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Friday, September 16, 2022

The Bivalent COVID Booster Episode

Episode 73

Speaker 1 (00:04):

Coming to you from Beaumont. This is your House Call.

Dr. Asha Shajahan (00:14):

So it's fall of 2022 and the Bivalent COVID-19 booster vaccine is out. So who should get them? When should you get one? Do you really need one? You're about to find out.


Hello and welcome to the Beaumont House Call podcast. I'm Dr. Asha Shajahan. Our goal is to help you and your families live smarter and healthier lives. Today we're talking about the new Bivalent COVID-19 boosters. But I got to do a quick timestamp because as we know, evidence is changing, things change with time. So today everything we discuss is based on what we know up to today, which is September 16th, 2022.


And joining us today is Dr. Russ Lampen, infectious disease specialist from Spectrum Health. And I'm super excited about this guest because he is joining us for the first time from West Michigan. And this is kind of our first Spectrum Beaumont podcast. So welcome Russ. So excited to have you here.

Dr. Russell Lampen (01:17):

Yeah, thanks a lot for having me. It's great to be part of this collaborative.

Dr. Asha Shajahan (01:21):

Yeah. So let's kind of recap about the Coronavirus. So to date, I think there's about 2.8 million cases in Michigan, about 38,000 deaths, it's still a high number. And I think the number of COVID-19 hospitalizations, at least from this week, has gone up about 16%. So what are you seeing in terms of hospitalizations, number of cases, severity? Is COVID still a big deal?

Dr. Russell Lampen (01:49):

Yeah. I think this is really interesting and for most of us, there's no longer any masking out in the community. There's no longer any limits on capacity. So I think most people are kind of living their lives oblivious to maybe the toll that COVID continues to take. And I think it is important to continue to frame this.


Nationally there's about 35,000 people that are currently admitted to the hospital, and there's about 400 deaths per day on a national level. So we're still talking about 12,000 people dying per month from COVID, which if you were to compare that to a flu season, this would be a horrific influenza season. So this is becoming almost what is our baseline.


Now I think locally in West Michigan we are seeing a slight uptick. So throughout most of the summer, our inpatient census has been around 60 COVID patients, which doesn't sound like a ton, but this is 60 additional patients with severe respiratory illness that we just don't normally have in the summer. The summer, for us, is typically a low census season and you know, add 60, 70 patients, it puts you at capacity.


Over the past couple weeks we have seen a slight trend upwards. And so as of this morning when I check the data, we have 108 patients that are currently admitted. So up just a little bit from that 60 to 70 range, 12 of those are adult patients in the intensive care unit. We have six children admitted to our pediatric hospital, of which one of those is in the ICU.


So we are seeing some severe illness still here. Not to the same degree that we saw during our peaks. We had a peak of over 400 patients in the hospital at one point. So we're certainly down from that and we're able to manage it. But a 100 additional patients, it puts a strain on the system.

Dr. Asha Shajahan (03:29):

Yeah. It's still very much, I think, for healthcare providers, we know it's still there. So let's really dive into the vaccination. Okay, come on. There's been so many boosters. I think it's confusing for everyone. The average American is like, "Okay, I got one booster and I got two boosters," and now there's some people have gotten four shots. What is so beneficial about this booster and why is it important to get it?

Dr. Russell Lampen (03:57):

Sure. So this booster that's now being released, we'll kind of refer to it as the updated booster for the rest of this show. It does contain some of the ancestral or original COVID or the OG strain of COVID, kind of what was there from the beginning. And that was what was present in the initial vaccine series and the initial booster.


So it still contains that strain, but then it also contains a strain that will provide immunity from Omicron BA.4 and 5 variants, which are the dominant circulating variants at this time. So this is the first time that we've released a vaccine that is specific to the mutations that have been occurring over the past two years. So we've seen all these mutations occur and this is the first vaccine that's being released that addresses those issues.

Dr. Asha Shajahan (04:47):

I think that's great news because a lot of people have been saying, "I got my booster and then I still, I'm getting COVID." Or, "I still got sick with COVID." And some people were saying, "Oh, don't even get your booster because the newer strains, it doesn't really help." So it's refreshing and it's good news to know that there is a booster that will actually take those variants into consideration.

