Navigating COVID vaccines
September 6, 2023 1:04 PM Subscribe
I am a middle aged man under 60. I received the bivalent vaccine almost a year ago. I skipped the most recent vaccine in the spring because I was told it was for people over 65 or with immunity issues. Am I protected at all if I get the virus before the fall vaccine?
To my knowledge (knock wood) I have not had covid but my wife did while we were sharing a home. She went in to isolation on day 2.
My immune system is fine as far as I know.
My doc says to wait but I wanted to get a consensus on what others are doing/thinking.
So, should I go ahead and get the existing vaccine or wait it out?
To my knowledge (knock wood) I have not had covid but my wife did while we were sharing a home. She went in to isolation on day 2.
My immune system is fine as far as I know.
My doc says to wait but I wanted to get a consensus on what others are doing/thinking.
So, should I go ahead and get the existing vaccine or wait it out?
Response by poster: So what happens if I get covid between now and when the booster comes out? Is it like having no protection?
posted by captainscared at 1:21 PM on September 6, 2023
posted by captainscared at 1:21 PM on September 6, 2023
You still have a lot of protection against severe disease if you've had the initial course of vaccine and last year's booster - you are very unlikely to be hospitalized or die (barring other health conditions you haven't mentioned). You can definitely still get symptomatic COVID, though - I got it like 3 months after my 2022 fall booster. The effectiveness of the booster wanes with time as your COVID antibody levels go down, but there's more to your immune system than antibody levels and most research shows continuing protection from severe infection if you've been vaccinated and/or infected previously.
posted by mskyle at 1:26 PM on September 6, 2023 [5 favorites]
posted by mskyle at 1:26 PM on September 6, 2023 [5 favorites]
If you haven't been testing weekly since 2019 you have no idea if you've had it. At least a third of cases, maybe a half, are asymptomatic. Both prior infection and prior vaccine doses provide long-term protection through mechanisms like t-cells, which remember how to fight for decades.
Statements like "vaccines only provide protection for 4 to 6 months" are antivax scaremongering and in my opinion should not be tolerated without substantial evidence. The vaccines we have against the novel coronavirus are damn good and don't stop working after a few months. Your prior vaccine doses absolutely do still provide protection – not as much as they did the exact week when your antibody response peaked, but that was never the point.
posted by daveliepmann at 1:41 PM on September 6, 2023 [7 favorites]
Statements like "vaccines only provide protection for 4 to 6 months" are antivax scaremongering and in my opinion should not be tolerated without substantial evidence. The vaccines we have against the novel coronavirus are damn good and don't stop working after a few months. Your prior vaccine doses absolutely do still provide protection – not as much as they did the exact week when your antibody response peaked, but that was never the point.
posted by daveliepmann at 1:41 PM on September 6, 2023 [7 favorites]
I am in my fifties. I had 5 vaccinations for Covid, the last one in October '22. I got Covid in July. Terrible sore throat, fever, fatigue, and just generally feeling crappy. I work from home but still took 4 days off to just lay around and recover. It wasn't the worst, still wish I hadn't gotten Covid.
posted by poppunkcat at 2:00 PM on September 6, 2023 [1 favorite]
posted by poppunkcat at 2:00 PM on September 6, 2023 [1 favorite]
My understanding is that antibodies from either the vaccines or infection fade in roughly 6 months. I will continue to get every vaccine I can within that interval. I am indeed worried about what would happen if I get it in the next month.
As an aside, all the articles that say "we have the tools, and almost everyone is already immune!" don't acknowledge that the last widely offered vaccine was the bivalent, almost 12 months ago, and uptake on it was ~30%. Herd immunity remains ... well out of reach. As does the trailing 's' on "tools".
posted by Dashy at 2:08 PM on September 6, 2023 [5 favorites]
As an aside, all the articles that say "we have the tools, and almost everyone is already immune!" don't acknowledge that the last widely offered vaccine was the bivalent, almost 12 months ago, and uptake on it was ~30%. Herd immunity remains ... well out of reach. As does the trailing 's' on "tools".
posted by Dashy at 2:08 PM on September 6, 2023 [5 favorites]
The vaccines we have against the novel coronavirus are damn good and don't stop working after a few months.
