Every month I hope that we don’t have to do this.
You know what I mean.
More than two years on, we’re all over it, aren’t we?
But guess what, COVID has other ideas.
Cases are up 10% in the U.S. – could the BA.2 subvariant be the next big wave?
And the question I want answered: when should I get my second booster?
As always, I turn to Dr. Jeremy Faust.
Top ER Doctor, fellow Bulletin writer and the person I trust the most when it comes to questions about COVID-19.
ALINA CHO: Just when I think things are getting better, boom! I read a headline that says cases are spiking in the Northeast.
Cases are up by 10% across the United States. Is this the BA.2 subvariant and what is going on?
DR. JEREMY FAUST: There are always going to be these little increases, these little flare ups, and the question is, do flares become waves?
ALINA CHO: Do they become hospitalizations?
DR. JEREMY FAUST: And do waves become tsunamis?
ALINA CHO: Right.
DR. JEREMY FAUST: We would've liked to have thought that we can get to a low level of cases, and it'll just stay there and that's what we're going to be dealing with forever. Maybe someday we'll get there. But right now, we're still in this phase where it's not endemic, which means it's not that predictable. Endemic means predictable.
ALINA CHO: Like the flu.
DR. JEREMY FAUST: Well, exactly. Within the flu, there's predictable and then there's some areas [that] we can't predict. Like, is it a good year or a bad year?
ALINA CHO: Right.
DR. JEREMY FAUST: But right now, we can't even predict week to week what's happening with this thing. That's what's frustrating because the uptick in cases that you're talking about could end up being just a little flare up, or it could end up being another huge wave. There's no script, so we don't know.
ALINA CHO: Yep.
DR. JEREMY FAUST: What determines that is a combination of several factors, all of which are variable. We don't know what the existing immunity in the population means with Omicron. We don't know what role weather will play. We don't know what role the fact that no one's masking is going to play.
There's all these question marks or wild cards, so that all you can say is what's happening. It's impossible to say what will happen.
ALINA CHO: You can look at what has happened in Europe, which tends to be a couple of weeks, maybe a month ahead of us. The BA.2 subvariant wave in Europe did not result in a huge spike in hospitalizations. One might deduce that maybe that's what's going to happen here. What's your thinking on that?
DR. JEREMY FAUST: It's certainly possible. We've seen waves be averted before.
ALINA CHO: Let's talk about boosters. As you know, when we spoke a month ago, turns out I had COVID. My question is, let's say you are like me, you're vaccinated, two shots of Pfizer, a Pfizer booster. And then I got COVID. At what point do I get fourth shot?
DR. JEREMY FAUST: When were you boosted?
ALINA CHO: I boosted early because I was going to Europe in the fall. So, I boosted at the end of September.
DR. JEREMY FAUST: Okay. When you think about this, your immune system has seen the [COVID-19] spike protein at least four times, right?
Twice when you got initial [vaccine] series. You got boosted. That's a third time. And now, [you got COVID] recently [and] you saw it again. So, your immune system is very familiar with this pathogen.
ALINA CHO: Yes.
DR. JEREMY FAUST: You’re not a person we're worried about. Age is not a risk factor for you.
ALINA CHO: Not, yet.
DR. JEREMY FAUST: In my view, if you were to get boosted right now, it would be for one reason, which is to avoid infection because the risk of you having a bad outcome is extremely low right now. Your body, your immune system, is very ready to deal with this pathogen in a way that it wasn't when you started. So, for some people, avoiding an infection is really important because they live with someone who's immune compromised.
ALINA CHO: And they can't pass it on.
DR. JEREMY FAUST: They can't pass it on. So, you just get boosted as soon as you can, because then, 4, 5, 6 months later, you can get boosted again, probably.
Because the booster essentially is a short-term protective barrier. It's not a long-term one. We know it fades.
ALINA CHO: Exactly.
DR. JEREMY FAUST: So, do you want to spend your 12 weeks of extra protection right now, when we have 30,000 cases per day in the country? Or would you rather wait until we have a wave and we're back to Omicron where there's literally what, 700,000 cases per day, at one point?
ALINA CHO: Geez, right.
DR. JEREMY FAUST: I mean, 20 times greater than there is now.
ALINA CHO: Wow, yes.
DR. JEREMY FAUST: Can you time your booster? I think you can. I think that we see the wastewater, we read the news. We know right now [that we are not where we were] in December.
ALINA CHO: Definitely.
DR. JEREMY FAUST: I think for a lot of people gaming it, timing your booster might make a lot of sense. You can't time the market in investing because you never know what's coming. But with this, we actually kind-of do know what's happening and you do see it coming. Cases went from 30,000 a day to 50,000 to 100,000 to 500,000. It's not going to go to zero tomorrow. Some people ought to consider to time their boosters so that they spend their protected, their extra protected time wisely.
ALINA CHO: So that means waiting to get my booster in the fall.
DR. JEREMY FAUST: Yeah.
ALINA CHO: How much does your answer change if I'm asking you the same question, but about my mother who is 79 and relatively healthy. Does she get boosted now?
DR. JEREMY FAUST: The likelihood of a bad outcome [when you’ve had] three doses in a person with your mom's health profile, it's quite low to begin with. So, then we reflect back to the same question. How long does that protection last? Wouldn't we rather spend that at a time when the virus is much more rampant?
ALINA CHO: Right.
DR. JEREMY FAUST: Another argument to what I just said is that, well, it's April, go ahead, get the booster. And maybe in six months come October, she can get another booster.
ALINA CHO: That’s what I was thinking, but what do I know?
DR. JEREMY FAUST: Here's the thing — we know that four doses appear to be pretty safe in older populations. But is there some frequency of dosing that will eventually have a safety signal that we're worried about? Does a fifth, sixth dose add a little bit risk that we've seen, say, in young males? We're in a little bit of uncharted waters.
ALINA CHO: Right.
DR. JEREMY FAUST: Let's be honest. The doses that we're giving are mRNA vaccines, they're pretty hefty. Like they work, but they pack a punch.
ALINA CHO: Right.
DR. JEREMY FAUST: I’m glad it works, but is twice a year for the elderly going to be safe forever? It could totally be. Or at some point, is there a safety signal that we're worried about? That part’s hard to gain. Which is why I’m a little more conservative.
We’ll cover two more important topics:
What age groups of kids should get boosted? And when are two doses enough?
Why he thinks we could return to normal life soon!!!