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.

finally, but…

Broome County, New York, where I live, finally managed to get into the low community risk category on the CDC’s COVID map late last week, after many months in the high category with a few weeks of medium thrown in.

This is long hoped for news, but it is likely only a very temporary lull.

We had been high for so long due to our lower level of up-to-date vaccination and the fact that an Omicron subvariant that became dominant originated in central New York.

Unfortunately, another Omicron subvariant BA.5, is making its way into our area. BA.5 is already the most dominant strain in the US and carries the dubious distinction of being more contagious than other forms of Omicron. It may also have a tendency to more often affect the lower part of the respiratory tract, although this is still being researched; Omicron in general has been more likely to remain in the upper respiratory tract. It also appear to more easily infect people who are up-to-date on vaccination and those who have already had Omicron, even if the prior infection was only a few weeks ago. It’s difficult, though, to tease out which effects in the population are from the variant itself and which are from decreasing immunity that occurs over time.

It is also unfortunate that repeat infections increase the post-infection risk of stroke, heart attack, and other serious illnesses and bring the risk of long COVID.

Even with BA.5, though, being vaccinated and boosted is helpful. It lowers rates of severe disease, hospitalization, and death. Pfizer and Moderna are each developing vaccines/boosters that are more effective against Omicron that will be available in the fall. Of course, masking, avoiding crowds, and other public health measures are also helpful if transmission is high in your area.

Remember: the pandemic is still with us. Another new variant is spreading in India and several other countries and could cause another global wave of infections if it can out-compete BA.5. Stay alert and do what you can to take care of yourself, your family, and your community.

I’ll be doing that here. Even though our current infection rate is low, it has begun to creep up. I’ll be watchful.

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.

the Moderna vaccine

Today, Moderna announced that their early data indicate their coronavirus vaccine is 94.5% effective. This follows the announcement last week from Pfizer/BioNTech that their vaccine, with which I and two members of my family are participating in the phase III clinical trial, is over 90% effective in the immediate time period after the second immunization.

Like the Pfizer vaccine, Moderna’s is a messenger RNA vaccine. The caveats that I wrote about here apply, but there is now hope that there will be two effective vaccines approved for emergency use in the United States before the end of the year. I’m sure the companies are also pursuing approval in other countries, as well.

Unlike Pfizer, Moderna accepted US government funds for the development of their vaccine. Like Pfizer, the US government also pre-ordered 100 million doses from Moderna. Initially, priority will be given to health care workers and other front-line occupations, expanding to highest risk people. Availability, pending full approval, for the general public will not be until spring 2021.

The Moderna vaccine will be easier to distribute than the Pfizer one because it can be kept for up to a month in a refrigerator. The Pfizer vaccine currently needs a super-cold freezer or dry ice for transport and storage.

Having two good candidates that might be available for the most vulnerable this winter is great news. I’m hoping that more of the vaccines currently in Phase III trials will also be shown safe and effective in the coming weeks. The more vaccines we can make available, in the US and around the world, the better, so we can get the pandemic under control globally.

Meanwhile, Pfizer, Moderna, and other companies need to continue their trials, following everyone who received the vaccine for the coming months to watch for how effective the vaccine is over time, if it protects some people better than others, e.g. seniors or children, and how much it might reduce symptoms in vaccinated people who do become sick with COVID versus unvaccinated. It’s possible that the placebo group may be released early from the studies when the vaccine is fully approved for ethical reasons. The companies may very well ask those participants if they would like to join the study as a second set of vaccinated subjects, doubling the amount of data on vaccine efficacy over time.

So, more good news today, but we have to keep in mind that masks, distancing, restrictions on gathering, etc. will need to stay in effect for months still. Until we have a large majority of the population fully vaccinated – and both the Moderna and Pfizer vaccines need two doses several weeks apart – we need to stay on guard. Sadly, the United States passed 11 million cases recently and is approaching a quarter of a million deaths. We need to do better now, not let more people suffer while we wait for the vaccines to be generally available.