Dr. Russell Lampen (05:06):

No, absolutely. And I think when the first vaccines came out, they had a 95 to 98% effectiveness in preventing symptomatic disease. And then we watched a couple variants in the vaccine tend to hold up, but really it was when Delta came out and then Omicron right around the beginning of 2022, we began to see that the virus developed some techniques to evade our immune system and to evade either previous immunity for natural infection or to evade the immunity that occurred through the original vaccine series.


Now I think the thing to remember is that those original vaccines still provided protection for people. So you were still less likely to go into the hospital, you were less likely to die, you were less likely to get serious disease if you had received a booster or you had received along with a primary series. But we certainly saw an increase in breakthrough rates and especially in older patients, a breakthrough for them tended to be more serious and ended up putting them in the hospital.

Dr. Asha Shajahan (06:06):

So talking about the severity, so many people are saying, "Okay, if I haven't gotten COVID, I'm eventually going to get COVID." Everyone's kind of gotten it, people are getting it for the second and the third time. And so if it is more mild and kind of like cough, cold symptoms, does everyone really need a booster or just those at risk?

Dr. Russell Lampen (06:27):

A couple things to keep in mind. One is that that individuals probably greater than age 60 are at risk for severe illness. And I think that population, there's a personal risk to them that they need to take into account. And so yeah, maybe they've survived previous infections, but that's no guarantee that future infections are going to be mild or not put them into the hospital.


So I think there's that group of people, those who have medical conditions that put them at risk. So whether they're immune compromised, they have lung disease, heart disease, kidney disease, obesity, those people are at risk for hospitalization and severe disease. So I think certainly this vaccine is going to give them some protection and keep them out of the hospital.


I think the next group as you go, well these are people that statistically would be of lower risk for developing severe complications. But I kind of framed this with do you really want to get sick? Even a mild case of COVID can make you feel awful. So why would you take that risk if you have the ability to get a booster that could prevent that?


COVID continues to be disruptive. Isolation periods are still five days and most people that we've talked to, they feel sick enough that they don't want to go outside for five days. So again, if you could prevent that, why not?


And then the third part of this, especially even looking maybe more in the pediatric range, younger kids, again less likely to develop severe disease, but there's a public health aspect to this. So the more people that we can get boosted the less circulating disease and the less chance there is going to be to transmit this to people who are at higher risk.


So I think that those are all parts of this. The other thing is that people who have mild disease are still at risk for long COVID. And we have shown that people who are vaccinated and protected from vaccines are at lower risk from developing long COVID symptoms. And I think we all know people that had relatively mild disease and you talk to them two months out, three months out late and they're living their lives, they're going back to work, but they're like, "I'm still a little tired." Or, "When I go to the gym, I can't work out as hard as I used to." Or, "I go for a walk of my dog and I just feel more winded, more tired."


So I think, yeah, maybe you're not at risk for severe infections or severe complications, but it's like why roll the dice? And if you can even prevent mild complications from occurring, why wouldn't you want to do that through a vaccine?

Dr. Asha Shajahan (08:47):

There are a lot more cases of long hauler and I feel like there are the younger population that is complaining of this fatigue and the gym thing is a big one like, "I can't run on the treadmill I used to." Or, "I feel winded." And so my suggestion is also like, "Hey, just get boosted." It's what? Maybe one day of not feeling great as opposed to having months of complications.

Dr. Russell Lampen (09:10):

And I think we've been careful to draw parallels or too many parallels between COVID and influenza because they're clearly different diseases. But the vast majority of people that get a flu shot every year, they also are at low risk for severe complications from influenza. But you can still do it because you don't want to get sick. And so I think that's, to me, maybe the strongest argument for getting a booster.

Dr. Asha Shajahan (09:31):

So okay, let's talk about people that want to get a booster, but maybe they just had COVID or they were just boosted with the previous vaccine. What's your advice for them?

Dr. Russell Lampen (09:42):

So the CDC has recommended that if you've just received a booster, so kind of the original booster that just contains the ancestral strain, the recommendation is that you wait eight weeks before you get the new updated booster. There aren't very good guidelines or real specific guidelines about what if you've been recently infected and how long should you wait. But I think it's reasonable to put that same kind of parameter around this.


