Getting a boost, predicting the future and other things you need to know about the COVID-19 vaccine – Medical University of South Carolina

To borrow from one of the great literary minds of our time, the Fresh Prince, its summertime. And in order to maximize your and your familys ability to have fun while school is out (and its sort of a buzz), were here to help you to untangle and make sense of all the different guidance floating around when it comes to COVID vaccines. That way you can take time to sit back and unwind safely.

But first, just to point out how maddeningly confusing it can be as to who should be getting boosted and when this week well start things off with a little quiz.

HYPOTHETICAL QUESTION:You are 48 years old. Your spouse, who just turned 46, has an underlying health condition that necessitated her getting a second COVID vaccine booster. Your kids, one of whom is 12 and the other, who is 16 and suffers with asthma, have both been vaccinated and boosted. The older one recently contracted the virus and was prescribed Paxlovid by the family doctor. Your mother, who lives in Canada and you plan on visiting in two weeks, is currently going through chemotherapy, but shes been vaccinated and boosted as well. Are you eligible for a second booster? Solve for x.

Right. So, its a tad complicated.

To answer tough questions like these and plenty of others we chatted with Danielle Scheurer, M.D., MUSC Health System chief quality officer, who oversees all things COVID for the hospital system.

Q. If youre under 50 and its been more than five months since your first booster, should you be getting another one, even if the Centers for Disease Control and Prevention is only recommending it for those 50 and older? I ask because I imagine there arent lines out the door these days.

A. Its a good question, and you make a fair point. As far as should you, the CDC has released no new guidance for those age 49 and younger. And youre right; a lot of those folks are hitting their six-, seven-, eight-month windows, so theyre wondering what they should do. To be honest, we always ask people if theyre eligible for the booster, but if they come in seeking a vaccine, we dont pester them or over-screen. We never turn away people wanting to get a vaccine. Its an honor system.

Q. Same scenario, but lets turn the question on its head: are the boosters even that effective against the latest strains of COVID anyway?

A. For the most part the mindset has changed quite a bit on vaccines and boosters its less about can we prevent you from altogether getting COVID, and its shifted more to a focus on reducing how sick you get if you happen to get COVID. The boosters are still very good, but theres a lot we just dont know. The bottom line is and this gets back to some of the old boring and tiresome public health messaging if you want to prevent getting COVID, you need to social distance, wash hands frequently, wear a mask. That sort of thing.

Q. I keep reading about how the Food and Drug Administration says the next round of boosters should focus on the Omicron subvariants. How are scientists supposed to make a vaccine for variations that havent even happened yet?

A. Youre right. There is some work being done and I dont know how far theyve gotten with it to produce an Omicron-specific booster with some projection of what may happen based on the pattern of behavior. Just like with the flu, COVID is constantly changing. How flu vaccines are made from season to season is based on historical data and projections. Basically, its our best scientific guess, for lack of a better way of putting it. Some years we nail it, and flu numbers are low. Sometimes we dont, and its maybe 30% effective, and a lot more people get sick. So yes, it is possible for the vaccine makers to get a future COVID booster right, but its still based on their best guess, which is usually pretty good. My only concern is that this new round of boosters is only going to be good if the variants quit mutating. And the more time the virus has the luxury of hanging around, the more likely it is to keep mutating and varying. Every iteration of these variants, the vaccine becomes less and less of a shield against transmission. But its still very good at preventing hospitalization and death.

Q. Kids age 5 and younger were recently approved to get the vaccine. What kind of numbers are we seeing at MUSC Healths vaccine sites for kids in that age range?

A. The turnout has been pretty low for little kids. Maybe some of it has to do with it being so early in the approval process. Maybe parents are just overly cautious. Either way, theres not a high uptake yet.

Q. Basic question, but one that I know most people still care about: Regardless of age, does getting a COVID vaccine/booster at any of the MUSC Health sites cost anything?

A. We have chosen not to charge people for the vaccine. And that applies to everybody.

Q. Why does my pediatricians office charge for it?

A. Im not 100% sure, but my guess is theyre not charging you for the vaccine but rather an administration fee, like a payment for their time.

Q. Why isnt everybody who gets a positive COVID test prescribed Paxlovid?

A. The CDC has guidelines for prescribers, and just like with the vaccine, its all about the risk-benefit ratio. In other words, it comes down to the patients age, health history and timing: it needs to be started within five days of coming down with the virus. But that doesnt mean theres a hard and fast rule as to who can get it and who cant. Just like any prescription, it boils down to the expertise of the prescriber as to whether its a good fit for the patient. That said, getting Paxlovid is much easier than ever. More drugstores have it, and now pharmacists themselves are able to prescribe it, saving the patient the headache of having to scramble to find a prescriber and then a location that actually has the pills.

Q. Last one. Were in a weird time where were in a spike, but nobody really seems to be behaving like we have in the past: i.e., social distancing, masking, etc. To what do you attribute infection numbers being medium to high but hospitalizations and deaths so low? Is it because the strains are less severe or maybe were approaching some sort of herd immunity?

A. I think it might be both. There is pretty good evidence that were pretty close to, if not already at, herd immunity. Most Americans have evidence of antibodies in their systems, whether its from vaccine or natural antibodies. So, combine that with the fact that Omicron seems to be a little less severe, and thats my best guess as to why things havent spiraled out of control.

**Got a vaccine question you'd like answered? Email it to donovanb@musc.edu with subject line "Vaccine Q."

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Getting a boost, predicting the future and other things you need to know about the COVID-19 vaccine - Medical University of South Carolina