There is a lot of discussion now about whether all adults should get a booster for COVID, even if they are at a low risk for complications. If you have risk factors such as increased age or certain medical conditions that put you at a higher risk for complications from COVID-19, or you are in a job that puts you at higher risk of contacting people with COVID-19, you should definitely get the booster. However, there are many young and healthy people who are wondering if they should get the booster shot. While I can’t answer that question for everyone individually, here are some my thoughts about this:

• Many health experts are recommending that all adults ages 18 and over get a booster shot for COVID-19. From a public health standpoint, this makes sense. The booster shots have very few side effects and can provide additional protection against becoming infected. We do know that the immunity that you get from the regular series of the vaccine does begin to fade after a few months, and that getting a booster shot decreases your chance of getting infected with coronavirus, as well as making it less likely to transmit it to someone else. From a strictly public health standpoint, the more people that get a booster shot, the less likely they are able to transmit the virus to other people in the community who have not been vaccinated, can’t get vaccinated, or are at high risk for complications if they happen to get a breakthrough infection. Therefore, if you want to “do the right thing” and protect other people in the community, go ahead and get a booster shot even if you are at low risk.
• Some people understand that the risks of side effects from vaccines are very low, and they would like to be as protected as possible against all kinds of infections. Even if you are healthy and are at low risk for major complications from COVID-19, a small percentage of people who get the infection then develop long-term symptoms even after they recover, and the best way to prevent that is to avoid getting infected in the first place. If you are afraid of getting “long-haul” COVID-19 symptoms, you should go ahead and get a booster shot.
• Some people are not afraid of getting COVID-19, but they are around kids who are too young to get vaccinated, or are around people who are older or have significant medical conditions that puts them at risk for complications from the virus. You may be at risk for unknowingly transmitting the virus to these individuals, who can then develop a serious case of COVID-19. If you are in this situation, you should go ahead and get a booster shot.
• Some people may have had the full series of COVID-19 vaccine but then several months later, end up with a mild breakthrough case and are now totally recovered from it. These people can be considered as if they already had a “booster” by actually getting infected with the virus itself. Although the experts still say you should get a booster shot, I feel that it may not truly be necessary right away. It is unclear at this point whether getting infected with the Delta variant after receiving a full series gives you as much protection as a booster shot, but from a scientific standpoint, it is likely to give you pretty good protection. I would probably wait about 4-6 months after recovering from a breakthrough infection and then actually getting a booster shot at that point, although it would not hurt you if you get it earlier.
• Some people have been fully vaccinated but had significant side effects from the vaccines and are therefore hesitant to receive a booster shot. If your side effects were over within a few days and you have no residual from it, I would still say it is best to get the booster. If you feel like your symptoms were much more severe, you can certainly make an appointment and we can discuss your individual situation.
• If you are someone who is at low risk for complications, are not around anyone at risk for complications from COVID-19, and you plan on staying at home with very little interaction with other people for the next several months, that I feel that it is reasonable to hold off on a booster shot for now.

The bottom line is that if you are 18 years or older and want to get a booster, you should be able to get one. We will have both Pfizer and Moderna vaccines in the office, so call for an appointment.
 
The Omicron variant
​
Just a quick word about the recent news this weekend regarding the discovery of the Omicron variant, initially seen in South Africa but now being found in many other countries around the world. Although many people are worried about this variant because it has so many mutations on the spike protein, we don’t know yet at this point if it is much more transmissible or possibly more deadly than the current Delta variant. More information will continue to be coming out within the next week or two. Remember that even if we do see more people that are hospitalized with a new variant, it does not mean that it is more deadly – it could just be more transmissible. If the old virus causes 10% of people to be hospitalized and it infects 1000 people, we will see 100 people in the hospital. However, if the new variant also causes 10% of people to be hospitalized but it is much more transmissible, it could infect 10,000 people, and we would therefore see 1000 people in the hospital. People should not panic at this point, but I would continue to wear masks indoors if you are going to be in close proximity with many other people. While that is true that the face masks we wear do not provide 100% protection against transmitting or becoming infected with coronavirus, it is certainly better than not wearing a mask. Furthermore, wearing a mask is respectful to the people around you, as they may be at higher risk for complications from the infection, and wearing a mask decreases the risk of you transmitting anything to them. Stay tuned, as more information about the Omnicron variant should be discovered in the next few weeks.

