COVID is down, but far from out: It might be time for a booster shot

Should I take the new COVID booster shot?” 

I was asked this question again this weekend while speaking to a large breakfast group. I paused. It is a complex question to answer.

I told them I took it two weeks before traveling to Italy, and I didn’t get COVID, though I was traveling with others who did. There is still some evidence that the vaccine (including the booster) decreases viral shedding and therefore COVID’s spread, though certainly not to the extent that it did originally.  

As opposed to the White House, I am not yet recommending the COVID booster shot for everyone over the age of 5, though I do believe it is beneficial for all ages. I told the group I start with patients who are at higher risk such as the elderly and those with underlying chronic health conditions such as diabetes, heart and lung disease, rheumatological conditions and even obesity.

The vaccine clearly decreases the risk of severe illness and hospitalization, and this is sure to be true for the latest booster as well. Two small studies from Harvard and Columbia did show only a small bump in neutralizing antibodies against the circulating omicron BA.5 subvariant from the new bivalent shot as opposed to the original vaccine, but we await the full clinical data to determine exactly how effective this vaccine is to keep you from getting very sick. 

In the meantime, it makes sense to take a vaccine against COVID at least once in 2022, especially if you haven’t had a recent case of it. I think it also makes sense to delay a vaccine for two or three months after the illness because of the protection natural immunity provides. Keep in mind that a recent study showed little impact on either spread or severity if you took the original vaccine alone against the latest subvariants, but that severity and hospitalization clearly decrease from a recent booster. 

When it comes to children, I believe the booster discussion should involve a pediatrician, the child (if old enough) and a parent. I am in favor of the vaccine for children, not just because over 1,000 children have died during the pandemic, but because evidence suggests that the vaccine decreases your risk of long COVID, which involves persistent fatigue, brain fog, and damage to the lungs, heart and other organs.  

One of the tragedies of the pandemic has been the hyper-focus on myocarditis in male teens who have taken the COVID vaccine. This is of course worthy of discussion, but keep in mind that the latest data out of Israel looking at 4 million people showed an incidence of only approximately five in 100,000, and the cases were mild and self-limited. By contrast, the heart issues associated with COVID itself tend to be more severe and long-lasting, especially in the unvaccinated.  

A line of reasoning that has been applied to children by naysayers throughout the pandemic is that children tend to have mild cases of COVID, so why vaccinate them? Unfortunately, this same time of thinking could be applied to measles, polio or mumps, eroding confidence in our greatest vaccines. Far more accurate and helpful is a public health “herd” mentality — decrease the impact on the herd by getting more people immunized, even if the risk to the individual is low. 

And here is the type of discussion going on in doctors’ offices — with COVID still circulating throughout the U.S., the risk of getting it no matter what age is still high enough to suggest vaccination. In other words, the chances of your child getting very sick from COVID (especially if unvaccinated) is far higher than the risk of a major side effect from the vaccine. If you had a bad side effect from a previous COVID shot, this is certainly taken into consideration and may well be a reason not to have another one. 

With public focus moving away from COVID at long last and now shifting to flu and respiratory syncytial virus (R.S.V.) which are both on the rise, it is too easy to say no to a COVID booster. For most of us, this would be the wrong decision. 

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”