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Steve E. Bishop, M.D.

By: Steve E. Bishop, M.D. on August 25th, 2021

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COVID-19 Update 8/25: J&J Boosters, Immunocompromised, Get Vaccinated, and More

COVID-19 | Facebook Live Recap

On this week's COVID-19 updater, Dr. Bishop discussed the initial data on the Johnson & Johnson boosters, the data behind boosters for immunocompromised individuals, why vaccination is strongly recommended at this point, breakthrough infection symptoms, and more. 

Watch the video below and read on for the full recap. 

Initial Data on J&J Booster

Johnson & Johnson has released some data on a booster shot for their J&J vaccine, which is great.

I've been waiting to see some of this information, and I hope that the FDA and the CDC will probably act on that and make a recommendation for a booster shot for J&J people soon because a lot of J&J people are feeling a little stranded, a little kind of not sure what to do about a booster shot right now.

It looks like in a small study a couple thousand folks got booster doses six months after their first dose of the J&J vaccine, they did have a pretty significant increase in antibody levels. So it seems that booster doses are probably going to work.

I have not seen the full dataset from this. This is just sort of the press release on it. I have not been able to find the sort of pre-print data yet to look at the side effects and all that sort of stuff yet, but it's an initial good piece of data for booster J&J. It appears there is a good antibody response to the second dose of that vaccine for the J&J.

Recommended: Boosters if Immunocompromised 

Right now, the only official recommendation that we've got for booster doses for anyone is those who fall into those immunocompromised categories.

Basically, if you're on immune system drugs, if you're on treatment for cancer, if you have cancer, untreated HIV, and some other specific types of immune system disorders, you are recommended to get a booster dose of either Pfizer or Moderna.

They do recommend you stick with whatever you had before, Pfizer, get another Pfizer, Moderna, get another Moderna, but if you want to switch, or your doctor recommends you switch from one to the other, that is also acceptable and fine to do. But again, that's just for people with compromised immune systems right now.

Why Immunocompromised Should Get a Booster

I'm going to share with you guys a couple of brief study articles about the folks with compromised immune systems getting booster vaccines. These are small studies, but it's part of what the CDC has based their recommendation data on.

Again, they're pretty small studies, but in the folks who get a third dose of vaccination, it does appear that a significant percentage of them do develop increased levels of antibodies.

And some people who didn't respond to the first doses of a vaccine, the first two, do respond after the third dose.

That's particularly important for people who had maybe an organ transplant, bone marrow transplant, people like that who maybe had very little to no response to the first two doses. They respond well to the third dose. Again, that's in immunocompromised people specifically.

Pfizer Submits Data for Booster

There was another little bit of a data release. Again, it's a press release. I haven't been able to find the raw data yet about Pfizer. And there's one more article here about an early phase one trial for booster doses in adults essentially.

They did find good response after the third dose to increase antibody levels, et cetera. Again, these are the small sort of phase one studies. Is it safe? Does it cause any problems to get a third dose? Do the antibody levels increase?

They started testing what's called the immunogenicity of a third dose. It doesn't necessarily follow a large number of people out for a long period of time to figure out if it reduces the hospital stays and fatalities and infections and that sort of thing.

It's just sort of testing the immunogenicity of a third dose. Does it do anything and is it safe to get a third dose? And so Pfizer has got some of that data out there.

CDC Meeting on Boosters Next Week

Apparently, on August 31, the CDC vaccine committee is going to meet to review the data that's out there on booster doses, and I suspect that at that point they will release some more of the data that they have around boosters for Pfizer and Moderna in sort of otherwise healthy people, not just people that have immune system problems, but other folks as well.

And then we'll get some recommendations probably next week about who should or shouldn't get an additional booster or third dose in the coming months.

My guess is that they're going to recommend most people get a booster at some point over the next few months, but we'll see what the data shows and then how that goes next week.

Please Get Vaccinated. 

I think this is a good time to segue to the fact that, I saw a headline in a data point earlier today, we've got more patients in the ICU across the country now than we have ever had throughout the pandemic.

If you haven't gotten vaccinated at this point, please seek out your physicians, trusted people to get good advice on whether you should get vaccinated or not.

As I said last week, I think a lot of people are really underestimating their risk of doing poorly with COVID. Please do carefully consider getting vaccinated if you haven't gotten vaccinated yet.

