September 18, 2023
fall thoughts
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Now to the important fall update.
Covid is here to stay, morphing and mutating like the flu virus, putting us at risk for repeat infections. Infections are going up. Hospitalizations and deaths are too. Not as high as before, but enough to get my attention. Some fastidious friends of mine finally succumbed (to an infection, they are doing OK with meds.) The newest variants evade our prior immunity from both vaccinations and infections, due to new mutations and waning immunity. We are all more vulnerable. Data shows that most of those who have been in the hospital with COVID since January hadn’t gotten last fall's booster.
The fact that new cases, in general, are less severe is reassuring for most of us. Hospitalizations are rising and deaths are occurring, but not at the rate with Omicron or Delta. Symptoms are much less with sore throat and congestion being the most common. The burden of disease is lower since the pandemic began, but still excess hospitalizations and deaths are occurring especially in persons at higher risk, older adults and those with weakened immune systems.
Infections are not risk free. Long Covid is still occurring. Adults and children with no underlying conditions may develop severe symptoms. Only 45% of people from the age 18-49 who died from Covid were immunocompromised. That means the other 55% were considered low risk.
The Advisory Committee on Immune Practices, orACIP, reviews data and makes recommendations to the CDC. They met last week after the FDA approved the updated vaccines from Pfizer and Moderna. The data reviewed by them confirms the benefit. The new shots are a much closer match to the new variants than the former booster. ACIP and the CDC recommend that everyone 6 months and older get the updated vaccine. It can help prevent complications and decrease transmission rates so the vulnerable are less exposed.
Benefits outweigh any concerns or risk of the vaccines. Serious reactions are rare, including the risk of myocarditis in young males who have a 1.8-5.4 risk of myocarditis from a COVID infection compared to the vaccine. If you have worries, read the CDC page on “Respiratory Viruses, What’s New”.
The website is: https://www.cdc.gov/respiratory-viruses/whats-new/covid-vaccine-recommendations-9-12-2023.html
New data from another study also reassures those with MS that vaccines do not increase their risk of an exacerbation of their disease, a relief for them.
You can get the booster as soon as it is available if it's been 2 months since your last booster or 3 months since a Covid infection. That means most of us can get it now, or wait 3 months if you’ve just had an infection. Your immunity increases after two weeks and should last several months. If you have low risk of exposure or illness, you might wait a month or two if you are planning holiday travel so your protection will be maximized. Plan an early November vaccine if you're flying over Thanksgiving. That is often a peak infection time.
Since the “Emergency” was lifted, a booster is no longer free. Most insurance covers it but many less people have health insurance since the pandemic. Children can get it from the Vaccines for Children program. The CDC has a Bridge Access Program for people who don’t have health insurance to pay for a vaccine. Help people find free vaccines through that program if you know uninsured folks out there.
RSV, or respiratory syncytial virus, has been in the news because of new vaccines and treatment for it. RSV has been identified for years as the cause of a severe, life threatening respiratory infection in children under 5 years old. Especially infants 6 months and under. Their tiny airways fill up with fluid from the infection causing severe respiratory distress. Older kids do ok, but the tiny ones often need to be in the hospital with oxygen and other support. Watching an infant struggle to breathe with RSV is one of the scariest things I’ve seen as a doctor. Their respiratory rate is rapid, you can see retractions when they take a breath. Retractions are when you can see the rib lines with each breath because their chests are working hard to suck in air. They are risk for tiring out, unable to breath. When I’ve seen it, I’ve gotten the kid help with oxygen and ICU support as fas as possible. Now, life saving progress has been made with new monoclonal antibodies that can prevent serious illness in kids most at risk.
RSV is also a risk for older adults. It’s estimated 60,000-160,000 are hospitalized in US each year with 6,000-10,000 dying. There’s been no medication to treat it, testing for it was unreliable, but now testing is better and there is new vaccine approved for those older than 60. Since it is not a virus that mutates as frequently as the flu or Covid, you may only need one for now. It might become like Pertussis boosters and be recommended every 10 years or so. Too soon to know.
The CDC recommends everyone get a flu vaccine and a Covid booster this fall and consider one for RSV. RSV cases are rising in the south, meaning it will be spreading countrywide soon, as it does every fall. I’m planning to get my Covid booster and flu vaccine at the same time, getting the RSV one a month later. We know it is safe to do flu and Covid two together. People have the same number of side effects as if they only got the Covid vaccine. Might as well do them at the same time. The data about RSV vaccine given with others is not clear yet, so waiting a month or so is ideal.
Whew, that’s enough for now. Keep safe, get boosted, wear your mask when needed. See you next week.
And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available. Thanks for reading.
Links are below.
https://nymag.com/intelligencer/2023/08/what-to-know-about-the-new-covid-mini-wave.html
https://www.nbcnews.com/health/health-news/icu-doctors-see-rise-covid-cases-less-severe-disease-rcna103584
https://www.nbcnews.com/health/health-news/covid-symptoms-mild-follow-pattern-doctors-say-rcna105090
https://www.cdc.gov/vaccines/acip/committee/index.html
https://www.cdc.gov/media/releases/2023/p0912-COVID-19-Vaccine.html
https://www.cdc.gov/vaccines/programs/vfc/index.html
https://www.cdc.gov/vaccines/programs/bridge/index.html
https://www.medpagetoday.com/neurology/multiplesclerosis/106190 MS and vaccines
https://www.seattletimes.com/seattle-news/health/what-to-know-about-covid-levels-masking-as-updated-vaccine-lands-in-wa/
https://www.medpagetoday.com/opinion/second-opinions/106179?xid=nl_secondopinion_2023-09-05&eun=g1593252d0r vaccine season
https://www.mayoclinic.org/diseases-conditions/respiratory-syncytial-virus/symptoms-causes/syc-20353098
https://www.cdc.gov/rsv/high-risk/older-adults.html
https://www.cdc.gov/vaccines/vpd/rsv/index.html
https://www.cdc.gov/respiratory-viruses/index.html
https://emergency.cdc.gov/han/2023/han00498.asp
https://www.nytimes.com/article/flu-covid-rsv-vaccines.html
https://www.webmd.com/vaccines/covid-19-vaccine/news/20230911/study-getting-covid-flu-vaccine-at-same-time-is-safe-effective