Frequently Asked Questions about COVID-19 — April 6, 2022

“Shared expectations lead to predictability.”

511. The FDA approves a second booster (a fourth shot) for mRNA vaccinations.

         QWhen can I get my second booster shot?

         A:  On Tuesday, March 29, the Food and Drug Administration authorized a second COVID-19 booster for people age 50 and older.  This is a step to offer extra protection for the most vulnerable in case the coronavirus rebounds.  This decision opens a fourth dose of the Pfizer or Moderna vaccines to those people at least four months after their previous booster.

512.  A substitute drug is available in place of vaccines for vulnerable patients.

         Q I am immunocompromised.  What can I do to get some protection against Covid-19?  

         A:  Evusheld is the first FDA authorized drug to prevent COVID-19 in high-risk people who aren’t adequately protected by vaccination alone. The FDA granted emergency use authorization on December 8, 2021.  It has been shown that Evusheld reduces the risk of symptomatic COVID-19 by 77% in unvaccinated high-risk adults.  When the immune system is exposed to a foreign protein – for example, by infection or vaccination – it produces antibodies in response to the potential threat. Evusheld is a monoclonal antibody drug that binds to the spike protein of the virus that causes COVID-19 and prevents it from entering and infecting cells.  It functions differently from antiviral drugs like molnupiravir, which work by stopping the virus from replicating within cells.  This means that Evushield must be taken before a person becomes infected.  The protection from developing Covid symptoms lasts for months.  It is expected that Evusheld will need to be given about every six months to keep antibody levels high enough to be effective against the virus. Patients may need to keep getting repeated doses as long as there is a significant risk of COVID-19.

Not all immunocompromised patients are eligible for this prophylactic, and it is important that anyone who knows they have limited immunity from vaccines contact their physician for guidance.  Evushield is administered by two injections in one outpatient visit with an hour remaining afterward for any of the rare reactions to emerge.

513.  A new teenage anxiety is appearing named (by them): “mask fishing.”

         Q:  I heard some teenagers talking about mask fishing.  What is this?

         ATeenagers are showing anxiety over an issue called “mask fishing.”  This is a new term played on the former term “catfishing,” the slang for improving one’s image online.  For a generation that has grown up with smartphones and Instagram, creating a more positive illusion of identity was commonly accepted.  “Some of these people really haven’t seen my face outside of social media and things like that,” one teenager was quoted in a recent New York Times article.  “What I post on social media I make a little bit different than what I look like day-to-day.”  That’s catfishing.   But now that New York City has ended its mask mandate for public schools, students are dealing with old anxieties about their appearance and the pressures to fit in.  As they get a closer look at each other’s faces, they’re finding out who among them has been mask fishing.  “The majority of the people in my classes that I don’t see outside of school, I don’t know what they look like without their mask.”

The concerns felt by many were explained in another quote: “Three years ago, it would have been like, ‘I have so much acne lately, I do not know what to do, but guess what?  It was middle school.  Everyone had acne. Everyone was dealing with the same thing. It was everyone’s insecurity.  But now it’s become a more personal thing, and it feels like, ‘Oh, this person doesn’t have it; I didn’t know because I haven’t seen their face. So it’s only me that has it.’”  Yet another concern, “I’m still pretty anxious about taking my mask off completely,” she said. “If people see the newer version of me where I don’t look the way I did, there’s a lot of stress that I’ll be seen as less pretty as I may have once been.”

514.  Expert scientists predict Covid-19 will become endemic – like the seasonal flu.

         Q: Will we have to get shots every year for Covid like we do flu shots?

         A:  Sarah Cobey, MD at the University of Chicago along with Jesse Bloom, MD, and Tyler Starr, MD at the Fred Hutchinson Cancer Research Center in Seattle are three scientists who study the interaction of immunity, virus evolution, and transmission.  They collaborated recently to discuss the future of Covid-19.  Will it go away?  Will it become seasonal like the flu?  What can we expect?  The following is extracted from their report:

It’s impossible to say whether future variants will have larger Omicron-like jumps or less dramatic changes, but we are confident Covid-19 will continue to evolve to escape immunity.  While transmissibility of most viruses does plateau at a certain point, many human viruses that escape immunity keep doing so. The influenza vaccine has been updated annually for decades to chase viral evolution, and some influenza viruses show no sign of slowing down.  Immune escape is an endless evolutionary arms race because the immune system can always make new antibodies and the virus has a vast set of mutations to explore in response.

Taking all this together, we expect Covid-19 will continue to cause new epidemics, and they will increasingly be driven by the ability to skirt the immune system. In this sense, the future may look something like the seasonal flu, where new variants cause waves of cases each year.  If this happens as expected, vaccines may need to be updated regularly similar to the flu vaccines unless we develop broader variant-proof vaccines.  And of course, how much all this matters for public health depends on how sick the virus makes us.  That is the hardest prediction to make because evolution selects viruses that spread well, and whether that makes disease severity go up or down is mostly a matter of luck.  But we do know that immunity reduces disease severity even when it doesn’t fully block infections and spread, and immunity gained from vaccination and prior infections has helped blunt the impact of the Omicron wave in many countries.  Updated or improved vaccines and other measures that slow transmission remain our best strategies for handling an uncertain evolutionary future.  The development of a broad variant-proof vaccine, currently being undertaken, will be an ultimate answer to this and other annually recurring viral diseases.

515.  A personal reflection on three habits someone wants to continue after Covid.

         Q:  There are a lot of bad memories from the last two years.  Is there any good from this?

         A:  Tish Harrison Warren is a priest in the Anglican Church in North America, and an opinion writer for the New York Times.  She recently reflected in an article on the past two years, identifying three practices she and her family hope to continue. From her column:

First, in the early days of the pandemic, when my family of five abruptly found ourselves crammed into a small house, we developed a practice of having tea around 4:30 each weekday afternoon. With cookies, Earl Grey, juice for the kids, and sometimes a shot of bourbon for the adults.  We would ask one another, “Who do you need to apologize to or reconcile with today?”   This ritual helped our family to take responsibility for the ways we griped at, nipped at, or yelled at one another, and to seek forgiveness. We would leave the tea feeling more connected, more tender toward one another, and more able to offer and receive love.  I’d like to continue this, at least as a weekly rhythm.

Second, a month or two into the pandemic, as it became clear that seeing people outside was a safer way to interact, we began to center our nights on our backyard firepit.  Our ancestors sat around fires for hundreds of thousands of years but I had somehow lost this ancient custom.  I found again and again that something about those flickering flames brought easier connections with others.  The crackle and beauty of staring at a fire actually lowers blood pressure, according to a University of Alabama study.

Lastly, hiking had long been a favorite family activity, but Covid took it to a new level. With city playgrounds shut down and a longing to be out of the house, we bought a hiking pack to carry our baby with us and hit the trails. There are days when we leave the trails exhilarated, having seen something extraordinary or beautiful. So, I hope we keep this up, even now, when it’s safer to be inside with other people again.