Building The Plane While We Fly It, Part 706

Our lull in the middle of mild storm clouds continues. In Massachusetts the number of cases has ticked up a bit. The number of people in the hospital is stable and a fraction of what in was in January (like 200 vs 3000) . The wastewater has again gone up which is ominous for some kind of surge in a couple of weeks but it’s not currently indicating a huge nightmare of cases.

We are seeing unmasked schools with a bit of an uptick as well. The colleges, too. We knew this would happen — that as soon as the masks came off, the bugs — Covid, flu, rhinovirus, etc — would come bouncing in. And sure enough.

One thing cancer patients have taught me is that there are very different ways of seeing the same numbers. There is the glass half full and the glass totally empty. I am (if you haven’t caught on yet) a glass half full person which is why I myself am reassured by the numbers RIGHT NOW.

Our numbers are rising, no doubt about it; but the numbers are still low relative to what they once were. Our chances in Massachusetts of walking into a store or a dance recital or a restaurant and sitting next to someone who is currently actively contagious is pretty low this week, particularly as compared to the craziness of February.

So even though there’s a little uptick right now, this upcoming week still looks good. A lot of experts think cases will go up for a bit after that, but hopefully not hugely, and not for long, and not with huge horrible life and hospital disruption for the population as a whole. (Individual people and families and work-teams, yes, but society as a whole: no.)

So the question of the day is: should you get another shot (i.e., booster number two)?

First off, if you’re confused or feel muddled about this, you’re in good company.
The main reason people for this confusion is that once again we are “building the plane while we fly it”: we’re having to make recommendations before there’s been time for long-term real-life data to emerge.

Right now, who qualifies for a second booster?
—Over 50
—People with certain medical conditions that place them at higher risk for getting serious Covid (more on this in a moment)

Special snowflakes:
J&J people: You can get a THIRD shot. If you have had two J&J shots (one primary, one booster), you can now get a second booster using an mRNA vaccine (Pfizer or Moderna)

Immunocompromised: you can get a FIFTH. People with serious immunocompromise should have gotten three primary doses and then a booster, and now can get another booster.
So should you get one if you’re over 50 or have one of the very many medical conditions that put you at higher risk to get bad Covid?
Here are possible answers:
—- Yes, immediately because you are at high risk or for whatever reason you do not want to take any risks whatsoever right now
—- No, maybe wait and see what happens next
—- Yes, if things change so your risk goes up

Which category do you fall into?

People are in the YES IMMEDIATELY category if they are elderly, have multiple serious medical conditions, are seriously immunocompromised or live with unprotected people

The NO, WAIT AND SEE category might consist of:
— people who are (of course!) already vaccinated and boosted but are lower risk because of younger age and no medical problems
—people who are willing to assume the risk of getting Covid and having their lives disrupted for a week or two
—people who are willing to accept the unknowns about what their chances are of long covid or covid complications after vaccination (answer: we don’t know)
— people who were recently infected and so presumably have some (not complete but some) protection for a few months
—people who are willing to go get a second booster the second cases look like they’re rising (watch that wastewater!) or if they are going to travel to higher-incidence areas.

People who say YES MAYBE if risk goes up could be people who live in low-case areas but decide to travel, people who develop medical problems or find out a medical issue they’ve got has been added to the list of risky conditions.

This is an important point — the CDC adds new “higher-risk medical conditions” every couple of months as the data evolves and the plane gets built. It’s not just “chronic lung, kidney, heart disease” anymore.

Each time a new study comes out saying, “Hey look, we’ve seen worse outcomes in people with XYZ disease,” the CDC looks at the literature to see if this is a real trend. Then, if there’s multiple other studies showing more hospitalizations and deaths in people with XYZ disease, they add it to their list of “People with Certain Medical Conditions.”

In February they added physical inactivity, disabilities and primary immunodeficiencies as possibly associated with higher risk of severe Covid. In October they added schizophrenia, depression, chronic liver disease. And pregnancy and substance use disorders were added last year. And we’ve known for a long time that being in a racial or ethnic minority group is higher risk.
It’s also become clear that having MULTIPLE medical problems seems to be particularly additive for risk.

So if all you’ve got is a little high blood pressure controlled with a low-dose med, that’s one thing. But if you’ve got several major medical problems AND you’re a couch potato AND you’ve got depression AND etc, you should recognize you are at higher risk for severe Covid and you should consider boosters earlier and often.
It’s worth checking out CDC’s website on medical conditions. It’s at the following address. https://www.cdc. gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#MedicalConditionsAdults. Please note I put a space between cdc and gov so as to not annoy the FB gods. The link will work when you remove the spaces.

Finally, if you get Covid and you do have major medical issues, or you’re over 50, or you have a BMI > 30, or you are at high risk in any way, you should IMMEDIATELY contact your doctor about getting Paxlovid. Paxlovid is a five-day oral anti-viral medicine that is currently acting like a miracle cure for people — it’s said to have an 89% effectiveness at preventing hospitalization, and it clearly reduces symptoms and viral load as well.

My doctor friends who have taken Paxlovid describe it as “feeling at death’s door at 24 hours, hopped out of bed at 32 hours,” or “It’s fantastic. You can sort of see which way the wind would have blown. And then it doesn’t blow – just slowly calms down and stops.”

Covid is still around and can work its way around our precautions. We are much much safer than we were 18 months ago, though, thanks to VACCINES. And now, even if you are high risk, a BOOSTER can help minimize risk for at least a little while and PAXLOVID can help minimize suffering. So nice to see this airplane getting built!