So getting naturally infected does provide an immune system boosting response. And so I think waiting two months is again a reasonable thing to do. When we look at what's been circulating, it's been Omicron Variant, BA.4, BA.5 pretty much exclusively since July. So if you've been infected in the past couple months, it's likely that you developed it from these Omicron strains that are now represented in the update updated booster. And so you probably have a window of safety, window of immunity, from getting reinfected for the next couple months.

Dr. Asha Shajahan (10:45):

And so this is an interesting thing. I was talking to one of my patients the other day and she mid 50s and she was kind of saying, "Okay, well I heard the boosters out, I had COVID in March, I don't want to get the booster yet because I want to make sure I'm still protected for Christmas and New Year's and the holiday," she's got this big Europe trip coming up. And so she said, "What do you think, Doc? Should I just take it now or should I wait?" So I'm interested to hear what you would say.

Dr. Russell Lampen (11:15):

Well, I think trying to time COVID and when you might be infected and when you would have the most protect, it's like trying to time the stock market, you have no idea when it's going to go up and when it's going to go down. But I think it's in some ways, I'm not going to say a dangerous game to play, but especially if you're at somebody at risk of developing severe infection, why would you want to have a window or a period of time in which you were vulnerable?


I think the other aspect of this is assuming we don't see any major shifts or mutations in the current circulating Omicron strains. It's expected that this booster will have some durability, and whether that's six months, 12 months, we don't know, but the CDC is really hoping that we can start to move to a cycle where you get a booster once a year.

Dr. Asha Shajahan (12:03):

That would be great.

Dr. Russell Lampen (12:08):

So I think, for me, and I think the recommendations I'm getting is that when you go in for your flu shot, go ahead and get your COVID booster at the same time, make it a one stop shopping experience and get it done. And so we should be getting more and more vaccine available by the middle, by now, it's becoming available shortly, but in the next couple weeks it should become widely available. And I would say go get your flu shot, get your COVID updated booster all at the same time. Don't wait to find out when you're going to get sick.

Dr. Asha Shajahan (12:36):

Yeah, I think that's one thing I've also been telling my patients and many people say, "Hey, I need to get my shingles vaccine or my pneumonia vaccine. Can I do it all at once or do I need to wait? How do I know I'm not having side effects?" And I just say that if you didn't really have anything with the previous two, you should be pretty safe for with this one as well.


And so my dad actually just got his vaccine and the flu shot and he was proudly walking with band aids on both arms.And I was like, "Oh, I need to get my booster." And he did really well. He's in his 70s and he's a soldier. I think he didn't feel well for maybe a couple hours and then he was fine the next day.


You did talk about maybe that this might become an annual vaccine, which I think would be fantastic because then it kind of gets rid of that fatigue of having multiple boosters. Do you believe that this current booster would protect us throughout the entire season? What are your thoughts on that? It might be speculation.

Dr. Russell Lampen (13:36):

There's a lot of things that we don't know yet. The tricky part is that it's very easy for us to measure antibody levels or to get antibody titers, but those don't tell the whole story about protective immunity. So we've got multiple aspects of our immune system that are not easily represented through regular laboratory testing.


And so the same thing with the flu. A lot of people try to game the flu shot and say, "Oh, I'm going to wait so that I'm at maximal protection." Well, just because your antibody levels are higher two weeks after you get the influenza vaccine, that doesn't mean that you still don't have protection two, three months out down the road. So I think barring any major mutations in the Omicron strains that are currently circulating, I would expect that the booster vaccine would provide durable immunity looking at six plus months of protective immunity. And some of the modeling right now is talking about an 80% reduction in symptomatic disease.


So a pretty potent vaccine and I think, yeah, if you get it now end of September, beginning of October when you're going in for your flu shots, I would expect that that's going to provide you with coverage through the holiday season, through the winter months, and into the spring and summer.

Dr. Asha Shajahan (14:49):

So who is currently eligible to get a vaccine? And then when is this particular booster going to be authorized for kids? You think?

Dr. Russell Lampen (14:58):

So anybody 12 and over can get it right now and this is going to create some complications. I'm not a pediatrician, so I'm fortunate that I don't have to memorize all these pediatric vaccine tables.

Dr. Asha Shajahan (15:08):

I do.