Right now we do NOT have any COVID-19 vaccines in the office. Vaccine storage requirements recently changed, and we are in the process of getting re-certified. The earliest we will get any is November 1, but it is not guaranteed. Please do not call the office to schedule any boosters until after that date. If you get the booster at a local pharmacy, please let us know so we can document it. With the CDC coming out with their guidelines last week, here is what I am recommending regarding COVID-19 vaccine boosters:

• Pfizer: Boosters have already been authorized and are recommended at least six months after your second dose of Pfizer if you fall into the following categories:
  • You SHOULD get a booster if you are 65 years or older; or you live in a long-term care setting; or you are age 50-64 and have underlying medical conditions ; or you age 50-64 and are at increased risk of social inequity 
  • You MAY get a booster if you are age 18-49 and have underlying medical conditions or are at increased risk of social inequity; or you are age 18-64 with no underlying medical conditions but are in an occupation which puts you at a higher risk of exposure to COVID.
• Moderna: Boosters are now authorized and are recommended at least six months after your second dose if you fall into the following categories:
  • You SHOULD get a booster if you are 65 years or older; or you live in a long-term care setting; or you are age 50-64 and have underlying medical conditions; or you age 50-64 and are at increased risk of social inequity.
  • You MAY get a booster if you are age 18-49 and have underlying medical conditions  or are at increased risk of social inequity; or you are age 18-64 with no underlying medical conditions but are in an occupation which puts you at a higher risk of exposure to COVID.
  • Unlike Pfizer, the Moderna booster is half the strength as the original two shots. This is important because there is a difference between the Moderna booster versus the Moderna third shot. Boosters are given in individuals who have received a full series of the vaccine, but over time, their antibody levels fall and therefore need a “boost” to increase the antibodies again. On the other hand, third shots are recommended in individuals who have a compromised immune system, and therefore their two shots never get to an acceptable level of protection. They need that third shot to get their antibodies high enough to protect against COVID-19. These third shots are actually a full-size dose of the vaccine, not the half-size shot for boosters. Individuals who need this third shot include people who are actively being treated for cancer, have a diagnosed immune system deficiency, or are on immune suppressing drugs. If you are unsure if you fall into this category, please contact our office.
• Janssen/Johnson & Johnson: Boosters are now authorized and are recommended at least two months after your second dose for EVERYONE. The single shot vaccine does not appear to be as effective as the other two, so it is recommended that everyone get a booster shot.
• If you do not fall into any of the categories for receiving a booster but would still like to receive one, please contact the office and we will put you on our list. As before, we will likely have doses that will need to be thrown away at the end of the day if they are not given out. We can contact you to see if you want to get a booster dose instead of having that dose thrown away.

With regards to the “mix and match” of vaccines, there are some studies that show that using a different vaccine as a booster may lead to a higher increase in your antibodies. At this point, I would only recommend that if you got the Johnson & Johnson shot initially, you get a Pfizer or Moderna booster as your booster shot. Studies show that a second Johnson & Johnson shot does increase your antibodies, although not to the degree as a booster with the other two vaccines. Some individuals who got the Johnson & Johnson shot did so because they wanted to avoid the other two, and if that’s the case, then by all means get a second booster of the Johnson & Johnson vaccine. Also, there was a study showing that Moderna as a booster may lead to a numerically higher amount of antibody production compared to Pfizer, but it is unclear how significant this is. Therefore, if you had Pfizer for the first two shots, I am not recommending that you get Moderna over the Pfizer booster, but if you want Moderna as your booster, we will be able to give that to you as well. The vast majority of studies for boosters are with the same shot as the first two.
Finally, there has been some information about a new pill from Merck that has been shown to be helpful in treating COVID-19, but it is currently not approved. When more information is available, we will contact you again.

Influenza Vaccines:

Flu season is coming soon, and we are making preparations to vaccinate our patients. We had a light flu season last year because we were wearing masks all the time, but this year, with no mask mandates and everything being open, we will probably have many more cases of the flu. We feel the optimal time to get vaccinated in San Diego is late October or November because flu season here peaks around January, and by vaccinating at that time, you will have the most antibodies to protect you around the peak of flu season. However, if you are traveling out of town before November, you can certainly get your vaccine sooner. The CDC usually recommends getting the flu vaccine right now, as early as it's available, but that's because they are more concerned about developing "herd immunity" in a community -- if more people are vaccinated early on, there is less chance that influenza hits that community hard later on.

