What to Know About the New COVID Booster

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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Well, the FDA has granted emergency use authorization for new COVID boosters targeted at the Omicron sub-variants, and the CDC recommends the shots for anyone 12 and older. The boosters made by Moderna and Pfizer target the BA.4 and BA.5 Omicron sub-variants, which are the dominant strains in the US at least right now. The shots which are already becoming available have been authorized as public COVID precautions have hit an all time low.

Michael was just talking in the news about Governor Hochul officially lifting the mask mandate for New York's public transportation, as well as detention centers and homeless shelters. Masks are only still required now in nursing homes, hospitals, and other healthcare settings. What's not going down is the number of people dying in New York from COVID every day, about 24 or so, about two dozen a day statewide all this summer, 400 to 500 a day nationally all this summer.

We talked on the show yesterday about how the murder rate was down to 27 murders in the month of August. 27 people were killed in the entire month of August. More than 27 people die every two days in New York City from COVID, but the precautions are being lifted.

With me now to discuss mostly the new booster is Daniel Griffin, MD, PhD, Infectious Disease physician with a PhD in Molecular Medicine. He's a researcher at Columbia. He's also ProHEALTH's chief of the Division of Infectious Disease, president of the group Parasites Without Borders, which I've said before, sounds like a bad thing but it's really a good thing, who really wants parasites without borders, but you know, and co-host of the podcast This Week in Virology. Dr. Griffin, always good to have you. Welcome back to WNYC.

Dr. Daniel Griffin: Thank you, Brian. Always good to be here. We're trying to get rid of those parasites without borders, so we're not encouraging them.

Brian Lehrer: That's your job. So to start a little geeky maybe, these new boosters are bivalent, meaning they contain some of the original virus spike protein and then some of the new Omicron spike protein, if I understand it correctly. Why were they formulated like that?

Dr. Daniel Griffin: Yes, you understand it well and hopefully the people listening get that quite as well. What these new boosters have is they have the original formula, but they've also got the ingredient in there. These are mRNAs, so they've got the mRNA in there that is going to allow our body to produce and then get an immune response against not just the original but also the BA.4, the BA.5, which really make up about 90% of what's currently circulating here in the United States. This is a a chance to give us a boost in those antibodies going into the fall.

Brian Lehrer: I haven't even given out the phone number yet, but our lines are half full, 5 of our 10 lines with people with questions, so let me give everybody else who doesn't have us on their speed dials a fighting chance. 212-433-WNYC is the number, 212-433-9692. If you have Omicron-specific booster questions for Dr. Daniel Griffin, 212-433-WNYC or you can tweet your question @BrianLehrer. The official guidance is that if you're 12 or older and it's been at least two months since your last shot, you can get the Omicron booster, but some experts say it's probably better to wait at least three or four months before getting another shot. What's your opinion on that?

Dr. Daniel Griffin: I think it's good that you bring this up, Brian. We've gotten in this habit over the last two years now of making broad recommendations to everyone, but everyone is not the same and the recommendations could be a little different for different folks. If this is an individual who just got over an infection, and as I mentioned 90% of that is BA.4, BA.5, I'm not sure they need to run out and be first in line. I even talk a little bit about behavior coming up.

If you're an individual getting ready to celebrate the High Holidays, if you're a Jewish, you maybe wanting to jump in a little bit earlier. If your High Holidays are going to be Thanksgiving and in December, then you may be looking at waiting a little bit before you do that. I think [crosstalk]--

Brian Lehrer: Meaning if those are the times when you're gathering with a lot of people, right?

Dr. Daniel Griffin: Yes. That's exactly it, Brian. We have to be honest about what we expect these vaccines to do. We're expecting them to boost our antibody levels, we are hoping that they're going to, to some degree temporarily reduce our risk of infection, we are hoping they continue to reinforce our protection against severe disease and death, but that protection against infection that we're hoping to get, it looks like that will, like the other vaccines that we have so far, not be something that endures for years. We're thinking there will be a monthly decline, a monthly contraction of those antibody levels.