Dr. Russell Lampen (15:09):

Yeah, you do. Good for you. I'll leave that to you. So this is going to be strange. So the boosters that are now going to be available, only the updated booster is going to be available for individuals 12 and older. For those age five to 12. They are still eligible for a booster, but they're not eligible for the updated booster. So they have to get the original prior booster as opposed to the updated one, which is a little confusing.

Dr. Asha Shajahan (15:35):

Still helpful.

Dr. Russell Lampen (15:36):

It's still helpful. Yes, very much. And so I don't know really when kids are going to get, that five to 12 year group, when they're going to get eligibility for the updated booster. Typically, in the previous patterns that we've seen, it's after a few months of real world clinical data with individuals who have been receiving the updated booster that they then go ahead and give either conditional or full FDA approval for that group, the five to 12 year olds.

Dr. Asha Shajahan (16:07):

So there you have it folks, 12 and older, you can get it.

Dr. Russell Lampen (16:09):

Go get it.

Dr. Asha Shajahan (16:12):

It can make a huge difference. I think it's going to make a huge difference in reducing the severity of the fall and winter surges. I think 60% of our population is considered vaccinated, but we got to keep that going. It's not just one and done.


Actually, I was looking at, I was traveling, and so I was looking at my vaccinations and my last one was in October of 2021 because I wasn't eligible. So I did end up getting my booster on Monday and so I don't want to drop brands, but the reason I'm saying it, a lot of people are confused like, "Hey, I got three Pfizers and then now I'm going to a pharmacy and they're offering Moderna, can I do that?" So I ended up getting three Pfizers and I got a Moderna at local pharmacy and I was down for, I was not down at all for the first three.


I was like, "Oh, yeah, I got this. This is easy, no big deal." And those ones I remember I was like, "Oh, I should have a lighter schedule the next day because I might not feel well," but I really didn't feel well the following day, but within 24 hours I was back to normal and good.


So let's talk a little bit about the symptoms of this booster versus the others. I found it to be the same fever, maybe some mild aching, my arm was sore. Tell me about your experience. Did you get boosted?

Dr. Russell Lampen (17:39):

I have not gotten boosted yet, so I am still waiting for the flu clinics to open up for employees here. So as soon as that does and I'm going to go get it. So no, I haven't gotten it. People I've talked to have had I think wide ranging, and I think it is going to be the same way that some people with their second shot or with their last booster, it was a minor inconvenience. Other people said, "Oh, the booster was worse than the first two." I guess I feel like I've heard it all over the grid.


I think if you're to draw conclusions, by and large, people tend to have less severe reactions as they go down the vaccination pathways. So the more COVID vaccines you've had, subsequent boosters tend to be less severe in people's symptoms. But the symptoms are the same with this. It's the body aches, joint aches, maybe low grade fever, maybe low grade headache. And again, as you're pointing out, tends to be done and gone within 24 hours or less.

Dr. Asha Shajahan (18:39):

So I want to stress that because some people think, "Oh, I didn't have anything. I'm not going to have anything." Or the others think, "Oh, I had it so bad, I'm so worried it's going to be so bad." It just depends. I mentioned that my dad had gotten his last week and I think his first two he had gotten fever and this one he was fine. So it just depends.

Dr. Russell Lampen (19:00):

Yeah, I think one of the things to bring up here when we start talking about side effects, probably the most serious concerning side effect with the mRNA vaccines was the myocarditis that occurred in younger men. And so we're talking primarily age 12 to 30 would be probably the highest risk group statistically.


Now interestingly, they looked at that group for the second shot and then they looked at that group again for the booster. None of those individuals were eligible for a fourth vaccine. But after the second and moving into the third, that myocarditis became less and less of a risk as they received second and third doses. So far fewer individuals, young men, developed myocarditis inflammation around the heart with that third dose than they did with a first.


Now we're again talking very, very, very small numbers of individuals getting sick, but that small percentage shrank as they move down the path.


The other thing that's interesting with those cases, one is that the vast majority of them within 90 days had complete resolution of their symptoms. And so even though it was concerning for most of these individuals at first, well over 80% had complete resolution of their symptoms within that time period.


