so that we can re-institute them when the next variant or spike in cases occurs.

The thing is that a virus doesn’t care about your age or status or location. It’s only mission is to live and replicate and it will adapt to make that happen as easily and widely as possible. Exhibit A: the Omicron variant, which is wildly contagious and somewhat able to cause breakthrough infections in the vaccinated.

As regular readers here may recall, spouse B, daughter T, and I are all part of the Pfizer/BioNTech phase three vaccine trial. We are all vaccinated and boosted, although we were boosted on the early side of the curve, B and T as part of the trial that is contributing efficacy data that we see reported out in the news, and I who received a booster through the trial as soon as it was authorized for public use but before most people in my age range were eligible. I am also contributing data for the study, but I’m not on the leading edge like B and T. Therefore, while many of the boosted can get comfort from knowing that their immunity is likely still strong because the data from the trials is showing that, I don’t know if B and T might be showing a decline because there hasn’t been enough time to collect and analyze that data. I’m sure we would all love to know that booster immunity lasts a year or longer but it’s only been about seven months so far, so we can’t know. Likewise, we don’t know how long immunity lasts after infection.

I know that I am unlikely to become seriously ill, to be hospitalized, or to die if I contract COVID, but that doesn’t mean that I’m ready to be cavalier about it. I don’t want to be sick if I can prevent it by continuing with masking, distancing, and avoiding crowds. Even mild cases of COVID can result in months of symptoms, which is termed “long COVID.” As someone who has lived with a person suffering from FM/ME, which causes similar symptoms, I find the prospect of long COVID frightening.

What frightens me even more is the danger of spreading COVID to someone else. I have many friends who are older than I and at higher risk, as well as friends who are immunocompromised. Young children still are not eligible for immunization, although Pfizer/BioNTech has just applied for emergency use authorization for children 6 months-4 years of age, so perhaps that will begin in the coming weeks. I’m sure I also happen upon unvaccinated people because the fully vaccinated rate in my county is 62% and the boosted rate is only 33%. Some of the fully vaccinated are not yet booster eligible but we know that boosted people have the best chance against Omicron, so, if I am out in public, chances are that only 1 in 3 people I encounter will be a similar status to me.

Those are not great odds, especially with a variant as contagious as Omicron accounting for 99% of US cases. I have recently upped my mask protection to N95s, as I wrote about here. I’m learning how to deal with them as someone who needs progressive lenses in her glasses. The tighter fit of the N95 masks makes it difficult for my glasses to be in the correct position, so I can get a headache from eyestrain if I try to do close work for any length of time. Still, I’m trying to wear the N95s when I have to go out with a surgical mask/good quality cloth mask combo if I have to take the N95 off.

I used this site, https://covidactnow.org/us/new_york-ny/county/broome_county/?s=28791756, to find today’s Broome County statistics. (You can use it to find statistics in your area in the US. International data may be found here: https://coronavirus.jhu.edu/.) It rates our risk level as “Extremely High.” While other may be “over COVID,” I am not ready to take that much risk for myself, my family, and my community.

As conditions change, I will re-evaluate and adjust my behavior as I see fit. Until then, I hope that those I meet will respect my viewpoint.

I’m not “over COVID” yet.

N95s

With the immensely transmissible Omicron variant so prevalent, I’ve decided to try to get N95 masks to wear when I have to go out in public. I have been double-masking with a surgical mask under a very good quality cloth mask made by medicalwear producer Jaanuu but thought that I should probably go to an N95 mask which is designed to fit more closely and filter out 95% of particles under NIOSH standards. (NIOSH is the US National Institute for Occupational Safety and Health.)

It’s somewhat difficult to find N95 masks in stores here. We did get a few from a home improvement store which stocks them because they are protective against dust and other particles for people doing construction or renovating. The problem is that they only carry one size which is too large for my petite face. I was able to find N95s in a size small online and a second fold-flat style that people complained about in the comments as running small, so I have ordered some. They won’t arrive until late this week or early next but I think I’ll be safe with my current mask set-up until then.

Or safe enough…

Masking is just one piece of our strategy. The three doses of Pfizer/BioNTech vaccine is my primary protection. The masks, avoiding crowds, distancing, etc. are additional measures to stay as safe as possible but, especially with Omicron, there are no guarantees.
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the pandemic – year 3

My first post about the pandemic was February 29, 2020, a Stream of Consciousness Saturday post, no less! COVID-19, the illness caused by the SARS-CoV-2 virus, was already killing people in China, other parts of Asia, and Europe but had just begun to sicken and kill people in the United States, where I live.