Brian Lehrer: Well, based on the data we have, how effective are these boosters against Omicron, specifically, compared to the original vaccines?

Dr. Daniel Griffin: We know they're good at raising those antibody levels, but we don't yet have the data on how actual effective they are out there. That data is going to come over the next few months as we see these rolled out in the real world. These were rolled out based upon getting those antibodies up, but we as yet don't have that efficacy data.

Brian Lehrer: Now, Dr. Paul Offit who's pretty well respected and has been a guest on this show and well respected beyond that, obviously, a member of the FDA's Advisory Committee voted against authorization for the Omicron booster saying the benefits don't really justify their use and that the new vaccines won't do much more to prevent infections than the originals that people have already gotten if they've gotten them. How much do you agree?

Dr. Daniel Griffin: I'd like to think of Paul as a friend. I like to think we have a lot of ideas in common and at least my perception of him voting against the recommendations a few months back was that what was put before the FDA was not BA.4 or 5 boosters, not the bivalent ones that got rolled out but really ones that were going to help us against the earlier Omicron. What he said in his discussion at the end is, "Give us a little more time. Let's see the BA.4 or 5 data before we move forward with this." I think it is important for us to follow the science, not just sort of follow hunches. We've been wrong far too often in the last two years.

Brian Lehrer: Let's take a phone call. How about Bill in Fort Lee, you're on WNYC, hi Bill, with Dr. Daniel Griffin.

Bill: Hi. Thanks for taking my call. I read somewhere something about I think D-cell or T-cell exhaustion, which reduces the body's ability to fight COVID and that that can result from having multiple injections. For those of us who had two vaccines and two boosters, this would be a fifth. Is that something we should be concerned about?

Dr. Daniel Griffin: Yes, I'm glad you asked this question because I'm going to just say straight out no. This is not something you should be concerned about. It's definitely something that people who are not pro-vaccine have been circulating this concept of T-cell exhaustion. This is not something that we expect, this is not something we're seeing. The human immune system sees things over and over again, and so there really isn't a concern here from a science point of view that that's a problem.

Brian Lehrer: Let's take another call. Maria in Long Branch, you're on WNYC. Hi, Maria.

Maria: Hi, Brian. I'm signed up for the booster next week, and I want to know if I can get my flu shot safely with it or should I wait?

Dr. Daniel Griffin: Now, that's a great question, and the answer is yes, go ahead. You can get that flu shot and your COVID booster at the same time. We're actually recommending it. I'm glad you bring that up because now is not only a time that we have access to these new bivalent boosters, which we're encouraging folks to consider, but we also have flu shots rolling out. I hate to say this, we are anticipating a bad flu season this winter. Hardest thing to predict, I'll admit, is the future, to quote Yogi Berra, but we're a little bit worried about the flu season, so get those flu shots as well.

Brian Lehrer: Why are you worried about this being a bad flu season?

Dr. Daniel Griffin: Well, a couple of reasons, Brian. One is we always watch what happens down there in Australia. They're sort of a bellwether of what we're going to see and they had a bit of problems. Also, as you notice, as you just discussed earlier, the masks are coming off, people are getting back to the offices, people are getting back together, so our behaviors are really going to be friends for influenza this winter.

Brian Lehrer: On your latest episode of TWiV, This Week in Virology, you said essentially that with 500 COVID deaths a day in the US, it's incredible that anyone could characterize Omicron as just a mild cold. That being said, what's your take on Governor Hochul's decision to lift the masking requirements on public transportation now, as well as in homeless shelters and detention centers?

Dr. Daniel Griffin: Yes, Brian, it is really tough. I'm shocked that we're sort of immune to where we are. There was a tweet recently this last week, which I will read when I record This Week in Virology later tonight, where they said, "Hey, other than 500 deaths a day, everything is looking good," which reminded me of the, "Other than that, Mrs. Lincoln, how was the show?"

