Frequently Asked Questions about COVID-19 — February 16, 2022

“Shared expectations lead to predictability.”

471. Booster shots protection is waning after 4 months.

         Q:  Will I need to get a second booster shot later?

         A:  Data published a week ago by the Centers for Disease Control and Prevention suggest that Covid booster shots lose much of their potency after about four months.  This raises the possibility that some Americans — specifically those at high risk of complications or death — may need a fourth dose.  Preliminary research from Israel and Great Britain has hinted that protection from booster doses declines within a few months. This CDC data offers the first real-world evidence of the mRNA shots’ (Pfizer and Moderna)  waning power against moderate to severe illness in the United States.  The analysis did not include a breakdown by age.

Other studies have shown that while vaccines may lose some ability to prevent severe illness and hospitalization in adults older than 65, they remain highly protective in younger adults in good health. Federal health officials will need to know who exactly is at high risk even after three doses before recommending a fourth shot.  “There may be the need for yet again another boost — in this case, a fourth-dose boost for an individual receiving the mRNA — that could be based on age, as well as underlying conditions,” Dr. Anthony S. Fauci, the Biden administration’s top Covid adviser, told reporters.

472. A new monoclonal antibody drug for the Omicron variant is now authorized.

         QWhat’s new in therapeutics against Covid?

         A:  With Covid treatments still in short supply in the United States, the Food and Drug Administration last Friday gave emergency authorization to a new monoclonal therapeutic, Bebtelovimab, that has been found in the laboratory to be potent against the Omicron variant of the coronavirus.   The Biden administration said it would make the therapy immediately available to states free of charge.  The United States now has four available drugs that have been found to neutralize the Omicron variant early in the course of illness for high-risk patients.   While there are more Covid pills and treatments now than at any other point in the pandemic, the available drugs have been so scarce that doctors have been forced to make painful rationing decisions during the Omicron surge.

The drug that the F.D.A. authorized last Friday is manufactured by Eli Lilly, which said it had signed a contract with the Department of Health and Human Services to provide the government with up to 600,000 courses of treatment for at least $720 million. The company said it had already manufactured hundreds of thousands of doses and was ready to begin shipments within 24 hours.  The Lilly drug has not been tested in a study that can show whether it can stave off severe disease. The F.D.A. said it should not be a preferred product and instead should be used only when alternative treatments are not “accessible or clinically appropriate.”

Like other drugs for recently diagnosed Covid patients, Lilly’s new treatment is authorized for people who are vulnerable to becoming seriously ill because they are older or have a medical condition like obesity or diabetes. People as young as 12 can be eligible.  The drug is meant to be given as a quick intravenous injection by a health care provider, typically at a clinic or hospital. It must be administered within seven days of symptoms starting.

473. Johnson and Johnson has temporarily stopped its vaccine production.

         Q: Are American vaccine manufacturers meeting the demand to supply other countries?

         A:  Last Tuesday, the New York Times reported that Johnson & Johnson had quietly and temporarily shut down its largest manufacturing plant for its Covid vaccine.  This plant is based in the Dutch city of Leiden.  It was reported this move was quietly made to increase production of a different experimental vaccine for an unrelated virus that is “potentially more profitable.”  While company officials have stated they already had millions of doses in the warehouses ready for shipment, this move blindsided officials at two of the company’s most important customers: the African Union and Covax, the clearinghouse responsible for getting vaccines to poor countries. Leaders of those organizations learned of the halt in production from New York Times reporters.  It is now reported that the American company has already fallen behind on its deliveries to poorer countries.  Over the next several months, the interruption has the potential to reduce the supply of Johnson & Johnson’s Covid vaccine by a few hundred million doses, according to one of the people familiar with the decision. Other facilities have already produced the vaccine but either aren’t up and running yet or haven’t received regulatory approval to release what they’ve already made.

Johnson & Johnson’s easy-to-deliver Covid-19 shot is the vaccine of choice for much of the developing world.  It is given as a single shot and does not require cold-chain storage making it easier to transport and store in remote areas.

474. The CDC continues to recommend school masks should be worn.

         Q:  I’m confused,  Shouldn’t masks continue to be worn in schools?

         A:  The Center for Disease Control has been often cited for issuing conflicting and confusing guidance.   First, it has to be understood that the CDC is not a regulatory agency.  It cannot require activity.  Its role is to produce scientific evidence defining ways that minimize risk.  Secondly, it must be understood that the mission of CDC is public health – that is for the entire population not just groups within it.  Some have defined the confusion at CDC results when it publishes different guidelines for separate groups, and when it defines policy decisions, which is not one of its roles.

The first issue that caused confusion was when vaccinations became available.  The CDC started to establish guidelines for the vaccinated and other rules for those not yet vaccinated.  As an example, for holiday gatherings, if everyone present has been vaccinated….(do these steps).    But if someone present has not been vaccinated….(do these instead).  Dealing with flow-chart-like decisions makes it hard for people to find their position in the matrix to know exactly what the appropriate guidance for them really is.  Later, when hospitals were becoming overwhelmed, guidance was issued for unvaccinated people exposed to infectious people to remain in isolation for only 5 days instead of the previous 10 days – to allow healthcare workers to return to their tasks more rapidly.  The risks were not perceived to have changed, but the policy was downgraded.

As early as last week, the CDC restated its guidance on the issue of school masks that students and staff “should” wear masks in school.  For vaccinated and unvaccinated students and staff, this recommendation protects all people.  The political decision to remove the mandate for school masks is seen by many citizens that masks are no longer needed in schools.  The CDC continues to say otherwise.

475. The decision to lift mandates for school masking is a political decision.

         Q:  Our governor is lifting the school mask mandate.  Is it safe to stop wearing masks?

         A:  No!  Over the past several months, the political right in America has gathered support for their stance of “personal freedom.”  No mandates!  “If I don’t want to be vaccinated, no one can make me get a shot.”  This is in opposition to public health – where to prevent a disease from infecting all people, certain requirements on all people must be imposed.  This growing opposition is becoming seen politically as the “will of the people.”  After the U.S. Supreme court struck down the OSHA regulation requiring workers in companies with 100 or more employees must be tested or be vaccinated to protect all the workers, the political will to impose mandates has been evaporating.  Many Democratic officials, facing upcoming elections, are making the choice to follow that public sentiment.  An unspoken assessment is being made that if we support free choice, and speak against mandates, we won’t be politically opposed by those against mandates.  If we let people avoid masks and vaccinations, maybe they will become ill or worse, and thus they can learn for themselves the value of these measures.

By supporting the removal of mandates and allowing everyone to “get back to normal” more rapidly, the consequence will be a higher risk of morbidity and mortality.  This is not “doomsday thinking.”  We all know that we can reduce the risk of car crashes if we more strictly enforce drunk driving laws.  Hospitalizations and deaths from the seasonal flu could be reduced if mask-wearing and vaccinations for that disease were mandated.  But as a public, we have come to see these as “acceptable risks.”

The CDC is still concerned about the future of Covid.  Among these concerns are the waning Covid immunity from the vaccinations and boosters, and the potential for new variants to emerge.  They guide us to continue to accept wearing masks and getting shots.  But the will of the public will decide what level of risk is acceptable as we pace our rush back to normal.  That, in a way, is the normal, political, democratic process in our constitutional republic.