I’ve written dozens of posts since then about the impact of the pandemic on our lives and about spouse B, daughter T, and my participation in the Pfizer/BioNTech vaccine trial. Yesterday, B and T, who are being followed currently on the efficacy of the third dose, had an appointment for blood work to add to the data on the longevity of antibodies and other immune markers six months after their third dose. I am also boosted and remain part of the trial, although, as someone who was in the placebo group initially, I am now part of the group who received their third dose later, so I am not on the leading edge in terms of data. There is a possibility that, when Pfizer/BioNTech develop an Omicron-specific booster, we may be asked to participate in that phase of the trial as well. Meanwhile, we continue to do weekly check-ins via app and do testing if symptoms that could be COVID appear.

I am grateful that we are able to help advance the science on the vaccines which have averted millions of hospitalizations and deaths. Even though the Omicron variant causes more breakthrough cases among vaccinated and boosted individuals than earlier variants, the vast majority are still protected from serious complications and death. I’m just sad that so many people around the world, by personal choice or by lack of availability, remain unprotected.

While Omicron tends to cause less severe symptoms than some of the earlier variants, it can still be deadly. The case numbers in the US, almost all caused by Omicron at this point, are staggering, reaching record numbers. On January 11, the US reported 1.35 million new cases with 136,604 hospitalizations, both records. The case count is somewhat elevated by the fact that some states don’t report new cases over the weekend, making the Monday numbers higher, but the seven-day average is over 700,000, so there are extraordinary levels of infection in evidence. Some hospital systems are overwhelmed, especially because staffing is a challenge. Many health care workers are exhausted by the sheer volume of patients and length of the pandemic and some have left the field. Right now, there are also a lot of vaccinated and boosted staff who have developed breakthrough cases; even if they are asymptomatic, they could still be contagious, so they have to isolate until they test clear of the virus.

The difficult thing for me to accept is that so many people in the US have chosen not to be vaccinated, despite the risks to themselves, their families, and their communities. Because Omicron is so transmissible, the safest course of action is to be vaccinated and boosted, while continuing to mask in indoor public spaces, to distance from non-household members, to avoid crowds, to sanitize appropriately, and to test before (small) social gatherings. By combining all those measures, B, T, and I were able to travel to London, where Omicron was running rampant, and get home virus-free.

Yes, going into year three of this, we are all tired of having to think about COVID safety all the time, but the virus doesn’t get “tired” of mutating and infecting people. We need to do everything we can to promote public health and to protect those who because of age or health condition can’t develop vaccine protection. We have to continue to study the virus, including all variants, to assess their impacts, including how long and strong immunity is from vaccines and from infection. Unfortunately, many viruses don’t tend to confer long-lasting immunity. If they did, we wouldn’t continue to get common colds repeatedly. Current research on SARS-CoV-2 shows immunity extending to about eight months. Some suggest that immunity could stretch to five years but we can’t know that yet, as this virus hasn’t been around that long. It also looks like some of the variants, like Omicron, are better at evading immunity, whether from prior infection or vaccines. We also have to be prepared for further variants that could be even more transmissible and/or cause more severe disease.

We are still in the pandemic phase with COVID-19. The world is unlikely to be able to rid itself of the virus totally. At some point, we will reach an endemic phase, where the virus is in circulation but not causing widespread serious illness/deaths through some combination of vaccines, natural immunity, and treatments. Will year three be the final year of this pandemic? No one knows for sure, but I am trying to hang onto hope that it will be.
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Pfizer booster

As part of my ongoing participation in the Pfizer/BioNTech COVID-19 vaccine phase III trial, yesterday I received a third vaccine injection, seven and a half months after my second. There was a blood draw to test levels of antibodies, T cells, etc. and the blood work will be repeated in a year. I will continue a weekly symptom check through a phone app and have a couple of phone appointments over the next year, too. The data collected will be used to inform on-going decisions about how often boosters may be needed in the future.

I’m fortunate that my side effects have been milder than they were with the second injection. I have a very sore arm, which is obviously from the shot. I’m tired and have a bit of a headache, which could be side effect and could be just life in general these days. Today is the one-month anniversary of Paco’s death, so how I am feeling could be attributable to that rather than to vaccine side effects. When spouse B and daughter T, who are also study participants, received their third doses, they both lost a day to fever, body aches, and fatigue; because I had had a similar reaction to my second dose, I was expecting a similar experience, but apparently have lucked out.

In the United States, a third dose of the Pfizer vaccine is approved for those aged 65 and up, people who have medical risk, and those in certain professions that have close contact with vulnerable populations. It’s possible that the third dose will be recommended more generally in the future as more data become available. It’s also likely that emergency use authorization for children aged 5-11 will come soon, with shots in arms starting in early November.