I know that's a lot of people. Only about half the adult population has been vaccinated at this point. So please do strongly consider getting that vaccine.

Again this is a very serious illness. We've got lots of people in ICU right now. I know there's been a lot of crazy stuff on the internet about the vaccines and all over the place, but, please do at least, trust me, trust your doctor. Talk to them.

The vaccines are generally safe. They are going to work well to keep you out of the hospital and keep you from dying from COVID. They may not be perfect. They're not going to do everything the way we want, but they are generally safe. They do work.

Please do strongly consider getting one if you haven't already at this point. I just think it's important to reiterate that again as we continue to go through this and watch the numbers.

The proof's in the pudding, right, when we look at these things. Please do consider it strongly. Even in Virginia, our case numbers and our hospitalization rates do continue to climb, and we are back around where we were kind of January, February, March of 2021, in terms of overall cases and people in the hospital.

Luckily, because our ICU doctors have gotten a lot better at treating COVID, our fatalities have stayed pretty low, which is wonderful news, but being in the ICU is still no joke and it's a long recovery road if you do make it through that process.

Again, just looking at cases right now, we're kind of actually back to where we were early, late January, early February, in terms of case numbers, and hospitalizations we're sitting right around where we were in February, March, April of this year.

We've definitely moved backward in a lot of ways because of Delta variant transmitting so frequently.

That's why, at this point, a lot of people who didn't get exposed before are getting exposed now. And I think that's my sort of takeaway message for folks is you need to strongly consider getting vaccinated if you're at increased risk.

Definitely age 50 and above. Probably age 30 and above, and especially if you've got any other medical conditions. And that means if you take medicine for anything. If you have any problem at all. Pretty much anything that's kind of a standard adult medical problem. Blood pressure, cholesterol, heart problem, overweight, acid reflux, all that counts, okay?

All of that stuff counts, which means about 90% of people who are adults in the United States probably need to strongly consider getting vaccinated, because if you haven't been exposed to COVID yet, you are going to be exposed in the next few months because Delta variant transmits so rapidly.

Attending College Football Games

"What would you suggest as far as precautions for someone planning to attend a college football game with several thousand other people in a week? Asking for a friend of course."

Well, what I'd say is that you're likely going to a Virginia Tech game (Editor's Note: Dr. Bishop is a UVA grad, and knew this question came from a VT grad), in which case I would say absolutely avoid it without question. It's a horrible, horrible environment to be in. As a Wahoo, I strongly recommend that you not go to a Virginia Tech game for any reason whatsoever.

Likelihood of Exposure

"I have heard people say we don't go anywhere to get exposed so we don't need vaccines. I'm not sure what they mean by that. What would you say to them?"

I would say to them, if you are interacting with other humans in any way at this point, anywhere, any time, you are going to get exposed.

It doesn't matter what you're doing. If you're just going to the grocery store, if you're just ordering takeout food, whatever it is, you're going to get exposed, because the viral loads that people are carrying around from the Delta variant are so high that even for vaccinated people who can be carrying it asymptomatically, the exposure is just a matter of when, not if.

PMD Vaccination Status

"Is everyone working at PartnerMD vaccinated? Is it a requirement of the practice?"

So I don't have that information. It's private medical information. I'm not privy to that. I know that of our staff, I know that the vast majority of our staff are vaccinated just from general conversation, but I don't know exact numbers or anything of that nature. We do not currently require it because again, as far as I know, the vast, vast majority of people have gotten it voluntarily.

Symptoms of a Breakthrough Infection

"Because the vaccines prevent serious symptoms, it can be difficult to recognize a breakthrough infection. What symptoms should you look out for?"

Same thing as always before. Any sort of upper respiratory symptom is something that you are going to want to get evaluated pretty carefully. Talk to your doctor. You may need to get a COVID test done.

And we at PartnerMD have gone back to this at this point — anyone who has respiratory symptoms, even if you think it's just a cold or a sinus infection, we generally are testing those people for COVID again and trying to do telemedicine to reduce the exposure risk of the staff and other patients in the office setting. We are back to treating any respiratory illness as potentially COVID at this point.

Fever, cough, runny nose, congestion, or again, loss of taste or smell is still a pretty telltale sign for most folks.

