Kudos for the human race and four updates.

I remember how officials were predicting people would never return to “normal life” after the COVID pandemic. I thought that was crazy; I felt people would struggle to normalize their lives as soon as the risk of death was mitigated. That is exactly what has happened. The resiliency of the human race has been demonstrated by taking the worst that nature could throw at us and returning to normalcy!

Bravo!

Now for four important updates and clarifications for recent COVID stories.

New COVID Vaccine Booster
The FDA advisory committee on vaccines met this week and decided that an Omicron component should be included in the COVID vaccine booster made available this fall (September-October timeframe). Given this, the fall booster will be a combination of two different virus mRNA and different from the currently available shots.

Previously, I suggested most individuals who have had at least a third COVID (mRNA) vaccine or any combination of vaccine shots and COVID infections should wait until this fall for another booster. Unless there is a truly unique need for a booster at this point it makes no sense for anyone to get a fourth shot now given the fall booster will be different. It should also be much more effective in preventing infections from the most recent COVID viruses circulating in the United States.

Paxlovid rebound
A number of people have had concerns about rebound COVID infections after stopping the drug Paxlovid. Many folks, including Dr. Fauci and I have had these symptoms. This is not a reason to avoid the therapy, since it is simply a reactivation of the infection after the drug ends. Usually this is only a few days of symptoms, which are much milder than unvaccinated people have without the drug. It is however important to remember that most people are infectious when they have these symptoms.

The data now seems to show that people with normal immune systems who have been vaccinated do not benefit from the drug like unvaccinated individuals. If you have immune problems, you might need both the drug and antibody therapy (Eversure). In contrast, if you are vaccinated, less than 65 years old, and well you probably don’t need any treatment.

The vaccines are less effective against current Omicron viruses

As mentioned above, there is somewhat decreased protection of infection from new COVID viruses by vaccines.
Much has been written about this (see below) and it was to be expected, since viruses circulating in populations with immunity will eventually evolve to escape the protection. Despite this, the decreased protection of vaccines has been grossly overstated.

While people have decreases in antibodies from the vaccine that protect against infection with new variants (see figure), and the protection against infection is sometimes only 50% (dependent on timing), people are not still getting sick!

We have 10 times the infections we had a year ago, but hospital intensive care units are not full of COVID patients and deaths with COVID (but maybe not from COVID) are at or below what they were at that time. So no one should think that vaccination is not of value! The new vaccine in the fall should be a particularly important booster!

Vaccinating children and closing schools
Finally, for those who live in Michigan there’s been some confusion around childhood vaccination. An article in MLive highlights the State of Michigan’s lead public health official Dr. Natasha Bagdasarian arguing that the COVID-19 vaccines needed to be given to children to avoid potential school closures in the fall. It also quotes CDC Director Walenski arguing the vaccines are necessary to prevent outbreaks, “despite the fact these vaccines do not protect against infection.” I covered this last statement above.

While I am a strong advocate of vaccinating children, I don’t think we should be threatening to close schools due to potential COVID infections. In addition, the current, approved vaccine still prevents against infection albeit not nearly as well as they did initially. This is mainly because of changes in the virus especially the recent Omicron variant viruses. It is also why the vaccine is being modified for the fall. Therefore, the comments made to the paper are not only incorrect currently, but will be much less of an issue in the fall.

Children dying with COVID make up less than 2% of all childhood deaths in Michigan since the pandemic started. It also is not not clear what other medical conditions are involved with these deaths or if the children are actually dying of COVID. Given what we now know about the problems with school closings we should not consider taking that approach again.

I will post again after the holiday!

Best,
JB