Waiting on the latest booster... but maybe not for long

[dreamshark]

Fact: There is some evidence for the efficacy of a 2nd COVID booster, but the data is sparse. Mostly two preprint studies from Israel, one of which suggests that 4th shots in the midst of a massive Omicron spike significantly reduces mortality/hospitalizations in the elderly. The other one showed minimal efficacy for middle-aged health care workers (average age 50), arguably because they were young and healthy enough to have reached peak vaccination-fueled immunity already and had little to gain from another boost. But in neither case was there any sign of harm. There is, as far as I know, no data to show that another booster does anything to reduce transmission of the current viral variants - we're just talking about preventing catastrophic outcomes for the people that are infected. So whether or not to get that 2nd booster right now is a matter of personal risk management, not public health. 

One interpretation of all this is "Get the booster if you are eligible. It might help and it almost certainly won't hurt. And it's free, so why not?" Okay, that makes sense. Richard is going with that philosophy, and just got his 2nd booster today. 

My viewpoint is slightly different. It seems pretty clear that the effect of an mRNA booster shot is a large but transitory surge in coronavirus antibodies. Originally everybody hoped that the first booster shot would result in greatly improved long term immunity. That was revised downward to 8 months, then 6 months, and now the advice is to get another booster after 4 months. Immunity doesn't drop suddenly like falling off a cliff - it drifts downhill. If the current thinking is that the booster has pretty much worn out by 4 months, that suggests that it gives you at most 2 or 3 months of robust additional immunity. 

It seems to me that the time to get a booster that will only protect you for 2 or 3 months is at the BEGINNING of a COVID surge, not at the end. So my plan is to wait until the roller coaster starts up the next hill for that booster, not to waste my two months of turbo-charged immunity in a flat period. 

Of course, the next surge may well be in the offing. Minnesota releases its weekly infection numbers on Monday. Last Monday, the decline had essentially plateaued. Today the new numbers came out, and it's up 9%. Still under 10 cases/100K, but moving the wrong direction. The wastewater surveys the last couple of weeks have also reported increases. So I'm biding my time, but watchful. 

Comments

[pameladean]

I got mine today. I don't want to be one of the cases they point at to say, "Look, cases are rising!"

It probably will peter out at the wrong time, but in the meantime I can finish doing my medical appointments and maybe get about a little bit first.

P.

[quadong]

I guess it depends on whether they are really going to stop you from getting a 3rd booster 3.5 months after your 2nd if we enter a new surge.

I'd really like to see the wastewater data for the last week, but I have noticed it seems to appear in roughly-week-long batches. Currently, the latest is 8 days old. Someone fund these guys some more!

[dreamshark]

Continuing to revaccinate entire populations at ever-decreasing intervals does not strike me as a viable long term strategy.

[quadong]

Well, sure, but I was thinking of your personal strategy, not public health.

[dreamshark]

For those of you following the "It might help and it can't hurt" philosophy, here's one more thing to keep in mind. Mixing brands. The evidence that this might result in better-quality immune response is at this point just theoretical, but there is lots of data that mixing and matching won't hurt anything. In other words, might help/can't hurt.

deep dive on antibody isotopes I knew that there were measurable differences between the immune response from J&J and the mRNA vaccines. But it turns out there are also differences between the two mRNA ones.

J&J now seems to be off the table as a booster, but you can still mix and match the mRNA vaccines. I booked Moderna for Richard, since he had Pfizer for the first 3 shots.

[davidwilford]

Erin and I are still scheduled to do a cruise down the Danube River in late October this year, so I'm thinking if I get a 4th booster now, then I'll be eligible for another booster in early October right before the trip. Also, it looks like I'll be going back into the office in May and working with the public again, so it might be good to be boosted by then.

[dreamshark]

That assumes that the FDA/CDC decides to recommend a 3rd booster (and that Congress passes funds to pay for it). Both of these assumptions are questionable.