Yes. Some recent results show antibodies decline from the initial peak over several months after vaccination, but they don't decline to zero; rather, they stabilize at a long-term level (how long? as long as we've been able to observe, it seems). This "stabilization phase" does not prevent all symptomatic infections, particularly from new variants; however, it does appear that "mismatched immunity protects from severe disease and mortality" (twitter link). The rest of the thread at that link, from a virologist at Mt. Sinai, has more details on the time course of vaccine-induced immunity as measured in a 3-year study -- which is as long a study as it's possible to have at this point, of course. What this means is that you have a pretty high degree of protection against severe disease.
If you don't fall into a known high-risk group I would follow the standard recommendations and wait for the updated booster, and maybe tighten your precautions (masking, less time in public spaces) until you can get it.
posted by egregious theorem at 2:30 PM on September 6, 2023 [5 favorites]
Yes. Some recent results show antibodies decline from the initial peak over several months after vaccination, but they don't decline to zero; rather, they stabilize at a long-term level (how long? as long as we've been able to observe, it seems). This "stabilization phase" does not prevent all symptomatic infections, particularly from new variants; however, it does appear that "mismatched immunity protects from severe disease and mortality" (twitter link). The rest of the thread at that link, from a virologist at Mt. Sinai, has more details on the time course of vaccine-induced immunity as measured in a 3-year study -- which is as long a study as it's possible to have at this point, of course. What this means is that you have a pretty high degree of protection against severe disease.
If you don't fall into a known high-risk group I would follow the standard recommendations and wait for the updated booster, and maybe tighten your precautions (masking, less time in public spaces) until you can get it.
posted by egregious theorem at 2:30 PM on September 6, 2023 [5 favorites]
I will add a data point here, mostly apropos for anyone reading this whose worried about getting it in the next month or few weeks. My husband got COVID in July; he was fully vaxxed, including the bivalent booster. He was not severely ill — mostly snuffles, fatigue, and a sore throat. This past Friday, September 1, he had some respiratory symptoms, which we figured must be a cold. Nope — he tested positive for COVID again. He’s in his mid-50s and in ok health in general but has a couple of underlying conditions. He’s taking Paxlovid and the COVID is even more mild than last time. So that’s just one piece of anecdata, but I figure it might be useful to someone.
posted by holborne at 2:33 PM on September 6, 2023
posted by holborne at 2:33 PM on September 6, 2023
60 year old male here. Have had four shots. Didn't know I could get a fifth. Going into the hospital next week for a slew of surgical procedures. Really wish I had known about that 5th shot being allowed.
That said, I too am waiting for the next booster. Will take it as soon as I have recovered. And I have not gotten it yet, which seems crazy. But, I do mask still where there are other folks around.
posted by Windopaene at 2:52 PM on September 6, 2023
That said, I too am waiting for the next booster. Will take it as soon as I have recovered. And I have not gotten it yet, which seems crazy. But, I do mask still where there are other folks around.
posted by Windopaene at 2:52 PM on September 6, 2023
I am basing the 4-6 months on many scientific studies I have seen in my Covid informed, disabled, pro vax community. Here is an NPR interview from 2022. Here is another from Time magazine. I am pro pro pro vax. Which means we all need ENOUGH boosters and vaxes given the research.
posted by Crystalinne at 3:02 PM on September 6, 2023 [2 favorites]
posted by Crystalinne at 3:02 PM on September 6, 2023 [2 favorites]
Epidemiologist and vaccine developer chiming in: get whatever vaccine is available to you, for anything, at any time. Do not try to play lottery games with vaccines. I don't mean to minimize your concerns, because there is a lot of extremely bad information out there to inform your question (including a recent NYT piece that made my entire field cringe and scream and gnash teeth). The bottom line is that vaccines have different metrics of success than, like, medicines you take to address an individual health issue. Example: you have a toothache, you take ibuprofen, your toothache lessens, hooray. Vaccines aren't like that. Vaccines are population-level aggregate, preventive, immune system-priming tactics. That means that the question you ask is less "am I protected" and more "how are we all protecting us." The answer to the latter question is simple: no matter what, take the vaccine that is available to you the moment you are willing and able to be vaccinated.
posted by late afternoon dreaming hotel at 3:23 PM on September 6, 2023 [21 favorites]
posted by late afternoon dreaming hotel at 3:23 PM on September 6, 2023 [21 favorites]
Crystalinne's sources do not support the claim that vaccines stop working after 4-6 months.