The other thing to remember is that getting COVID actually puts people at risk for developing myocarditis. So anywhere, depending on the study, if you actually get COVID and you're a male in that age group, you're anywhere from two to six times more likely to get myocarditis or inflammation of the heart from actually being infected than you were from the risk of getting vaccinated.


So again, vaccine is far safer with a lower likelihood of complications when compared to getting directly ill. I hear that argument, "Natural immunity is better immunity." And it's not better immunity and it's not safer immunity.

Dr. Asha Shajahan (20:51):

Yeah. And you can get long COVID and lots of other things.

Dr. Russell Lampen (20:55):

But I think that's a group just worthy of calling out and I think that's probably the group of most concern when we start looking at these mRNA vaccines.

Dr. Asha Shajahan (21:04):

So I'm so excited because, like you said in the beginning of the podcast, we're walking around without masks, things are kind of back to normal. People are having weddings, people are traveling. I'm a big traveler. I've gone all over already. So we said 12 and older can get the new vaccine. I got mine, you're about to get yours. And where can people get vaccines?

Dr. Russell Lampen (21:27):

So they're not going to have these big mass vaccination clinics like we did with the initial rollout, but I would say go to your healthcare systems website. Both Beaumont Health and Spectrum Health have links that will direct people on how to get scheduled and where to go. The commercial pharmacies are already releasing them.


I know people that have gotten them from Rite Aid, CVS, Meyer Pharmacy is giving boosters. So the same places that we're giving boosters for over the last year and are giving boosters currently are continuing now with the updated boosters. So it's pretty widely available and it shouldn't be too difficult to find a place to get it.

Dr. Asha Shajahan (22:02):

Nice. And one other thing I wanted to bring up is that if you are traveling, and let's say some people are saying, "Well, I got mine at a pharmacy first, then I got it at my healthcare system and then oh, I had it at a community clinic." You can get a QR code from wherever it is that you got your vaccine from that should help you with travel if you're going to a country or a place that's restricted. So if you're concerned that like, "Oh, I have to always get it at the same place," you really don't. There's records of that.

Dr. Russell Lampen (22:29):

Absolutely. There's a database, MCIR, in the state of Michigan, so if all of your vaccines were done in Michigan, they should all be recorded and readily available for proving that you've been vaccinated.

Dr. Asha Shajahan (22:42):

So Russ, any last thoughts?

Dr. Russell Lampen (22:44):

This is an exciting development. I've said to people, "If I got a dollar for every time I said, "We're going to know more in a couple weeks," I wouldn't be doing this. I'd be on a warm, sunny beach someplace as opposed to doing podcasts and working for a living. But I think this is going to be really interesting to see how well this booster works. And I think it's a huge step towards normalcy, keeping kids in school, keeping people safer, keeping people out of the hospital. And so I'm very excited about that.


And I think kind of looking at this updated booster as, "Hey, this is a pattern that we can begin to adapt, that could make sense, that we would look at less frequent vaccines, that we would maybe look to the fall for an updated booster on an annual basis." But kind of getting away from, as you're pointing out this, every three months new recommendations coming out saying, "Hey, let's get another shot if you've got A, B, C, D, E, F conditions."


So I think that's going to be very exciting and I think, hopefully, we could continue to keep numbers at a low level and avoid some of the peaks that we've had in the past.

Dr. Asha Shajahan (23:52):

Yeah, I think we've come a long way. If you just think last year, this time, what was happening and then the year before this time, what was happening. We've made huge strides and I think a lot of it has to do with the fact that we have a vaccine and that people are vaccinated and that we're all keeping each other safe.


So thank you so much, Russ, for joining us today. It was such a pleasure to have you.

Dr. Russell Lampen (24:17):

Hey, thank you very much. It was a lot of fun.

Dr. Asha Shajahan (24:19):

All right. Thanks for tuning in to the Beaumont House Call. We leave you today with this healthy thought. The Omicron Bivalent Booster is here, and this vaccine can restore protection that has waned since the previous vaccine by offering broader protection. COVID-19 is still the third leading cause of death according to the National Institutes of Health and getting boosters in arms this fall could prevent an estimated 12 to 15% of deaths a month. This means we finally have something to prevent this illness. So let's stay safe this season. Be informed, make your choice, and get boosted.

Speaker 1 (24:57):

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