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In the last week of June, some 6,000 people in the United States were hospitalized for COVID. In the last week of July, that number had climbed to 9,000 – still a historic low level but definitely an upswing. WHO reports that global numbers are climbing as well.
It's a reminder that even though the World Health Organization and the Centers for Disease Control and Prevention have declared that the COVID "emergency" is over and data collection is nowhere near as rigorous as it has been, the pandemic is not over.
"Indicators all point to an uptick, which is expected based on prior summers," says Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and an infectious disease specialist.
So folks may be worried, especially if they are in a higher risk category and/or are planning late summer travel, sending kids back to school or in regular contact with older folks, who stand a greater chance of developing severe disease.
That raises the question: What to do about boosters?
If you're keeping score, the Centers for Disease Control and Prevention first recommended an updated (called bivalent) COVID-19 vaccine boosters in September 2022 for people starting at age 12. This bivalent vaccine brings about an immune response against two variants of the virus.
These boosters, manufactured by both Pfizer and Moderna, protect against both the original virus that causes COVID-19 and the omicron variants BA.4 and BA.5.
The recommendation was updated in April 2023 to include children 6 months and older in April 2023. The updated guidance also "allowed" (rather than recommended) a second bivalent booster dose for people 65 and older so long as it was given at least four months since their last shot. The four month waiting period is because "if spaced too close together there could be interference with the immune response," says Dr. Adalja. In other words, the second vaccine might not be as effective in stimulating an immune response if it follows too quickly on the heels of a previous booster.
The minimum of four months is based on theory, however, and not on studies, says Dr. Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau in West Hempstead, N.Y.
People who were immunocompromised got the booster nod as well, along with guidance to talk to their doctor about additional boosters, two months apart — that's because of concern that people who are immunocompromised may not mount a robust response to the vaccine and so could benefit from getting a booster more often.
Meanwhile, there's a new booster expected this fall that should be more effective against the currently circulating strains of COVID. Based on guidance from its vaccine advisory committee, Pfizer and Moderna are developing vaccines using XBB 1.5, a subvariant of the omicron variant responsible for a growing number of infections. The revised boosters are expected to be available by the fall although there is as yet no definitive date.
The current boosters contain both the original virus and two variants BA.4 and BA.5, none of which are still circulating. The vaccines still hold up pretty well against severe disease, but are not thought to be very effective against getting the virus at all.
New variants continue to emerge with most of the difference in the spike protein on the virus's surface. The goal is for updated vaccines to better detect the different spike proteins on the surface of the new variants and so better prevent the virus from entering and infecting cells.
After the FDA approves the new vaccine version, expected in the next few weeks, it will be up to the Centers for Disease Control and Prevention to decide who in the U.S. should get it and how often.
So should you go for a booster now? Wait until fall? Or is a double dose advisable?
"The timing right now is a little bit funny," says Dr. Abraar Karan, a infectious disease fellow at Stanford. The dominant variant in the U.S. is EG.5. Neither the current booster nor the booster coming this fall is an exact match although the fall booster will be "closer to that strain than the old shots," he says.
But if you're worried enough to consider a booster before the fall booster's debut, Karan says: "I would discuss your individual situation with your doctor because it is complicated and for most people, it won't provide much benefit," Karan says.
Dr. Preeti Malani, an infectious disease specialist at the University of Michigan School of Medicine largely agrees. "Waiting for the new vaccine will provide a better match to the currently circulating variants," she says.
Malani adds: "There might be some very specific scenarios under which we might recommend the bivalent vaccine right now instead of waiting for the newer formulation but for the majority of people, better to just wait and be careful about exposures" and use the familiar strategies, like wearing masks in crowded indoor settings.
But the decision "is a bit nuanced," she notes. For example, she says, if you had all the recommended vaccines/boosters but it's been a long time since that last booster – maybe you got it in fall of 2022 — and you have not had COVID and are heading out on a trip, it's not unreasonable to get the current booster and then wait a few months to get the new version in the fall.
By contrast, she advises, if you've had COVID at any point during the pandemic (which enables your body to better fight off future infections) and are up to date on vaccines and boosters and not high risk medically, it's probably fine to just wait for the fall vaccine. Like Karan, she highly recommends a conversation with your health care provider to guide your decision.
Dr. Paul Offit, head of the Vaccine Education Center at Children's Hospital of Philadelphia and a member of the FDA's advisory committee, adds that people who haven't had the most recent booster and are at high risk of severe disease should talk to their doctor about getting the shot now. That groups includes older adults, people with underlying health conditions, pregnant women and people who are immunocompromised.
