Your "Dumb" COVID Questions, Answered (Part 2)
From second booster shots, to monoclonal antibodies, to the 12-month outlook, Dr. Jeremy Faust is here (again) to clarify our COVID confusions.
So, I’m back.
Here is Part Two of my interview with the brilliant Dr. Jeremy Faust.
Top ER Doctor and Harvard Educator.
WHAT ABOUT GETTING A SECOND BOOSTER SHOT?
ALINA CHO: On the front page of The [New York] Times [on Monday], there was a story about a woman who got five vaccines, five shots.
What is your feeling on people who will be eligible as early as next month for a second booster shot?
DR. JEREMY FAUST: I feel that this country is bizarrely over and under boosted. We are under boosted with respect to seniors and people with a handful of serious medical risks, immune compromised. Those people need a third and maybe even a fourth dose, because if they get infected, they still could end up in the hospital or worse.
ALINA CHO: The FDA, as you know, just approved boosters for 12- to 15-year-olds.
If you had a 12- or 15-year-old, what would you do? Would you boost them?
DR. JEREMY FAUST: Well, I haven't seen the 12- to 15-year-old dataset, but the 16- to 17-year-old dataset, I have seen. They approved that as well. I would be highly unlikely to boost a 16- to-17-year-old person in most situations, because I don't see what benefit it adds other than delaying the inevitable.
ALINA CHO: What do you mean?
DR. JEREMY FAUST: The two-dose series for a teenager has never been shown to wane with respect to any serious consequences. It's rock solid. In fact, the two-dose series against Omicron, for crying out loud, was 92% effective for 18- to 29-year-olds.
ALINA CHO: Wow.
DR. JEREMY FAUST: So, for me, if you're trying to decrease infections, you could boost every six to twelve months, and you'll get that temporary effect. But there's problems with that.
ALINA CHO: Which are what?
DR. JEREMY FAUST: Well, you can over boost. At some point, your body, if you boost every three, four months, or every six months, there is a situation in which our immune system needs to be able to do other things.
ALINA CHO: Well, what I read was that it can decrease your immunity, right?
DR. JEREMY FAUST: Yes, there’s this idea of immune maturation.
ALINA CHO: Exactly.
DR. JEREMY FAUST: I certainly wouldn't want to be giving people fourth, fifth, six doses without knowing what we're getting for it. If it's just about stopping an infection that sidelines you for a week, then to me, it's a matter of timing. We might want to get a yearly shot because we're heading into the season where we know it's bad. For me, I was thinking, "Well, maybe I want to get boosted when I know I'll be hanging out with people who are at risk." Whereas earlier in the fall, I really had no [reason to].
ALINA CHO: Got it.
DR. JEREMY FAUST: If you're boosting to stop infection, I question if that's sustainable. If you're boosting to decrease disease, then the data needs to show us that that actually happens. We clearly saw that with older individuals and people who are immunocompromised, but we have never seen that with younger people.
ALINA CHO: Right.
DR. JEREMY FAUST: The problem is that, at some point, you only incur risks, but you actually add on very, very little benefit. The other risk, by the way, is this rare myocarditis condition, which you probably heard about, this inflammation of the heart.
In the highest risk group, which is young adolescent, young adult males, it's as high as 150 cases per million.
ALINA CHO: Wow.
DR. JEREMY FAUST: Which is which not nothing, right?
ALINA CHO: That's right.
DR. JEREMY FAUST: At the level of the two-dose series, it's nothing. Because you're preventing thousands and thousands and thousands of hospitalizations with those first two doses. But if the third dose prevents one hospitalization, or none, or five or 10 out of a million, but causes 150 myocarditis hospitalizations, they've actually flipped the script. And you've given the vaccine deniers red meat.
WHAT ABOUT MONOCLONAL ANTIBODIES? DO THEY WORK?
ALINA CHO: Let’s talk about monoclonal antibodies. What I've read is that the GlaxoSmithKline monoclonal antibody is the only one that works against Omicron.