Once again, we will be carrying TWO different flu vaccines. We have the usual 4-strain (quadrivalent) flu vaccine that everyone is eligible to receive. We also have a HIGH DOSE 4-strain vaccine called Flublok. This vaccine has three times the amount of antigen for 4 different strains, and studies show that it gives 30% better protection than the usual 4-strain flu vaccine when tested in patients ages 50 and above. There is also a "senior” flu shot called Fluzone High-Dose which also protects against 4 strains of influenza. Given a choice between the two of them, I would choose Flublok because it is not grown in eggs, which prevents possible mutations that can occur in egg-grown vaccines. However, the difference is not huge, so if you can’t get Flublok, the Fluzone High-Dose is certainly a good substitute. Therefore, we are recommending the Flublok vaccine in all patients ages 50 and above. If you get your flu shot elsewhere, please let us know so we can document it, as we do try to monitor how many people get their flu shots annually. And if you are going to get a COVID-19 vaccine booster, know that it is OK to receive a COVID-19 vaccine together with a flu shot.

Most insurances, including Medicare, do cover all flu shots, but if it is not covered, Flublok costs around $80. If you happen to be in the Ximed building Tuesday, Wednesdays or Fridays, you can just stop by the office to get the vaccine. If you want to come in on Mondays or Thursdays, please call us first. If you have questions, please contact our office by phone at 858-452-7040 or through your web portal (accessed through www.sun-md.com).
 
Update on COVID-19 Boosters

We finally have some guidelines on boosters, but things will continue to evolve. This is what we know right now:

• The advisory panel to the FDA gave recommendations on September 17 that certain groups of people should get a COVID-19 booster vaccine. This is just the advisory panel’s recommendation, and the full FDA, as well as the CDC, will still need to give their recommendations, which should occur within the next week or two.

• This recommendation is ONLY for the Pfizer vaccine, as that was the first one that was developed and come out to market. Moderna still has to get full FDA approval, and recommendations for their booster vaccine probably won’t happen until after they get full approval. Recommendations for the J&J vaccine will also come later.

• The proposed recommendation for the booster is for eight months after the second Pfizer shot. To be due for your booster today, you would have to have received your second Pfizer shot at the end of January.

• Who qualifies for a Pfizer booster shot, eight months after their second shot?
  • Individuals ages 65 and older
  • Individuals whose jobs put them at a higher risk of contracting COVID, including healthcare workers, first responders, teachers, and other groups
  • Individuals who are at high risk for complications from COVID. This has not been defined yet, and more clarity will occur when the FDA and CDC give their final approval.

• What if you are 64 years old and don’t meet the other criteria? You really should not worry because all 3 of the vaccines have still been shown to be excellent at preventing severe disease and death, even after the eight months. Over the next few months, they will continue to look at the data and decide if additional people should receive boosters.

• What are we doing in the office? We are still getting small shipments of Pfizer and Moderna vaccines and will be giving third shots in people that meet the appropriate criteria once they are announced. Even though it is not officially recommended to give third shots yet, if we have open vials of doses that will otherwise have be thrown away, we are still utilizing our list of people who want a third dose before the official recommendations come out.

• What should you do? If you had the Pfizer vaccine, feel like you meet the criteria for a booster shot, and want to get it at our office, PLEASE DO NOT CALL THE OFFICE. Instead, send a message through the portal or email drsuncovidvax@choice.md with the following information: your name, age, date of your second Pfizer vaccine, and whether you work in a high risk profession or have a high risk condition.

We will continue to provide you with more updates as information becomes available.

Recently, there has been a lot of information in the news about COVID-19 boosters in people that have already been fully vaccinated. There is some evidence that vaccines may start to lose full effectiveness after a few months, but there is other evidence that protection may last for years. With the current outbreak of the Delta variant, a fair number of people who have been fully vaccinated are still contracting COVID-19, but it is important to note that these breakthrough infections are almost always mild and do not lead to severe disease or death. These are my thoughts on COVID-19 vaccine boosters:

• First, I want to emphasize that people that have not yet been vaccinated should get their vaccine now. Many people feel that they are healthy and are unlikely to catch it. However, the Delta variant is much more transmissible and can still severely affect healthy individuals. I recently admitted somebody to the hospital who was a healthy unvaccinated 60-year-old man taking no medications. His daughter’s boyfriend’s boss came down with COVID, and his daughter and boyfriend both tested positive even though they had no symptoms. The patient unfortunately caught it from his daughter, got admitted to the hospital, and is now in the intensive care unit because of respiratory failure. Had he been vaccinated, he likely would NOT have required hospitalization.

