Transcription:
The Third Shot and COVID-19 Boosters

Caitlin WHyte: As we head into the fall, we're now digesting new COVID-19 information regarding booster shots, variants and more. It can all get a bit confusing at times. So joining us to break down some of this new information is Dr. Gian Varbaro, the Chief Medical Officer at the Bergen New Bridge Medical Center.

This is Wellness Waves, a Bergen New Bridge Medical Center podcast. I'm Caitlin Whyte. Doctor, let's start first with all of these variants we're hearing about. There's original COVID and now the Delta variant. Can you help us understand what these new variants mean?

Gian Varbaro, MD: Sure. So with any infectious disease or infectious illness, over time, it changes. That's just evolution. And we call those variants. So you see that with other things you're used to. Like the flu virus, it's different flus and it's different strains every year, that's the reason why you need a yearly flu shot. It's not that the immunity doesn't last. It's that the flu virus changes. So this was always going to happen with COVID or specifically with SARS-CoV-2, which is the name of the virus. Those variants can differ in a whole bunch of different ways. Eventually, there may be variants that make people less sick. But the other big change, and this is what we're seeing with the Delta variant, is that it evolved or it mutated into a form that's much more infectious than the original version. So when people talk about the Delta variant, it's now I think over 95% of the COVID in the United States, because it spread so much faster than the original version. It spreads at least twice as much in probably more than the original did.

Caitlin WHyte: Getting more people vaccinated has been a key initiative nationwide in recent weeks. Why is vaccination so important?

Gian Varbaro, MD: Well, because it's our best tool in fighting against the disease and against the pandemic. When a person gets vaccinated, they protect themselves. And we can talk in more detail about what kind of protection they get, because obviously we've been hearing about breakthrough cases and so forth, but they protect themselves, they also protect the people around them. And coming back to the idea of variants, the way that a variant forms is it needs to go into a host, which would be a person, into somebody, and duplicate itself. And at some point while duplicating, it makes a mistake and that's where a new version comes from. Sometimes those mistakes don't do anything, but sometimes they make it more infectious or creates something else.

Well, if the virus can't get into as many people, because they're vaccinated, then new variants can't form and this is pretty true historically, too. If you'd look back, there's been a pandemic about every hundred years in human history, give or take. And all of them pretty much ended in the same way, they all took about seven to 15 years, about 10 years on average. And they all ended when they achieved what was called herd immunity and a variant formed that was less infectious because of that.

And so what that means is that eventually so many people got the illness, that they had immunity from getting it. And that is how the pandemic ended. Well, I don't think anybody wants to wait seven to 15 years for this to be over. We have though an advantage over 1918 with the Spanish flu or the bubonic plague, you know, hundreds of years ago or so forth, which is we have vaccines and we have good vaccines and we have safe vaccines.

So with Delta, it's so infectious that at some point, we're going to reach a point where everybody has some kind of immunity and it will either be from being vaccinated or from getting the illness. The vaccine is a much safer way to get that immunity and will also speed us to the end of this, because we don't have to wait that long period of time to end this if we get as many people as possible vaccinated.

Caitlin WHyte: How about these booster shots? Who are those for? When can we get them and why should we?

Gian Varbaro, MD: Sure. So as we've been seeing, and as we've been watching this pandemic evolve, one thing we've noticed and it's been all over the news is a new incidence of what they call breakthrough cases and that's cases in people who are already vaccinated.

Now, it should be noted that the number of cases in the vaccinated are still much less than the percentage of cases that come from the unvaccinated. I think as of right now, for the hospitalizations in New Jersey, less than half of a percent of those are from the vaccinated population where 70% of New Jerseyans are vaccinated. So that's a big difference, right? And it just shows you that, yes, while you're hearing so much about these breakthrough cases, there's still a much smaller fraction of the cases. But there still are these breakthrough cases. And the other thing is the vaccine is preventing those cases from turning into hospitalizations as much and deaths as much, but again, that still can eventually happen, but it's a much lower rate.

However, because we're seeing more cases spread to come back to your question, in order to cut down on the new cases in the vaccinated, we've noticed that people's "level of immunity" has decreased. And to explain what that means, because then you might say to me, "Well then, why do I get the shot if it fades? You know, am I going to need to get this every six months or so forth?" we don't really know totally the answer to that. You have to remember that this is a new vaccine. There were vaccines that are set up where you get three shots. The hepatitis B vaccine, for instance, you get one shot, another shot at one month and a third shot at six months, that could be what we're dealing with here or it might not be.

But the real issue is if you think back to before the vaccine came out, when it was being developed, people kept saying, "We'd be really happy, and this would be a good vaccine if it gave 60% protection." Well, the vaccines had 90% to 95% protection, which is really good. And what we're seeing is over time, it's fading to maybe around 80%, high 70s, which is still pretty good. It's better than we expect and better than most vaccines, but we can probably get that immunity up higher and potentially make it last longer by giving an extra shot. And they've already been doing this in some other countries, Israel in particular, and they're seeing a real change in the number of cases, hospitalizations and deaths by giving people the third shot.

