With summer travel in full swing, and masks a distant memory, it’s not entirely surprising that COVID-19 cases are creeping upward again. Along with the increase, some states in the U.S. are also recording upticks in COVID-19 hospitalizations, especially among older people.
According to the Centers for Disease Control and Prevention (CDC), weekly hospitalizations have been rising slightly since the middle of June, from around 6,300 to more than 8,000 for the week ending July 22. The agency no longer reports on national case numbers since the end of the COVID-19 public health emergency in May, meaning state health departments were no longer required to report this data to the CDC.
The trend reflects the waning immunity that most of the population has against SARS-CoV-2, since the last widespread recommendation for a booster shot was in April, when the CDC advised that most people receive a booster targeting the viral variants Omicron BA.4/5. These variants, however, have since been replaced by new ones, of the XBB variety, which means the protection the current booster provides is less than ideal. Earlier this year, US health officials decided to update the booster in the fall, but have yet to announce which variant to target, although it’s likely the new shot will focus on some version of the currently circulating XBB virus variant.
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Until that happens, does it make sense to get another booster shot to better protect against getting infected? The answer to that really depends on your individual situation, says Dr. David Wohl, professor of medicine at the Institute of Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill. For people who are older, and may be traveling or otherwise find themselves in close quarters with other people, getting a booster now may make sense, especially if their last shot was more than three months ago. “If people are doing square dancing, playing bingo or going on cruises, and it’s been a long time since they were last vaccinated, they should probably top up sooner rather than later,” says Wohl.
Existing boosters can still be effective
The same goes for people with weakened immune systems, whom the CDC also recommends get boosted more regularly to keep their immunity as strong as possible. Even though the current booster does not specifically target the XBB viral variants that are currently circulating, it “is not chopped liver,” says Wohl. “It works because there are enough conserved parts of the variants that the existing vaccines continue to work.” They have been particularly effective in protecting people from getting seriously sick with COVID-19, which is why hospitalization, even though they are increasing slightly in some parts of the country, remain relatively low.
But for most otherwise healthy people who take reasonable precautions against getting infected, such as wearing masks in public settings and in poorly ventilated environments, waiting a few weeks for the updated booster may make sense. “I’m 59, I was vaccinated with the bivalent booster in September, and I’m pretty careful where I breathe without a mask,” says Wohl. “I will continue to do that and wait [to get boosted] because I know the consequences of my getting infected are probably pretty minimal.”
Other experts believe it couldn’t hurt for even otherwise healthy people to get another booster now. “I believe that it’s important for those who feel they might be at risk for more severe disease, or for healthy people who feel they want maximum protection, to get a booster,” says Dr. Sandra Kemmerly, an infectious disease specialist at Ochsner Health in New Orleans. Kemmerly has written several prescriptions for the antiviral treatment Paxlovid for COVID-19 patients this week, and has seen more people hospitalized for the disease as well in recent weeks. “I don’t think that waiting for the updated booster to come around is necessarily prudent while we are seeing increased cases.”
Kemmerly points out that those who might want more protection aren’t necessarily those with weakened immune systems, but people who might be on multiple medications or being treated with slightly immunosuppressive drugs like prednisone for a skin condition who might be at higher risk of both getting infected with COVID-19 and becoming seriously ill when they do.
She acknowledges that there isn’t strong enough data showing that the current booster that targets Omicron BA.4/5 can protect against infection with the newer variants, but scientific precedent, such as with the flu shot, suggests that it can provide some protection, even if it’s not the maximum protection.
Immunity from infection
In addition, vaccines aren’t the only source of immunity. At this point in the pandemic, more people have also been infected with the virus, whether they have been vaccinated or not. While it’s not clear whether getting vaccinated or infected provides stronger protection, it’s likely the vaccine does protect people from getting seriously ill. Wohl points out that while we hear about cases of vaccinated people getting infected, we don’t hear about how often vaccinated people who are exposed to the virus don’t get infected. “I do believe there is some immunity [from the vaccine] against infection, or that people get transiently infected and knock out the virus before they develop symptoms,” he says. “But it’s hard to capture that in data.”
The protection provided by the existing vaccine, even if it’s not optimal, is therefore still important, and could be contributing to the smaller peaks in cases than we’ve seen in the past. “Hopefully the surges will be more like surge-lets, because of immunity we have from vaccines and infections,” says Wohl. That is, at least until a new variant shows up that may escape all of this built up immunity. Then it’s back to the starting blocks for vaccines and creating a new immunological wall of defense against that variant.
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