I've also seen that there is now a shortage of monoclonal antibodies in the US, probably globally. Do they work? How soon after a positive result should you be administering it?
DR. JEREMY FAUST: Everything you said makes sense. I think that [GlaxoSmithKline monoclonal antibody] sotrovimab, I believe, is the one you're talking about.
That's the one that still appears to work.
ALINA CHO: Right.
DR. JEREMY FAUST: I think that people who are at risk, older populations, need to have it early. That's why rapid testing is so helpful because it might catch you days before you would've gotten around to getting a PCR test.
ALINA CHO: Good point.
DR. JEREMY FAUST: The other monoclonals appear to not be working.
I think that even when they were working, they weren't working that well.
ALINA CHO: Interesting.
DR. JEREMY FAUST: The logistics of these things are really, really difficult. They're not like a pill. They're IV or they're injections. I think that any therapy that requires that level of medical care and expertise, which is nursing, doctors, it's hard to scale up, right?
ALINA CHO: Right.
DR. JEREMY FAUST: Whereas these pills that have come out, that's much more, to me, promising.
ALINA CHO: You mean [the] Pfizer and Merck antiviral pills?
DR. JEREMY FAUST: Yeah. This is more promising because pills are portable. They require no medical expertise to administer them. There's no difficulty getting that IV in. They're just so much more scalable to me.
ALINA CHO: And accessible.
DR. JEREMY FAUST: Exactly. The last mile is a lot easier, too. Good luck getting monoclonal antibody infusions into the middle of nowhere, where there's no good roads or whatever, let alone a refrigerator or a freezer. So, I tend to be pretty pessimistic on monoclonals' ability to…
ALINA CHO: Scale.
DR. JEREMY FAUST: ... change the shape of the curve.
ALINA CHO: Interesting.
DR. JEREMY FAUST: I think for people in remarkably wealthy circumstances, there's a role, and we should use them. But I've never seen them as the great beacon of hope that I think many have. I think that vaccines are that, and maybe some of these oral antivirals could be that as well.
THE COVID CRYSTAL BALL: WHERE WILL WE BE IN A YEAR?
ALINA CHO: With the number of infections that we're seeing right now, I know you don't like to look into the crystal ball, but are you hopeful about the next 12 months and where we will be a year from now? Could we reach herd immunity?
DR. JEREMY FAUST: Some of the words that get thrown around, like herd immunity, they bother me because they're imprecise, and they're a moving target. What I do think about when I think about something better in the future, or something hopeful, is a term that I use, which is herd protection.
ALINA CHO: Got it.
DR. JEREMY FAUST: We may not be immune to this virus, ever, because it might mutate.
But if we are all vaccinated and boosted as needed and if you combine that with some degree of protection from prior infection, the overall safety, the herd safety we have is growing every day, so that the implication of future infections is less severe, is less bothersome, is less worrisome, is less worrying.
ALINA CHO: Right.
DR. JEREMY FAUST: Barring a variant that, of course, sets us back, the only silver lining of these infections is that people who survive them walk away with some degree of immunity. So every day that goes by, we are closer to herd safety and herd protection.
ALINA CHO: That's music to my ears.
DR. JEREMY FAUST: Yeah. Which means that when we get an infection, it doesn't have to make your heart drop. You just go, "What a pain in the ass."
ALINA CHO: That's very encouraging news.
DR. JEREMY FAUST: I don't always agree with everything that [Dr. Anthony] Fauci says. I admire him deeply, but we have had our differences on some areas. But he did say something in [2021]. I remember when he said, "Well, I think things will start to look normal again in 2022."
I remember thinking, "Oh my God. That's a very long time from now. Why are you so pessimistic?” Now, as we get to 2022, I think, "Man, that guy…
ALINA CHO: That guy was right. He could be right.”
DR. JEREMY FAUST: I hope he is right.
ALINA CHO: Yeah. No kidding. No kidding.