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Steve E. Bishop, M.D.

By: Steve E. Bishop, M.D. on October 19th, 2022

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COVID-19 Update: Pfizer Boosters, Variants, Myocarditis, and More

COVID-19 | Facebook Live Recap

On this COVID-19 update, Dr. Steven Bishop provides an update on data released by Pfizer about their updated booster, the continual emergence of new variants, myocarditis risk from vaccination, a nasal vaccine trial, and Novavax. Watch the video below or read on for the full recap. 

Pfizer Updated Booster Data

I know we've talked a few times about how the new booster shots from Pfizer don't have a lot of human data yet, and that is true.

They are starting to come out with some human data at this point, and they've released some information.

They did a small study in a few patients 18 years and older and showed that the new bivalent booster did a good job of increasing the antibody levels that were present in the blood, so that's a good sign that the vaccine is doing what it is intending to do, which is to boost immunity to these variants that are going around.

I hope that we will see more studies come out in the next couple of months. I think you will see some trials. I think many of us want to see some trials come out that are going to show us data on hospitalizations and mortality, and if the vaccines are really having any effect on that at this point.

There are a couple of things going on there. A lot of people have had COVID at this point, and so they have some protection most likely. And these new variants tend to be less severe, so it is going to change the risk-benefit equation a little bit.

So, I think a lot of people are very curious to see what's going to happen with the new human trials on these bivalent boosters and other boosters that may come down the line in the future. 

Potential New Variants

I think one thing to always be vigilant about is that there's always some new variant coming about. There are going to be new variants you're going to hear about in the next few months.

The BQ.1 variant is coming up, and the thing is, like we've talked about all along, there are going to be new variants that are going to show up every few months. This is the natural history of these types of viruses. Just like with the flu, every year we see new versions of the flu, we're going to continue to see new versions of COVID as they circulate.

I don't think it's any reason to be alarmed. I think it's just something to be aware of, that this virus will continue to change over time, just like the flu will. And we will probably have seasons in the future where COVID will be worse than others and some seasons where it will be milder than others, just like we do with the flu season these days.

The important thing is figuring out who is at the most risk, who does need to get vaccinated on a regular basis, and making sure those people do indeed get vaccinated. And that's something that we'll talk about here.

Myocarditis/Pericarditis Vaccine Risk

I think the vaccine issue — it's been so charged and complicated over the last couple of years — and there are a lot of reasons for that. Some good reasons for that, and some bad reasons for that.

I think one of the big things that we all need to remember and keep in mind is that these vaccines were produced in an emergency, and sometimes there are things about them that we didn't know at first and they may take years for us to figure out

One thing that we have known for about a year is that there is a risk of myocarditis and pericarditis in men especially, and especially younger men, with these mRNA vaccines — the Pfizer and the Moderna vaccines.

And so, it does raise the question, very legitimately, of should younger men, especially younger men or younger people in general, be getting these vaccines on a routine or an annual or more than annual basis with this known risk that we have?

The answer to that question is going to lie in how frequently do these age groups get myocarditis and pericarditis or other severe outcomes from COVID, and how often are these things happening in relation to the vaccine?

The data we have right now, it's really unclear and it's almost roughly equivalent. So that makes it a little bit of a toss-up and a little bit hard to figure out what the best thing to do is for people in these age groups.

For now, none of the recommendations have changed, and I think at this point, it's become so nuanced and so personalized in terms of what your risks are for COVID versus potential risks from the vaccine, that especially if you fall into one of these groups, definitely talk to your doctor.

Ask them what they think you should do. Get their opinion on your risk level, both for COVID and having a bad COVID outcome and for getting vaccinated and the potential risk of having a side effect from the vaccine, realizing that in both cases — for younger people, younger men included — if you're of average or normal health, you're probably low risk either way, right?

Low risk of having a bad effect from the vaccine, but a low risk of having a bad effect from COVID, so it's sort of a toss-up in some cases. Again, that's something where you need to have a nuanced discussion with your physician about what the best thing is to do for you and your particular situation.

Take the guidance from CDC and others in mind, but go to your doctor, ask them what they think you should be doing, and ask those questions. It's okay to ask them questions and you should ask them questions about it.

I encourage you to read these articles here that delve into some of what's going on with the science and trying to track down, okay, what's going on with these vaccines? Are they causing problems? Are they not causing problems? And if so, in whom? And if they are causing problems, are they a big deal? Does it matter? Do these problems last? Do they cause permanent harm or permanent damage?

And so I think, again, these are things that are going to take us time to figure out, and I think that the important lesson here is that all of us need to have a little bit of humility in terms of what we truly know and know for certain because the truth is we often know very little for certain.

That's true in science, it's true in medicine, it's true in our personal lives, and so the best thing to do is to keep an open mind, read the data, try to interpret the data as best and honestly as we can, and then draw some measured conservative conclusions based on what the data is showing us, and I think that's the best way to approach pretty much anything in life, but definitely medical care and science as well. That's my message about vaccine risks and COVID risks in general.

Bad News on a Nasal Vaccine

Some bad news on the nasal vaccine. I know that you guys know that I am a huge fan of this theory that the intranasal vaccines are going to be better at some point for reducing transmission because of the mechanism.

But again, this is where humility is needed, right?

We have to do the trials. We have to see what happens. AstraZeneca's first little trial of a nasal vaccine didn't work, so they're back to the drawing board on that. I'll keep you guys posted as we come up with more information about those nasal vaccines, but perhaps they just need to reformulate them a little bit and things will work out just fine.

Novavax for Booster

I did see today as well that FDA did give the green light for people who are worrying about other types of vaccines other than the mRNA vaccines, Novavax is going to be getting approval to be used as a mix-and-match booster.

I know someone asked this a couple of months ago about Novavax. Previously, it was just approved as a primary series vaccine, meaning that it did not have any boosters to it and it couldn't be used as a booster to the other vaccines.

It is now approved as a booster option for a mix and match, so you can or will be soon able to get Novavax as a booster if you wish to do that instead of another mRNA vaccine. And so, for some people who may be interested in that, that will be an option available to you guys soon.