From the NPR link: "Turns out, protection against severe disease doesn't depend so heavily on those antibodies. The vaccine triggers other parts of the immune system that keep an infection from getting out of control. And data from the U.K. indicates that protection against severe disease stays robust over time."
From the Time link: "The studies in the review did not delve into how well the vaccines protect against more severe disease, hospitalizations, and deaths due to COVID-19; other studies to date have shown that protection against more serious outcomes wanes much more slowly than against symptomatic infection, and that the shots continue to protect pretty well against these more dire events."
Part of being Covid informed needs to be distinguishing between "protection against any symptoms" and "protection against very bad outcomes", and being critical of sources which don't mention T-cells and create the impression that antibodies are our only protection. T-cells can be explained, even in pop media – here's one from the Economist which at least mentions them, though I'm not a fan of the framing.
posted by daveliepmann at 3:24 PM on September 6, 2023 [3 favorites]
From the NPR link: "Turns out, protection against severe disease doesn't depend so heavily on those antibodies. The vaccine triggers other parts of the immune system that keep an infection from getting out of control. And data from the U.K. indicates that protection against severe disease stays robust over time."
From the Time link: "The studies in the review did not delve into how well the vaccines protect against more severe disease, hospitalizations, and deaths due to COVID-19; other studies to date have shown that protection against more serious outcomes wanes much more slowly than against symptomatic infection, and that the shots continue to protect pretty well against these more dire events."
Part of being Covid informed needs to be distinguishing between "protection against any symptoms" and "protection against very bad outcomes", and being critical of sources which don't mention T-cells and create the impression that antibodies are our only protection. T-cells can be explained, even in pop media – here's one from the Economist which at least mentions them, though I'm not a fan of the framing.
posted by daveliepmann at 3:24 PM on September 6, 2023 [3 favorites]
In the context of “it’ll keep you out of the hospital but it won’t prevent you from catching or spreading the disease, just reduce the odds a bit for a little while,” I don’t actually understand the usual public health math for vaccines. Keeping me out of the hospital is more individual medicine than it is public health, no? Unless we’re worried about hospitals being overrun again? But evidently nobody is worried about this (in fact, I’d say everybody is enthusiastically unworried about it).
It’s not actually unreasonable for people to expect that vaccines ought to prevent them from getting sick. Obviously, it doesn’t work that way with this one. But people aren’t misinformed or antivax because they came into this era with that expectation. We get tetanus boosters every ten years because we don’t want to get tetanus, not merely because we don’t want to die from it. When we get pertussis (as my family did) after being current on our shots, we’re confused. Whereas with this one, the message has been “vaccines are all you need” and also “you can expect to get Covid 1-2 times per year regardless of whether you get the vaccine, and you shouldn’t worry very much about that.” That’s confusing. Why should I do something uncomfortable (and now, potentially, expensive) if I’m going to get sick anyway and especially if I’m not supposed to care that I got sick? The story does not hang together. In this context it is really no surprise that uptake has been disappointing.
posted by eirias at 5:52 PM on September 6, 2023 [7 favorites]
It’s not actually unreasonable for people to expect that vaccines ought to prevent them from getting sick. Obviously, it doesn’t work that way with this one. But people aren’t misinformed or antivax because they came into this era with that expectation. We get tetanus boosters every ten years because we don’t want to get tetanus, not merely because we don’t want to die from it. When we get pertussis (as my family did) after being current on our shots, we’re confused. Whereas with this one, the message has been “vaccines are all you need” and also “you can expect to get Covid 1-2 times per year regardless of whether you get the vaccine, and you shouldn’t worry very much about that.” That’s confusing. Why should I do something uncomfortable (and now, potentially, expensive) if I’m going to get sick anyway and especially if I’m not supposed to care that I got sick? The story does not hang together. In this context it is really no surprise that uptake has been disappointing.
posted by eirias at 5:52 PM on September 6, 2023 [7 favorites]
I got the Moderna BA.4/BA.5 booster (which apparently came out in April) about a month ago because (a) it was 6 months since my last booster, (b) I'm teaching in a classroom starting tomorrow, (c) I'm high-risk enough to be eligible for Paxlovid under Ontario's quite restrictive guidelines, and (d) it was not at all clear how long it would be before the latest updated booster would be available in Canada. I have no regrets.
