The New Bivalent COVID Boosters

Now available from Pfizer and Moderna, and you can sign up this minute through pharmacies and vaccines.gov.

Condensed version of the CDC’s information if you’ve been considering one:

1. These are boosters; you must have completed a primary series first
2. You don’t have to be a particular age as an adult (12 or older for a Pfizer bivalent, 18 or older for Moderna’s), nor do you have to qualify with a particular health risk
3. If you’ve already been boosted, even double-boosted, you can get it as long as 2 months have passed since your last one
4. If you’ve recently had COVID, you’re naturally boosted for at least 2-3 months, but there’s no contraindication to getting this booster sooner

Why I’m going to get one

As a practicing physician, you can imagine there are many reasons to get vaccinated. I’d be doing no one any favors if I caught COVID and exposed my patients, co-workers, and family, especially if I got a bad case of it and had to completely stop rendering healthcare.

But many of my risk scenarios may apply to you as well.

I’m in people’s faces. Literally, 18” away in an exam room, or skin-to-skin doing martial arts like Brazilian jiu-jitsu. 

I have a respiratory vulnerability. Infections tend to activate my asthma and drop into my chest for months.

I also work and live with vulnerable others — you may be one of them. (The list of conditions that put people at risk of progression to severe COVID is surprisingly long; being overweight or obese is a thing, which accounts for about 3 out of 4 Americans right there.) 

I’m intimately familiar with 2 types of autoimmunity: asthma and eczema. Asthma isn’t exactly a struggle to breathe, it’s just that you have to exert effort to breathe about 10 times every minute — and stop talking.

Plus, I like being able to smell and taste. And I very much dislike the prospect of Long COVID and FOREVER losing the ability to smell or taste food, spirits, or tobacco. Or of being more chronically fatigued than I already am, more breathless than I already am, or more anxious or brainfogged than I currently am whilst juggling many personal and professional balls… 

I get it, but think of it this way

You have probably heard the que sera sera argument by now : Eventually, everyone’s going to catch COVID. I’m done with living in fear, I’ll do my thing, it’s mild, and I’ll shrug it off in a couple of weeks.

Maybe you feel the same. It’s not entirely unreasonable, since the ICUs and morgues aren’t packed to the ceiling.

Couple of thoughts about this:

If you had a tiresome, hostile in-law (or other “Oh God” relative), would you invite them to live with you for even a couple of weeks, much less years or even the rest of your life? If they were actively trying to worm their way into your house, would you sit back and let them? Or would you take steps to keep them at a distance?

The current BA.4 and BA.5 variants of the virus are the most contagious mutations, ever. They spread more rapidly than the Delta variant, and that variant gave new meaning to the term “wildfire” when it spread from 1 case to the majority of all cases in the US in the span of 3 months. 

It’s not slaying us in heaps because most of us have baseline immunity, from being vaccinated or contracting COVID. But the virus continues to mutate, not just in its spike protein but all over, and there’s no guarantee that the virus will mutate into more benevolent forms, and every indication it will continue to evolve into more contagious ones. 

Then there’s Long COVID, symptoms lasting months or years following the initial infection. And vaccine efficacy diminishes after a while.

It’s kind of like an in-law whom you really dislike, constantly finding ways to run into you, and new ways to mess with you just when you thought you could counter their usual tricks.

I don’t think you’d be cool with letting them do their thing.

There are options

Those who’ve been vaccinated and boosted have decent protection against ending up on a ventilator and dying. One option is to hope for the best, and seek out medical attention to discuss treatment with Paxlovid or Molnupiravir should an infection occur.

The option I’ve chosen is to get either a Pfizer or Moderna Omicron-specific bivalent booster (it contains both original strain and BA strain protection).

Another option is to wait a bit for the Novavax’s Nuvaxovid to be authorized as a booster (the company submitted a request for Emergency Use Authorization as a booster about 3 weeks ago). Even though 12.6 BILLION doses of mRNA vaccines have been given worldwide, those holding out for a more traditional vaccine technology could turn to Nuvaxovid, a protein subunit vaccine containing modified spike proteins, rather than mRNA instructions to briefly create spike proteins. Per Novavax’s CEO, using it as a primary vaccine offers protection agains the current Omicron variant despite having been created from earlier strains; the company is working on Omicron-specific versions. 

All this presumes you have an active interest in avoiding COVID. Hashtag maskingstillworks, as does being mindful of social distancing. If you’re not a patient of mine, you should definitely discuss your particular situation and risks in detail with your own physician.

In summary

Vaccine protection against severe COVID and death are good, but even that lessens with time. Protection against mild to moderate disease fades even faster, and some like myself wouldn’t find mild disease a picnic. Risks of Long COVID are significantly blunted by boosting, as are overall risks of being a COVID gift giver.

If you mix it up close with others, care for vulnerable folks, have chronic or autoimmune issues, or would be sorely pissed if you lost smell/taste or got Long COVID, the bivalent Pfizer and Moderna boosters are the only current options designed with the most recent variants in mind, and deserve a serious look.