• I agree with the World Health Organization that, with rare exception, people who are fully vaccinated do not need a booster at this time, and it is important that the rest of the world receive their first vaccine doses. Unvaccinated countries can lead to widespread transmission of the virus in their populations, causing more virus mutations and then potentially spreading to people who have fully been vaccinated. These mutated strains may not respond to the current treatments for COVID-19. To this end, the US has already shipped more than 110 million doses to other countries to aid in the worldwide vaccination effort.

• We are still conducting studies to see if certain population groups would benefit from a booster shot, and once the recommendations come out, those people would be eligible.

• If you have been fully vaccinated, and you do end up contracting COVID-19, you have a less than 0.01% chance of being hospitalized from it, and less than 0.001% chance of dying from it.

• Because vaccinated people can still catch and transmit COVID-19, I recommend that everyone who has cold-like symptoms or unexplained fevers to still get tested, either through the traditional testing sites, or through at-home antigen self-testing (click the COVID-19 tab above to read more).

• Likewise, if you have cold-like symptoms or “allergy” symptoms, please do not come into our office for your regularly scheduled appointment without calling us first.

Having said all this, is also true that there have been over a million doses of COVID-19 vaccines that have gone to waste in the US because they have expired or not enough people are choosing to get them. Our office is currently receiving only excess vaccine doses from health facilities that cannot use them, and we are not ordering them directly from the government. From my standpoint, instead of letting these doses go to waste when they expire, I would rather have someone receive them as a booster shot, even before we have definitive evidence that they are beneficial. I feel that as long as there is a chance that a booster shot will be beneficial, and any risks from the shot are negligible, it would be worth putting that vaccine in someone’s arms as opposed to in the trash can. To that end, we are now accumulating a list of people who are interested in receiving a booster shot. Because the data have not come back yet, we cannot say if it would be better to get the same manufacturer as your first vaccine or a different one. We will prioritize individuals over age 65 and those on immunosuppressive medications first, as these individuals are likely going to be the first that will receive approval for a booster shot if and when it is needed. If you are interested, please send us a message through the portal or email us at  drsuncovidvax@choice.md and let us know your name, phone number, and which vaccines you are willing to come in for.

By now, most people who have wanted the COVID-19 vaccine have probably already received it.  If you haven’t, or know someone who hasn’t, please read on.  With the increasing number of infections in the US right now, it’s important to know the following information:
​

• The increase in infections is largely because of the Delta variant of the virus, first detected in India.  This variant is definitely more contagious, so it spreads more quickly than the original strain, although most studies show that it is NOT more deadly.  However, even if a virus is not more deadly, it can still lead to more deaths.  If a virus kills 1% of people that it infects and is transmitted to 1000 people, you would have about 10 deaths.  But if the same virus is more contagious and is transmitted to 1,000,000 people, you will have 10,000 deaths, even though it is not more deadly.

• All 3 vaccines currently available in the US are extremely effective at preventing hospitalization and death from COVID-19.  Of the people that are currently hospitalized or die from COVID-19, more than 95% of them have NOT been vaccinated.  If you are fully vaccinated and still happen to get COVID-19, the overwhelming odds are that you will have mild symptoms and recover without any long term consequences.

If you are interested in getting the vaccine, we now have them available to give at our office, so please call us to schedule an appointment. 

For those of you who are still hesitant, here are my responses to several of the issues that people may be concerned about:

The vaccine approval process was conducted too quickly

It is true that most vaccines have taken much longer to receive authorization or approval.  This is because when a vaccine company starts testing a vaccine, they start off with smaller trials, and only when they are shown to be successful, do they move on to larger and larger trials.  Vaccine companies don’t want to spend a lot of money up front since they don’t know if their vaccine will be successful.  After their final trials are successful, they then have to manufacture the vaccines, which also takes a lot of time.  However, the Trump administration correctly offered to help fund several of the trials to allow them to be conducted much quicker (although Pfizer did not take any such money for their vaccine development), as well as guaranteeing to purchase millions of doses for all their vaccines.  This allowed the companies to produce millions of doses even before they knew if their vaccine was going to be successful.  If their vaccine was NOT successful, the government would have paid for those doses anyway, they just would not have been administered to people.  What this allowed was the immediate distribution of millions of doses that were already manufactured, ready to be given as soon as the Emergency Authorization was received.  So while it seems like the time line for the vaccine development and distribution was so short, this was NOT because scientific corners were cut, as all the proper steps were still followed, but instead, this occurred because we conducted and performed all of these steps at the same time, as opposed to waiting for each step to finish before moving on to the next step.