If it's true that the latest updated booster could be out as early as next week (!!) in the U.S., I would suggest going ahead and booking yourself an appointment for one.
posted by heatherlogan at 5:54 PM on September 6, 2023
If it's true that the latest updated booster could be out as early as next week (!!) in the U.S., I would suggest going ahead and booking yourself an appointment for one.
posted by heatherlogan at 5:54 PM on September 6, 2023
To add to the informed comment from late afternoon dreaming hotel, from my uninformed self: An often ignored effect of Covid is that, with all the insane garbage being printed and promoted, some of my relatives are going to just DIE from Howling Fantods and ripping their hair out and running down the street shrieking because as trained medical professionals they have more than had it up to here with nonsense like people thinking that the "mask optional" policy in their hospital is based on "everything's just fine now" and not on having spent - even after credits and incentives - many many much millions of dollars on updating already good HVAC systems to change the air so that what you are breathing indoors is as free of other people's exhalations as outdoor air.
And you might consider a Novavax. Data is looking better and better and better on having this as a booster for the Moderna or Johnson & Johnson and whatever have you. Seems to keep the old snoot more free of Covid nasties which would reduce transmission quite a bit.
posted by Lesser Shrew at 7:30 PM on September 6, 2023
And you might consider a Novavax. Data is looking better and better and better on having this as a booster for the Moderna or Johnson & Johnson and whatever have you. Seems to keep the old snoot more free of Covid nasties which would reduce transmission quite a bit.
posted by Lesser Shrew at 7:30 PM on September 6, 2023
The new vaccine will be available within weeks. It's hard to see a lot of downside to waiting just a bit more in order to get the most current version. If you are concerned, take more precautions during this interval.
60 year old male here. Have had four shots. Didn't know I could get a fifth. Going into the hospital next week for a slew of surgical procedures. Really wish I had known about that 5th shot being allowed.
Four is the number for someone (like me) who is not in any high risk group who has been following the recommended guidelines, with the fifth happening about now. People can easily get more, either by qualifying or by just seeking it out. If you are in the US, it has not been hard to get access to additional boosters if you want.
posted by Dip Flash at 7:38 PM on September 6, 2023 [1 favorite]
60 year old male here. Have had four shots. Didn't know I could get a fifth. Going into the hospital next week for a slew of surgical procedures. Really wish I had known about that 5th shot being allowed.
Four is the number for someone (like me) who is not in any high risk group who has been following the recommended guidelines, with the fifth happening about now. People can easily get more, either by qualifying or by just seeking it out. If you are in the US, it has not been hard to get access to additional boosters if you want.
posted by Dip Flash at 7:38 PM on September 6, 2023 [1 favorite]
My best source (Dr Daniel Griffin on the TWIV podcast) agrees pretty much with the advice from DIp Flash. The reasoning is that three shots are a good idea, but most people got the first three too close together, so get a fourth. Evidence is that the original vaccines still provide good protection against getting severe disease with any of the variants, but they really don't know why. Probably something to do with T-cells.
The new vaccine that will be available in a month will probably give protection against getting even a mild case but that benefit will taper off in four moths or so because of the way B-cell immune system works, not because of new variants.
posted by SemiSalt at 5:57 AM on September 7, 2023
The new vaccine that will be available in a month will probably give protection against getting even a mild case but that benefit will taper off in four moths or so because of the way B-cell immune system works, not because of new variants.
posted by SemiSalt at 5:57 AM on September 7, 2023
You absolutely can still get covid this fall in your vaccine status. I am you, basically. I caught it last week. It suuuucked. But I didn't die - I spent 5 days in bed in varying states of misery, including 6 hours literally not swallowing (don't ask, gross). Trying to find Paxlovid over the holiday weekend. Entire life on hold, lost work revenue. I really wish they had allowed us "youngins" to have that midyear vaccine.
