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  • Dr. Bow Tie

COVID-19: BIVALENT BOOSTERS ARE HERE!

As the pandemic has worn on and new variants have emerged, vaccine effectiveness has been under close watch. The original vaccines created excellent immunity against the original COVID-19 virus and some of the earlier variants, but since that time newer variants have been able to escape some of that immunity (but not all!). The emergence of Omicron and its particularly infectious subvariants has been particularly difficult (especially as the country grew collectively fed up with our already-lackluster mitigation measures and started abandoning them), resulting in calls for updated vaccines to help us face off against them.

Further research has yielded exactly that. There are several variants circulating now, but a new bivalent booster has been released, updated to include genetic material from BA.4 and BA.5, the latter of which is the most common cause of infection and COVID-19 death as of this writing. I went to get mine on Thursday, September 8th, and those of us following the evidence and best public health practices encourage you to get yours as soon as possible. Let's talk about a few things.


EASY QUESTION: WHEN CAN I GET MY BOOSTER?

Right now! If:

  • It has been TWO MONTHS since you completed your primary vaccination series (2 mRNA vaccine doses or one J&J) or your last booster

  • If you had COVID-19, you have recovered from the acute infection (2-3 months after testing positive)

  • Over age 12 (Pfizer) or 18 (Moderna)

Appointments are rapidly becoming available at pharmacies around the country. Book yours today! Some pharmacies have seen delays in their shipments, but they are coming, and at this point any booster you get will be the new bivalent booster. Consider getting your flu shot at the same time!


WHAT IS THE NEW BOOSTER LIKE?

Honestly, my experience was milder than previous doses. Previous to this I had my first two vaccines in December 2020 and January 2021, and then my third dose (first booster) October of 2021. My reactogenic effects (the side effects from the vaccine) lasted less than 48 hours again, and were milder this time, although pretty much the same sequence. Arm discomfort developed within a few hours, but I was able to easily play a 2-hour gig with my band that evening with a dose of prophylactic ibuprofen beforehand. The following day I had some mild joint aches that required a couple more doses of ibuprofen as I worked from home all day, and then night 2 was again plagued by insomnia, but only for a few hours and not all night like a year ago. Your mileage may vary (I don't think the insomnia is all that common). By the 48-hour mark, I was back to 100%.

Now let's talk about some of the tougher questions. Recently a friend of mine with many more followers than I have posted about the Bivalent Booster and got all sorts of trolls on his post. Let's talk about some of the misconceptions they brought up.


"IT WAS ONLY TESTED ON 8 MICE!"

Headlines and anti-vaccination folks have focused heavily on the fact that no human trials were done for these boosters. Human trials take a long time to set up and process, which is not time that we have as we enter the winter and a potential next wave of COVID. However, that time crunch is actually not the reason for this. This is another example of more people than ever before looking at the vaccine development process, and many of them unfortunately have an agenda who then influence others. The technology and method of delivery (synthetic mRNA) of these vaccines is not changing - it is only the image of the genetic material created by the mRNA that is changing. It's the same type of security briefing for your immune system's agents and officers, but an updated picture and profile of the villain. We do a similar thing with influenza vaccines every year (but given the different nature of this virus and vaccine technology, this ought to meet with more success). A United Kingdom release of a combination original/BA.1 booster revealed similar reactogenic effects as the original vaccine, so there is no reason to think this will be any different.


"COVID WAS A MODERATE FLU FOR ME, WHY WOULD I GET A BOOSTER?"

This is a privileged take. First of all, getting a moderate flu sucks anyway! More importantly, anywhere from 400-1500 people are still dying from infection from this virus on a daily basis. This goes back to the beginning of the pandemic, when people kept throwing around "oNe pErCeNt fAtAlItY rAtE" when that still mean that, unchecked, 3 million people would die. Too many people, even healthcare workers, wondered "what's in it for me?" to get a vaccine despite evidence that it was a good idea.

We use vaccines, masks, and other mitigation measures to get that number down, and they have worked significantly. Not 100%, but my last post had an article of how many lives have both potentially and actually been saved. I'll share it again here.


WHAT ABOUT ADVERSE EVENTS LIKE MYOCARDITIS?

I recently made a TikTok after a preprint from Thailand came out about myocarditis and it was touted as "stunning" by antivaccine folks. Traci Hoeg, a physician who has made a platform for herself spreading disinformation, was practically crowing about it. The study, monitoring 301 teenagers, found 18% with abnormal EKGs after the vaccine...but it does not talk about what they were like BEFORE the vaccine (meaning most of these were probably unchanged). Let's also talk about what was considered "abnormal":

Asymptomatic sinus bradycardia is not really abnormal.

Sinus arrhythmia (where your heartbeat changes slightly with breathing in and out) is definitely not abnormal.

Premature atrial contractions/premature ventricular contractions ("skipped beats") are not abnormal when they happen every so often. This paper makes no note of an increase.

There were multiple other findings, too, none of which were significant enough to diagnose myocarditis, let alone indicate any kind of causation. The preprint also discusses that 3.5% of males (7 out of 202) and 0 females developed myocarditis or pericarditis...but most of it was subclinical - asymptomatic and only found because of how closely they looked for it. That's how most cases are, and it probably happens far more often from viral infections than vaccines.

More recently, a meeting of the Advisory Committee on Immunization Practices presented findings that over 1.5 million vaccine doses have been given to kids under 5, with no cases of myocarditis! In cases among kids aged 5-11, we only saw 1 per >300,000 in boys, 1 in >1 million in girls.


12-21 cases of myocarditis per 1 million vaccines (most of which self-resolve) pales in comparison to 150 cases per 100,000 infections. Get vaccinated.


Here is the thing about a lot of these anti-vaccination stances...some of them are legit concerns that have blossomed, but so many of them also come from a serious misunderstanding of science, biology, virology, and public health. Too many of them are perpetuated by people who deliberately misuse science to gain clout and followers, and they are making others suffer for their gain.


New York City just abandoned masking mandates on public transit like the subway. Instead, their posters now mock public health by stating that even wearing a mask incorrectly is okay in the name of "respecting choices." A week later, they declared that polio is now causing a state of emergency due to its reemergence because of antivaxxers. Meanwhile, longer-lasting brain damage and heart damage from Long COVID is becoming more and more apparent even from mild cases, and Congress is letting funding run out for anti-COVID measures (including free vaccines). We are messing this up and it will continue to wreck lives (hospitalizations, deaths, long-standing organ damage, interrupted school, orphaned children - all of which have been very real consequences of COVID-19 infections so far). So before we go too much farther down that path, get your primary series and get boosted against the new variants.

As always, I welcome your questions.


Boosters:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html?s_cid=11706:covid%20vaccine%20booster:sem.ga:p:RG:GM:gen:PTN:FY22

Myocarditis and Other Adverse Events from Vaccines: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-09-01/05-COVID-Shimabukuro-508.pdf

Global Impact of COVID-19 Vaccines: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00320-6/fulltext


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