How can 500 deaths a day be something you just move right on past? Right now, that's like here, when everyone is outdoors before everyone starts getting into those classrooms, before people start getting together for the holidays, before people start getting back to the offices, before we start traveling on public transportation with our masks off. Yes, this is really concerning, and I think as a society we're making choices.

Brian Lehrer: We seem to be in the steady state now at the pace of hospitalizations and deaths. I follow a few of the COVID trackers and look at the curves over time. Of course, there was a big spike at the beginning in 2020, there was another huge spike in terms of the number of cases and deaths and hospitalizations at the beginning of Omicron, the beginning of this year, and then it leveled off and went way down in March.

Then as BA.4 and BA.5 came in, it went up again, but it hasn't come down again to that March level or the summer of 2021 level. It seems to be at this plateau where it's continuing at about two dozen deaths in New York State, about 15 deaths in New York City, about 500 deaths nationwide every day all summer. Where is it headed and why isn't it headed anywhere?

Dr. Daniel Griffin: Yes, it's tough because people have these modeling, and they say with this optimistic scenario, and then they throw in unless there's a new variant because that will change everything. Well, I'm already pessimistic with 400 to 500 people dying every day, that is not what I am happy with. Then when they talk about, "But what about another variant?" We already have BA.4.6 starting to increase in number, already making up 10% of what we're seeing. This is again another one of these immune-evasive variants. Yes, we really need to be honest and really need to ask ourselves what are we expecting, what are we happy with?

As the masks come off, we've really got to start educating people about what to do if you test positive. I'd like to say, these 400 to 500 deaths per day, the majority of those are preventable with vaccines, with early treatment. Get vaccinated, have a plan if you test positive, make sure your provider knows what the options are, the effective options, not the ones that don't work.

Brian Lehrer: Wendy in Fort Lee, you're on WNYC with Dr. Daniel Griffin. Hi, Wendy.

Wendy: Hi. Good morning, Dr. Griffin. Thank you for taking my call. My question is, you were speaking about what to do after you have an infection, that you should wait, how long should you wait?

Dr. Daniel Griffin: Yes, so Wendy, it's a little bit different for each person. There is, again, this difference when you're going to be in a high-risk situation, when you're going to be getting together and potentially exposed. We are seeing repeated infections as early as a month, about four weeks after that first infection. If someone is in a higher risk, we're actually going to say, "Let's go ahead and get you boosted a little bit on the earlier side." If a healthy person, early 20s, that might be a person that I say, "Oh, big holidays for you in December, you might want to wait until November."

The big thing I guess I'm going to suggest right now is we need to start having these conversations with our healthcare providers. Don't go on Twitter, don't do that internet search while you're in the toilet. Get out there, start talking about and finding out what's right for me. I think we really need to re-establish those relationships with the primary care physician and then also be ready to say, "Okay, if I do get infected, what's our plan? How do I reach you? How do we move forward and make sure I get the best care?" Because time really matters with COVID.

Brian Lehrer: Thank you, Wendy. This Omicron BA.4.6, is that what you said the new variant is?

Dr. Daniel Griffin: Yes, I hate to predict, but yes-- Maybe I'm not predicting, maybe I'm looking in hindsight. BA.4.6 has been gradually increasing and now is up to about 7% to 10% of what we're seeing as far as circulating variants.

Brian Lehrer: Does something make it different from Omicron BA.4 or BA.5 otherwise? And would that affect the effectiveness of the new vaccine which was developed I think before this emerged, this 4.6?

Dr. Daniel Griffin: Yes, I am concerned because I haven't seen data on how well the boosters will do with the BA.4.6. We are a bit concerned about the Evusheld, that's that passive antibody cocktail we're still giving to our high-risk individuals. Recent stuff out of David Ho's lab right at Columbia suggesting that the Evusheld may not be protective against this newly emerging variant, so that does raise concerns of how effective will these new boosters be, and I think that circles us back to Paul Offit. We're going to have to wait and see.