If I were you, I would just get the new vaccine as soon as you can, rather than trying to extent the protection period by deferring. Think of it as time value of health. Would you rather have your higher chance of being healthy in the next, say, six, months, in the fall when the risk is highest, versus, say, next summer?
Plus, Murphy's Law says that if you defer, you'll catch the virus during your deferral. If you'll only be kind of mad about that, go for it. ;)
posted by bluesky78987 at 7:37 AM on September 7, 2023 [1 favorite]
If I were you, I would just get the new vaccine as soon as you can, rather than trying to extent the protection period by deferring. Think of it as time value of health. Would you rather have your higher chance of being healthy in the next, say, six, months, in the fall when the risk is highest, versus, say, next summer?
Plus, Murphy's Law says that if you defer, you'll catch the virus during your deferral. If you'll only be kind of mad about that, go for it. ;)
posted by bluesky78987 at 7:37 AM on September 7, 2023 [1 favorite]
That means that the question you ask is less "am I protected" and more "how are we all protecting us." The answer to the latter question is simple: no matter what, take the vaccine that is available to you the moment you are willing and able to be vaccinated.
While we're talking about inconsistent messaging, this seems like another one. I've read widely that the new vaccine will be limited to the over-60 or immunocompromised set only.
I'm not sure what rationalizes limiting it at all. But how does limiting vaccine availability protect all of us, if that is the goal of public health and vaccines?
posted by Dashy at 9:07 AM on September 7, 2023 [3 favorites]
While we're talking about inconsistent messaging, this seems like another one. I've read widely that the new vaccine will be limited to the over-60 or immunocompromised set only.
I'm not sure what rationalizes limiting it at all. But how does limiting vaccine availability protect all of us, if that is the goal of public health and vaccines?
posted by Dashy at 9:07 AM on September 7, 2023 [3 favorites]
The FDA will probably make the new vaccine available tomorrow, early next week at the latest. Unclear whether the CDC will say it's for 65+ and immunocompromised people only; looks like they had a meeting and vote on that earlier this week.
posted by twelve cent archie at 9:32 AM on September 7, 2023
posted by twelve cent archie at 9:32 AM on September 7, 2023
The comment period is still open (only 1 more day) for the CDC's decision on whether the booster will be recommended for all, or just for a limited population. Get in there, y'all.
posted by ourobouros at 10:01 AM on September 7, 2023
posted by ourobouros at 10:01 AM on September 7, 2023
I think this question of booster eligibility this round is coming from some statements Paul Offit has given to the media in which he says only the elderly and immune compromised will need it, eg here. I gather that his belief is similar to what daveliepmann articulated upthread, that people should not expect vaccines to protect them from illness and that Covid vaccines should not be used for public health purposes in that way. He is a voting member of the FDA’s committee that advises on vaccines but I don’t think he has direct influence on what the CDC decides to do.
I realize that my earlier comment itself sounds pretty antivax. I was literally the first person to get the bivalent at my neighborhood Walgreens last year, and I’ll certainly get this season’s as well if I am eligible. I think, though, that our messaging around Covid is fatally incoherent, which has made a bad/politicized situation into a worse one in which most people (not just those in one party) are just going to believe and do whatever is least costly for them personally.
posted by eirias at 11:54 AM on September 7, 2023 [1 favorite]
I realize that my earlier comment itself sounds pretty antivax. I was literally the first person to get the bivalent at my neighborhood Walgreens last year, and I’ll certainly get this season’s as well if I am eligible. I think, though, that our messaging around Covid is fatally incoherent, which has made a bad/politicized situation into a worse one in which most people (not just those in one party) are just going to believe and do whatever is least costly for them personally.
posted by eirias at 11:54 AM on September 7, 2023 [1 favorite]
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posted by Crystalinne at 1:11 PM on September 6, 2023 [7 favorites]