So because of that, it's now being approved here in the United States. It's already open to do, if you've had either the Pfizer or Moderna vaccine. It's not open yet for the Johnson & Johnson one, although that's likely coming shortly. I mean, I wouldn't be surprised if within the next few days there's a change in that. But right now, if you have what's called immune compromise, there's a whole bunch of things that can cause that and everything from having had an organ transplant to certain form of cancers, particularly blood cancers, and also being on immunosuppressive drugs, steroids, things like Humira or other rheumatological medications, and there's a whole list of other ones.

At this point, it's recommended to get the third shot and you can pretty much get it as long as you are 30 days out from your second shot. Shortly, it's going to be opened up for everybody else who had two shots already. And right now, the recommendation here in the United States is eight months after your second shot. That could change. Again, we're getting more information by the day. I think there was a study that came out in the last day or so that said that maybe it should be at six months after your second shot, but we have to wait and see what gets approved and what gets opened up.

Caitlin WHyte: You know, we talked about we all want to get out of this pandemic. How do you see us getting there realistically?

Gian Varbaro, MD: So I think it comes back to what I talked about before. I think the path is really through vaccination. And unfortunately, it's going to be through more people getting COVID if people don't get vaccinated. And ideally, we get to a vaccination rate where it's enough to make it so hard for the virus to pass along, that it basically changes into a way that it's no longer a concern. So it's hard to say what percentage of the population vaccinated we're going to need for that. Again, if you think back at the beginning of the pandemic, people were estimating that maybe at around 80% of the population vaccinated, we might reach that point. That number is probably higher now because of the increased infectiousness of the Delta variant. What that number is, nobody really knows for sure. It's probably going to be somewhere in the low to mid 90%, which is a lot of people vaccinated. However, people getting the virus also kind of counts, but that's an unfortunate way to do it, and it'd be much better to get a vaccine than to actually get the virus just based on everything we've seen in the last year and a half.

Caitlin WHyte: Well, in conclusion here, doctor, is there anything else we should know as we head into this new era of the pandemic?

Gian Varbaro, MD: Sure. Again, everything that we do to help prevent the spread is another barrier, right? So the vaccination we've talked about a lot is one barrier. But you know, no barrier is perfect and that's, I think an important thing. You know, I keep hearing from people, "Well, it's not perfect. People can get it otherwise. I saw that there were people who were hospitalized. There were people who died on the vaccine."

Yes. Of course, there was, because nothing is perfect. That's true of anything in life. It's true of every medication, right? You've probably known people who were getting treated for cancer with chemotherapy and died despite of it and people who were getting treated with heart medication who died of a heart problem. No medication is perfect. These are much higher efficiency and efficacy, or not to use a medical word, effectiveness than other medications are, but they're not perfect.

And so if you think about it, as you know, the vaccine is like a barrier between us and the virus, it's a barrier that has some holes on it. Not a lot of holes, but some of them, almost a piece of Swiss cheese. And there's a thing called the Swiss cheese model that's used for quality improvement and also medical treatment. So if you add another barrier, another one that's not perfect to it, then maybe some of the holes line up and something can get through, but you're going to block some of those holes as well. So doing things like wearing a mask when you're in a large group even if you're vaccinated or you're out in public or particularly if you're indoors, masking outside is probably not necessary, but masking indoors or with large groups definitely adds an extra layer of protection.

There was a very good randomized trial that I saw earlier today that just came out that showed, in particular with the surgical masks, a pretty big decrease in the spread of cases in some areas where there were lower vaccination rates so they could study it. So masking is important. Getting tested if you have an exposure or you're in a high risk area. Like I'm vaccinated, I get tested every week, but that's because I work in hospital and I work on the frontlines, I work with COVID patients. So I get tested just in case so that if I catch the virus early, I can isolate myself and not spread it to other people. So that's another barrier. Testing, wearing masks, vaccinating, these are all important.

The other big thing that we didn't really talk about that I probably should bring up briefly, because it's the question that I get asked probably the most, which is when will people under the age of 12 be eligible to be vaccinated. And that, again, we don't know yet because I don't work for Pfizer or Moderna, but I can tell you what the companies have said. Moderna is currently saying that they'll have their data before the end of the calendar year. Pfizer is still saying that they're going to have it by the end of September. We're already in September. So they may have their data release. Now, that doesn't mean that it's going to be available by the end of September. Their data would still have to be approved and go through all the regulatory processes, just like everything else, because we need to check that it's safe and effective and if the data's correct and so forth. But if Pfizer is on target, that means we're probably seeing it available for younger children, probably ages five to 12 would be next probably by sometime in November, early December at the latest. So that would be an ideal thing too and another piece of hope that's on the way.

Caitlin WHyte: Well, thank you so much, doctor, for giving us all this information today. To learn more or to schedule a vaccine, visit newbridgehealth.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

Thanks for checking out this episode of Wellness Waves. I'm Caitlin Whyte. Stay well.