Everyone is making predictions, talking about how we'll be getting yearly COVID shots. We don't know, this is a virus that is constantly evolving, and we have to be ready to constantly evolve our understanding and our response to stay ahead of it.

Brian Lehrer: Margaret in Manhattan, you're on WNYC with Dr. Daniel Griffin. Hi, Margaret.

Margaret: Hi. Thank you for taking my call. I have a question for the doctor. I am a severe asthmatic, an eosinophilic asthmatic, and I got very nervous a couple of months ago because it was seven months past my second booster. I got tested to see how many antibodies I had left, and I only had something like 50. I decided to go ahead and get the third booster, which is not the one coming out, but that was three weeks ago.

I'm scheduled to get my high-dose flu vaccine in a week, and then four weeks after that, which would make two months between the third booster and the new one, I was thinking of getting my Omicron booster, the new one, so that would be two months in between, the third booster and the Omicron booster. I've read different things, and I've heard different things that it should be at least two months, that would be fine. Then I heard three.

In the beginning, it was four months, and now it's after two months. I just want to be sure. I'm very particular about all these injections. I get them all because I don't have a choice. I'm wondering what your opinion is on that, and one more comment is that with these gatherings of people, timing your booster shots, [unintelligible 00:18:07] when you might be gathering with, you know.

I have to take a bus. The mandate was lifted yesterday by the governor, which kind of shocked me because these buses are in close quarters when they're crowded and you can't open the windows. To me, I'm nervous every time I get on a bus. I haven't been on a subway in four years because they're dangerous. I don't like going underground and picking up more bugs, and every four weeks, I get a shot of Nucala [crosstalk]--

Brian Lehrer: Because of your other conditions. She's put a couple of questions on the table. First of all, Dr. Griffin, I should say that our board and you've already taken a few of them is just filled with people trying to figure out the timing for themselves, if they already want, know they want this new booster, so she had another timing question in addition to the ones you've answered before. You can go ahead and answer hers.

Also, the lifting of the mask mandate on public transportation right now and her new hesitancy to take a bus, I also wonder if there's any good data on how protective just the user wearing a mask is for protection, incoming, if people aren't wearing masks around you when someone is infected.

Dr. Daniel Griffin: Yes, this is-- Caller, thank you, you really threw so many of the questions there, which is, again, which sort of gets me back to, you should be sitting down having a 20-minute discussion, 30-minute discussion with your provider about all the subtleties here, because there's a lot, but I'll hit on Brian which you just asked is we are back or we are still in the one-way masking or maybe we're very much more in the one-way masking zone?

When you get on that bus, the question is how do I keep myself safe when everyone else has taken off that mask? That's my experience as a healthcare worker over the last two years. A lot of my patients are not able to wear masks or not wearing masks.

How have I gone two years without getting COVID? These are those high-quality masks that we refer to, the N95, the KN95s. These have actually been shown to be quite protective in the one-way masking scenario. You want to make sure that it is fitted well to your face. You may, even when you go see your provider, have them take a look, "Am I wearing this properly?" One-way masking, particularly for our more vulnerable individuals, for people that have to ride the bus, this may be the way that they can keep themselves safe when everyone else is just done doing that.

Brian Lehrer: One of the reasons that I think they lifted the mask mandate for public transportation is that there was barely any enforcement anyway, and I think even when they were trying to enforce it, it was discovered that it's just really hard to enforce. What are you going to do? Have a public health official or police officer on every subway car, on every bus? The bus drivers weren't willing to do it for every passenger they picked up.

Really how could they? So this is sort of an acknowledgment of reality as much as anything else. Are you hearing it that way or maybe by just lifting the mandate they give more people who would have voluntarily complied permission not to comply?

