August 29, 2021
Boosting up
The Delta variant has upended everyone’s plans for the remainder of the summer and fall. The IHME (Institute for Health Metrics and Evaluation) upgraded its projected deaths to 734,000 by the end of the year. If everyone wore masks the total would drop to 689K. We reached more than 637,000 deaths today. But many won’t wear masks. The mixed messaging in the beginning of the pandemic has left many convinced that the government’s recommendations don’t work
As this Seattle Times article says, COVID is giving us all “a crash course in scientific uncertainty”. Recommendations will continue to evolve. Data collection has been hampered by many obstacles and we could do a better job. Multiple variables change the stakes, from new data on vaccines, emerging variants, resistance to masking, resistance to vaccines, some encouraged by disinformation campaigns. It can be challenging to know what to do,
What is more clear now is that the vaccines’ effectiveness against the Delta variant is lower, more breakthrough infections are occurring. Still data shows the mRNA vaccines are 66% effective against the variant, enough to slow down rates of infection compared to the unvaccinated.
But what about the J&J (Johnson & Johnson) one dose vaccine? Analysis shows that more of the breakthrough cases reported from the Provincetown, Mass outbreak in July had been vaccinated with J&J, compared to the mRNA vaccines. J&J just released data showing good response to a booster. This supports the need for boosters if you were one of 14 million who received it.
What to do while waiting for the recommendations from the FDA and CDC, especially if you are immunocompromised? One of my favorite and well respected Infectious Disease doctors, Dr. Paul Sax from Harvard, recommends going ahead and getting a Pfizer mRNA vaccine as a booster. He and Dr. Michael Lin wrote an OpEd in the New York Times today recommending using the Pfizer vaccine as “off-label use”, arguing that we use FDA approved meds for off label use frequently already. They cite data from The Lancet, a respected British medical journal, that shows mixing types of vaccines is safe and effective.
That makes sense to me. I know many of you who got the J&J wonder what to do and why no news about the J&J vaccine. The data about the J&J vaccine has been slower to come, since it was approved for emergency use later than the mRNA vaccines. The full authorization of the Pfizer vaccine now allows for that “off-label use” which is more common than you think. As many as 1 in 5 prescriptions are used for “off-label use”. The surge of the Delta infections makes the consideration more valid.
Wash your hands, cover your nose when indoors and at risk in crowded areas, keep your distance, and get your boosters when you can.
And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.
https://covid19.healthdata.org/united-states-of-america?view=cumulative-deaths&tab=trend
https://www.seattletimes.com/nation-world/covid-is-giving-the-u-s-a-crash-course-in-scientific-uncertainty/
https://www.nytimes.com/2021/08/27/opinion/covid-data-vaccines.html
https://www.upi.com/Health_News/2021/08/24/coronavirus-vaccines-efficacy-delta-variant-CDC/6021629826082/
https://www.mdlinx.com/news/messenger-rna-covid-vaccines-66-effective-against-delta-us-study/5VBrZHXbD5KyxOLPHa2FNH
https://www.mdlinx.com/news/why-do-covid-19-breakthrough-infections-occur/5QB29BOLINa4MAFwRtQJHn
https://www.medpagetoday.com/opinion/second-opinions/94237
https://www.sciencedaily.com/releases/2021/08/210826170102.htm potency
https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e2.htm
https://www.nytimes.com/2021/08/25/health/johnson-johnson-vaccine-booster-shot.html
https://www.mdlinx.com/news/j-and-amp-j-says-booster-dose-increased-antibodies-in-early-stage-studies/6b5giA2uVEwOFMOt3seLAk
https://www.nytimes.com/2021/08/29/opinion/jj-johnson-vaccine-booster-shots.html
https://www.webmd.com/a-to-z-guides/features/off-label-drug-use-what-you-need-to-know
https://www.thelancet.com/action/showPdf?pii=S2213-2600%2821%2900357-X
https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html