Recommendations on booster doses for Moderna and Johnson & Johnson are expected soon, as well as the possibility of mixing manufacturers, for example, someone who had the J&J vaccine having a booster from Pfizer. All the companies are continuing to study the vaccines for long-term efficacy and side effects, as well as safety, efficacy, and dosage for children six months through seventeen years. Currently, in the United States, only Pfizer is approved for ages 12-17.

Another helpful development is that Merck has applied for emergency use authorization of molnupiravir, an oral anti-viral to combat COVID. It would be given to patients in the early stages in hopes of keeping their illness from becoming severe. While it is already possible to give treatments by injection or infusion, such as monoclonal antibodies, this medication would be easy to prescribe and administer for home use. A decision by the FDA is expected within weeks.

Meanwhile, over the summer, COVID cases were devastating parts of the US, especially states with low vaccination rates. Total fatalities are over 700,000 with over 44 million cases recorded. In some areas, hospitals were so overwhelmed that they had to send patients out of state to receive care. This applied to COVID patients and also to patients suffering from other serious conditions. Two states, Idaho and Alaska, had to implement crisis standards of care, which means that whether or not an individual receives treatment beyond comfort care is determined by the likelihood of survival as there is not enough capacity to treat everyone that needs help. This resulted in non-COVID deaths from heart attack, stroke, etc. – patients who ordinarily would have been treated successfully but who died because there were not personnel, equipment, and space available to treat them due to intensive care units being filled with COVID patients.

The delta variant was the power behind the summer surge, but, at least, the fear of it encouraged more people to seek vaccination. The increase in vaccination rates is helping the case numbers to fall at this point. Still, the current rate of fully vaccinated people is only 57% with 66% receiving at least one dose. I am hopeful that the Pfizer vaccine being approved for elementary age children in the coming weeks will add significantly to our vaccination totals, at least in states where the vaccination rate among adults is higher.

There are still terrifying amounts of misinformation floating around about the vaccines that are keeping some people from taking them. Unfortunately, this is keeping the pandemic alive, resulting in illness, death, lack of access to medical care, and the possibility of even more dangerous new variants developing.

We are all in this together. Please, everyone, get vaccinated if you are eligible and follow reputable public health guidelines on masking, avoiding crowds, handwashing, etc. Your choices affect your family, friends, neighbors and community directly and your nation and the world, as well. We can’t truly end this pandemic until there’s no population anywhere still vulnerable to COVID-19.

If you won’t do it for yourself, do it for someone you love.

Pfizer vaccine approval

Today, August 23, 2021, the United States Food and Drug Administration has announced the full approval of the Pfizer/BioNTech vaccine against SARS-CoV2, the virus that causes COVID-19, for people aged 16 and up. People aged 12-15 are still being immunized under the emergency use authorization. It is also expected that, in the coming weeks, Pfizer will apply for emergency use authorization for children aged 5-11. Research is ongoing on children 6 months-4 years. Also, most adults will become eligible for a third dose to boost immunity, given from 8-12 months after the second dose.

Meanwhile, both Moderna and Johnson & Johnson, the other two vaccines available under emergency use authorization in the US, are continuing their research and applications to expand their age ranges and gain full approval, too.

It’s possible that, for some people who have been reluctant to be vaccinated, the full approval of the Pfizer vaccine might be enough to convince them to receive it. The US has seen many more shots being administered in recent weeks as the delta variant has surged and people realize that nearly all the people being hospitalized and dying are those who were unvaccinated. Unfortunately, it takes several weeks to build immunity from the vaccine so the delta surge will likely continue into the coming months.

The other expected impact of the full approval of the Pfizer vaccine is that more employers may mandate that their workers be immunized before returning to in-person work and more businesses may require immunization (or alternatively a recent negative test) for their patrons.

As regular readers may remember, my spouse B, daughter T, and I are all part of the Pfizer Phase III trial for the vaccine. B and T were lucky enough to receive the actual vaccine in August 2020 while I wound up being in the placebo group. When the vaccine received emergency use authorization, the study was unmasked so that people in the placebo group could receive the vaccine, which I did in February 2021. I will continue to be followed as part of the original study through August 2022. B and T, meanwhile, have entered into the third dose phase of the study. They will be providing data for the continued study of how much immunity boost occurs with the third dose and how long it lasts.

I continue to mourn for all those who are suffering as a result of the pandemic. Please, everyone, listen to the public health specialists in your area, receive the vaccine as soon as it is available to you, and mask, distance, and wash hands as directed. Please, do everything you can to protect the health of yourself, your loved ones, and your community.