Dr. Daniel Griffin: [laughs] No, this has been a challenge. I think early on people were really trying to do a better job with wearing that mask, keeping it on, but now I think we've all seen an erosion of the way people wear masks over the last year. I have a colleague who was going to sneeze. He pulled off his mask to sneeze into his elbow right in front of me, and you can imagine my reaction, "Really? That's when you want the mask on, when you're sneezing right in front of me." People take off their masks. They pull it down to what? Scream at the sports players?

People are pulling the mask off when they should be having the mask on. They're wearing that mask below their nose, and I'm asking, "Are you a mouth breather?" People have not been wearing masks in an effective way as time has gone by. Maybe the one-way masking is something that we really need to start embracing, particularly if you're an individual who is at higher risk, but nobody is at no risk of long COVID, so that's still that specter for everyone, even people who are not elderly, even people who do not have a number of medical problems.

Brian Lehrer: One more call. Ernest in Scotch Plains, who I think says he's a doctor. Ernest, you're on WNYC. Hi.

Ernest: Hi, good morning. I'm calling you because I'm very concerned as a physician. We have a vaccine that has been approved worldover called Novavax, and all we keep hearing about is the mRNA vaccines. Novavax is good for a broad array of the new variants. It's much safer, it has negligible side effects compared to the mRNA vaccines. It can be easily stored. It lasts longer, almost six months, and yet we don't hear anything whatsoever about this wonderful vaccine that has been approved by the World Health Organization, the European Union, Japan, South Korea, and Israel.

In fact, Israel is moving away from the mRNA vaccines, as is Taiwan. Why is the FDA slow-walking this vaccine? When they applied for the EUA back in January, it took seven months for them to get the authorization. They have applied for booster, and they are still slow-walking it. Come this fall and winter, we are going to be in rude awakening. Why are we putting all our eggs in one basket called the mRNA vaccines?

Brian Lehrer: Ernest, thank you for the global perspective and such an important question. Doctor Griffin, Novavax versus the mRNA vaccines from Moderna and Pfizer.

Dr. Daniel Griffin: Yes, it did take a while for Novavax to get approved here in the US, and a lot of people were saying, "Boy, if people aren't getting vaccinated, they're not going to get vaccinated anyway," but I have to say I had a number of patients that were waiting for the Novavax. It was a technology they felt more comfortable with, and it is now approved, and I have a number of my patients that are going through the series, getting those Novavax vaccinations.

It wasn't an issue with the science. The big issue and really troubling was manufacturing issues. When they would go out and inspect these manufacturing sites where the Novavax was supposed to be made, lots of quality control issues held things back, so no politics here, no holding something back because of the science. Holding stuff back because of safety concerns.

Brian Lehrer: Ernest, thank you. As we begin to wrap up, I assume you don't have any concerns that these new boosters were not tested on humans, only mice, right?

Dr. Daniel Griffin: [laughs] People keep saying that, but they have been tested on hundreds, like over 1000 human beings, not just mice.

Brian Lehrer: Oh.

Dr. Daniel Griffin: Yes. I think that's one of the things that's been circulating on Twitter, but each of these new bivalent boosters were tested on 600 human beings. That's where we got the data on the antibody level, so yes, despite what's circulating on Twitter, the truth is these have been given to human beings. We have data on human beings as far as response and safety, and now we're going to see them go into thousands, millions, and we're going to continue to get that safety and efficacy data.

Brian Lehrer: Another reason to get your virology information from TWiV, not Twitter. TWiV, This Week in Virology, the podcast that Dr. Daniel Griffin co-hosts. He's an Infectious Disease physician with a PhD in Molecular Medicine, researcher at Columbia, and chief of the Division of Infectious Disease at ProHEALTH. Thank you so much for coming on again and talking this time about the new Omicron-specific boosters.

Dr. Daniel Griffin: Thank you so much, Brian, and everyone, be safe.

Brian Lehrer: Brian Lehrer on WNYC. Stay with us.

 

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