While the current booster isn't well matched to the current variants, "it's holding up well against severe disease," Offit says. He credits a type of immune memory cell, called a cytotoxic T cell, which kills cells infected by the virus, limiting how much virus a person is exposed to. Offit says that "people who have been vaccinated or naturally infected can take heart in the power of immune memory cells, which are highly effective in keeping people out of the hospital and out of the morgue."
Doctors say patients have also asked if getting too many COVID shots might diminish their benefit. There is a concern, says Dr. Adalja, that the prior series of initial vaccinations and boosters directed against the original version of SARS-CoV-2 could cause the new updated boosters to be "swamped by the prior immunity and stifle the ability of the immune system to respond to the new vaccine."
Remember tests? They still come in handy.
Offit advises people at highest risk of contracting COVID-19 to have tests on hand to use if they develop symptoms that could be COVID.
Common COVID symptoms right now include sore throat, congestion, cough, runny nose, fatigue and fever. Some people have reported gastrointestinal problems and pink eye. Read the CDC's full list of possible COVID symptoms here.
Offit says especially people in the highest risk category who come down with symptoms should test within the first day or two and reach out to their doctor if the test is positive to discuss a prescription for antiviral treatment such as paxlovid to help prevent severe disease. The drug is often underused – a research letter in JAMA found that that is the case in nursing homes. There may be concerns that paxlovid can interact with other drugs being taken although your doctor may be able to take you off those drugs for the five days of paxlovid treatment or find alternatives.
Kids and COVID
Then there are those back-to-school COVID jitters, since there's typically been a surge in the fall and winter as people are indoors more.
Parents should talk to their health-care providers about kids staying up to date on boosters, especially now that cases are already ticking up, according to the doctors we interviewed. One bivalent booster dose is recommended for children six months and older, says Dr. Adam Ratner, an infectious disease specialist at NYU Langone Health. "I do think the uptick is a signal for people to pay more attention and to start thinking about the risk of COVID-19 again, especially as kids are getting ready to go back to school," says Ratner. "The number one thing that parents can do for their kids to help keep them safe and in school is to make sure that they're up to date with their COVID vaccines."
Ratner also advises parents to make sure their kids are vaccinated with the new booster if it's recommended for children.
"A harder question to answer," says Ratner "is what precautions children should take, including at school since most schools have done away with masking and are not doing routine testing of asymptomatic kids and adults, which is understandable since there's much less COVID around than there was in the past."
Ratner says he thinks families need to have conversations about risk tolerance "which is a hard situation to put families in." And your risk tolerance as a family may be very different if you have someone who's immunocompromised and/or elderly and who lives with you.
He suggests talking to your kids about situations where they might mask or distance — like indoor sports games, for example: "So not wearing a mask most of the time but wearing a mask when you're in crowded situations with lots of people and paying attention to information on the COVID situation in your community by checking alerts, for example, from the local health department."
And there's still a need for testing, says Ratner, if you feel symptoms or have been exposed to someone who tested positive. "The need to test hasn't gone away just because tests [are no longer paid for by the government.]" The world is in a much better place than we were a year or two ago, he says, "but it's not a situation yet where we can declare victory."
And ... will COVID precautions now come at a cost?
Although the federal government stopped purchasing doses of the existing COVID vaccines in early August, many pharmacies likely still have the federally purchased doses in stock and would continue to administer them at no cost regardless of a person's insurance status, says Cynthia Cox, a vice president with the Kaiser Family Foundation.
"Just to be on the safe side, though," says Cox, "if you're going to get a shot now, it's probably still a good idea to call ahead and confirm with your doctor or pharmacy that the dose they are administering is indeed free." If there is a charge, you could check with other pharmacies to see if they are still stocking the no-cost government-purchased vaccine doses.
As for the booster coming in fall, health insurance should pay for it – but if you are uninsured or face high copays for COVID care, a new program from the Department of Health and Human Services may help cover your costs. Bridge to Care, launching this fall, will provide free vaccines and treatment to people who cannot afford them through many health-care providers, community clinics and pharmacies.
And what's the word on testing?
Dr. Karan says people are likely testing less for COVID-19 because they may mistake the virus for other respiratory illnesses "or may not want to test [because it] may then force them to decide whether to isolate and miss work or social events."
But he's an advocate of testing, pointing out: "If people test with at-home tests, it can personally help them isolate and protect people at risk of severe disease or seek out appropriate treatment."
However, those tests, once provided for free from the federal government, are free no longer. Expect to pay $15 to $30 per test kit online and in stores. But, the FDA has extended the expiration dates of some tests so check the ones you may still have stashed away to see if they can still be used.
Fran Kritz is a health policy reporter based in Washington, D.C., and a regular contributor to NPR. She also reports for the Washington Post and Verywell Health. Find her on Twitter: @fkritz