And that's part of sort of the problem, right? Most people who are getting these breakthrough infections post-vaccination, they're having few, if any, symptoms. And so they sort of just go about their day, which is fine for them, but the folks who are unvaccinated, that is a risk to those people.

That's why I really would tell people, "Look, it's a matter of when not if. You're going to get exposed. It's just a matter of time."

Boosters Immediately When Eligible? 

"If you were vaccinated this summer within the eight-month window that is cited, is there a need for the booster as soon as it's made available? Will it possibly offer any additional protection toward newer variants?"

It's going to offer a boosted antibody level against the general spike protein. It's going to have the same limitations as the first two doses, but you are going to have generally improved protection from severe illness and fatality.

We don't really know whether the boosters prevent infection or reduce transmission risk at this point. That's hopefully going to be something that we see in the dataset that comes out from CDC next week, because I just haven't seen anything to that effect at this point, but the boosters are the same. It's the same vaccine we got in the spring and in the winter last year. It's just a third dose of that same thing. They're not specifically formulated for the variants per se. It's just another dose of what we've already had.

Side Effects from Boosters

"When boosters are eventually approved, would you expect people to experience the same kind and the same level of side effects from the second shot?"

Probably. In general, I think that you might even possibly expect a higher rate of side effects just because your immune system's already been primed twice now by the vaccine.

My suspicion is we will see higher side effects with the third dose, but I still expect the side effects to overall be manageable and moderate. So we'll see. Again, another thing I need to see some data on.

CDC Tracking Hospital Cases?

"I read an article CDC is not tracking COVID cases unless you end up in the hospital. Is this correct?"

I do not think that is correct. Virginia Department of Health and all the health departments are still tracking COVID cases, and that data feeds right up to the CDC. As far as I am aware, nothing of that has changed. Now, I'm not sure that at the national level they are always tracking whether the case is from a vaccinated or an unvaccinated person.

Vaccines for Kids Timeline

"Did you already mention when we might see shots approved for kids? Many of my friends with young kids or grandkids are locking down hard again."

Yeah, I don't know. The latest things I've seen are that perhaps there'll be a EUA for 5 to 11-year-olds by the end of the year, but that's the latest thing that I have seen.

I have not seen any updated data other than that sort of just conjecture out there. The good news is for the younger kids, as long as they are normal, healthy kids, even if they do get COVID, they are far, far, far, far, and away very likely to have minimal symptoms and to do very well with the virus. Hopefully, that is at least somewhat reassuring.

I know people are scared. We are tracking the vaccines for five to 11-year-olds, but my guess is probably nothing on that before the end of the year.

Talking to the Unvaccinated About Getting Vaccinated

"Do you have any suggestions on how to encourage an unvaccinated person who had a very mild case of COVID several months ago to get the shot?"

That is a tricky one. I think all these vaccine conversations are hard, right? And they've been made harder by the way a lot of our political and other officials have handled the situation from the time that things began until now. It's often not helpful.

But I think most of these conversations are best had privately and with humility. Asking people what their concerns are and letting them express those and then trying to help them work through it.

Many people have legitimate concerns and fears, and I think that's fine and appropriate, and the best thing to do about that is to just talk through them with folks and give them all the information that we have. Tell them what we do and we don't know. Transparency is generally the best policy when it comes to these things.

For someone who had mild COVID, if it's going to help them make a decision, it might be worth having them talk to their doctor to see if they actually have antibody levels that are detectable on a test. And if they don't, that might be a wake-up call for them that they are not well-protected. That might be something helpful for them to do.

Shedding Virus While Vaccinated

"How long does a vaccinated individual with a breakthrough case typically shed virus? Massachusetts requiring isolation for 10 days, regardless of vaccination status or symptoms, which seems excessive."

Yeah, we're doing the same thing here in Virginia. I think if you are vaccinated, what the data has come out, is you basically shed the virus at the same rate as an unvaccinated person. So I think the 10 days of isolation for a confirmed case, even in a vaccinated person, is actually reasonable. It's probably the right thing to do because you do shed basically at the same rate as an unvaccinated person if you've acquired the virus.

When is the next update? 

Our next update will be on Wednesday, September 1, at 1:00 p.m. live on the PartnerMD Facebook page. We will post a full blog recap Thursday morning.