One other important reason why we were able to conduct these studies quickly was because of how prevalent COVID-19 was while the studies were going on in 2020.  If you are testing a vaccine against Ebola, you give half the people the vaccine and half the people placebo, and then you have to wait for a while so that enough people get Ebola, and then you can compare the two groups to see if the vaccine group contracted the disease less often.  For COVID-19, the disease was so prevalent last year, and we had many high risk groups such as nurses and doctors caring for sick COVID-19 patients in the hospital on a daily basis, that we didn’t have to wait very long before we could see the benefit of the vaccines.

The vaccine is experimental and we don’t know the long term side effects

While it is true that the Pfizer and Moderna vaccines are the first vaccines that utilize messenger RNA (or mRNA) to generate the immune response, that is really not a big deal.  Scientists have been researching mRNA vaccines for HIV and Zika virus for years – COVID-19 is just the first mRNA vaccine that has received emergency approval.  You should first realize that our genetic material is encoded by DNA in our cells, and in order to translate that DNA into proteins, we use mRNA that our body produces.  Therefore, mRNA is not a new substance, and it’s certainly not something that we don’t know anything about.  It’s something that is already in each and every one of us right now.  The Johnson & Johnson vaccine is called a viral vector vaccine, and it is the same method that the current Ebola vaccine utilizes.  This video does a good job explaining the various types of vaccines that are currently being evaluated as ways to deliver the COVID-19 vaccine.

With regards to side effects, it is important to know that other vaccines that we currently use (and that already have FDA approval) do not have any real long-term side effects.  There are certainly short-term serious side effects that are possible with the COVID-19 vaccines. However, they are still very rare, so it is important to know about them, but they should be put into perspective.

• The Pfizer and Moderna vaccines have been associated with inflammation of the heart muscle, mostly in males under age 30.  However, this has occurred in about 12 cases per 1 million vaccine doses given, the condition is self-limited, and people usually recover fully.

• The Johnson & Johnson vaccine was found to be associated with the possibility of blood clots associated with low platelet counts in the body.  This was mostly found in women under age 50 and occurred at a rate of about 3 cases per 1 million vaccine doses given. The reason the vaccine administration was halted temporarily was not because of how common this side effect was, but because the treatment of these blood clots is different than the usual treatment of using a common blood thinner, which would actually be harmful for patients with blood clots from the vaccine.  Therefore, it was important for all practitioners to know about the possibility of this side effect so that the wrong treatment was not used.  By stopping the administration of this vaccine for several days, this information got out to all practitioners so that physicians would know the right way to treat these types of blood clots.

• Recently, the Johnson & Johnson vaccine was also found to be associated with a rare auto-immune neurologic disorder known as Guillain-Barré syndrome that was found to occur at a rate of about 7-8 cases per 1 million doses given, mostly in men over age 50.  This is a disorder that can cause weakness and paralysis and has also been associated with getting an infection with certain bacteria or viruses such as influenza or Zika virus.  On average, we see approximately 17 cases per 1 million patients hospitalized with influenza.  Once again, the chance of getting this side effect is extremely rare.

The important thing to know after reading about these possible side effects is that the COVID-19 vaccines are the most studied vaccines in our history.  We are constantly on the lookout for possible side effects, and all the data to this point shows that these vaccines are extremely safe.  The major side effects occur in less than 10 cases per 1 million people, which is 0.00001%.  Putting it another way, every year, more than 100 people out of 1 million in the US will die in a car accident, so your chance of dying in a car accident each year is significantly higher than a serious side effect from the COVID-19 vaccine, and yet people are willing to take that risk and drive every day.  The benefits of being protected with the vaccine far outweigh the risks associated with any possible serious side effects.
​
So for those of you who have not yet been vaccinated, please reconsider and get vaccinated to protect yourself and those you love.  Please call our office if you want to schedule a vaccination or would like to set up an appointment to discuss it further.