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Covid-19 mixed messaging continues as US enters the booster era

<i>Steven Senne/AP</i><br/>Covid-19 cases and hospitalizations are on the rise.
Steven Senne/AP
Covid-19 cases and hospitalizations are on the rise.

By Paul LeBlanc, CNN

Cases are going up. Hospitalizations are too. Depending on where you live, mask mandates are either being dropped or enacted. Vaccines are more available than ever, but hesitancy remains a real problem. Experimental drugs are showing promise as well, yet regulatory approval takes time.

It’s a confusing time in the coronavirus pandemic.

Unlike the overwhelming anxiety that defined the spring of 2020 or the hope that came with the start of the US’ vaccination campaign late last year, fall 2021 has been more muddled: Some Americans are back at work or in the classroom, while other office returns were postponed to the new year. Underlying it all has been questions about boosters — who should get one and when? But Friday went a long way toward providing some clarity: The booster era of the pandemic is here.

US Centers for Disease Control and Prevention Director Dr. Rochelle Walensky endorsed the use of Covid-19 vaccine boosters Friday for all adults.

Walensky made her recommendation just hours after CDC vaccine advisers voted unanimously to recommend booster doses of Pfizer/BioNTech’s and Moderna’s Covid-19 vaccines for all US adults six months after they finish their first two doses. The US Food and Drug Administration authorized boosters for everyone 18 and older earlier Friday.

“Just go out and get boosted,” Dr. Anthony Fauci told CNN’s Dana Bash on “State of the Union” Sunday. “We know they’re safe and we know they’re highly effective in bringing very, very high up the optimization of your protection. So just go ahead and get boosted. Now’s the time to do it as we get into the holiday season.”

It’s all about simplicity. Chances are, if you’re reading this, you’re eligible for a booster shot. Previously, boosters had been authorized for anyone 65 and older who was vaccinated with the Pfizer or Moderna vaccines at least six months ago and for certain adults at high risk of infection or of severe disease.

Friday’s vote streamlined this, making clear every adult should or may get a booster six months after finishing the first two doses.

What drove the decision? Data! Recent real-world studies suggested that immunity from Covid-19 vaccines begins to wane and protection against milder and asymptomatic disease, in particular, may drop. Studies have shown that booster doses restore that immunity.

Members of the CDC’s Advisory Committee on Immunization Practices heard safety data from the CDC, from Pfizer and from Moderna that showed the boosters have not caused worrying adverse events. The most common reactions are pain at the injection site, headache and fatigue.

Did we wait too long? With cases already on the rise and colder months ahead, news of the booster approval was welcomed by public health experts who still made clear it could’ve come sooner.

A sample:

  • “I’ve said since January that Pfizer/Moderna are 3 dose vaccines,” Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital, tweeted.
  • “This took way too long,” CNN medical analyst Dr. Jonathan Reiner tweeted.
  • “Our rules about boosters are far too complicated. The winter is coming. Every adult (6 months out) should go get that third shot,” Dr. Ashish Jha, dean of Brown University’s School of Public Health, said before approval came on Friday.

Three shots and done? It’s too soon to say. Some context from CNN’s Maggie Fox: It’s possible that as with vaccines like the MMR (measles, mumps and rubella) vaccine, once the initial few doses are out of the way, people can count on being immune for life.

Doctors hope that boosting six months after the initial dose will provide much longer-lasting immunity than giving two quick doses a few weeks apart — even as they agree that was 100% the right approach for a new vaccine being used at the start of a pandemic.

It’s also too soon to know whether immunity might wane after months or years. And it’s too soon to know if a new variant might emerge and spread that evades the protection offered by a vaccine and, as with flu vaccines every year, the formula may have to be tweaked protect against the changed virus.

“We’re going to take a look right now at what the durability is of the booster. We’re going to follow people who get boosted,” Fauci, the director of the National Institute of Allergy and Infectious Diseases, told Bash Sunday. “It will be guided by the science — and people should not be put off by the fact that as time goes by and we learn more and more about the protection that we might modify the guidelines.”

What comes next? If we are actually living through what will be looked back on as the “booster era” of the pandemic, it’s natural to wonder what might be next.

At the moment, pills from both Pfizer and Merck are making a strong case for being the next big thing, and Biden administration officials are bullish about antivirals playing a big role in reining in deaths from the pandemic.

Pfizer says its pill, which it proposes to sell under the brand name Paxlovid if it gets authorized, reduced the risk of death or hospitalization by 89% in people who got it within three days of symptoms starting, according to its interim analysis. Merck says its capsule, molnupiravir, reduced the risk by about 50%.

“I see them as a one-two punch. Vaccines are prevention. These antivirals are early treatment. Both have utility,” Dr. William Schaffner, professor of medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine, told CNN this month. “Neither one is a substitute for the other.”

Traveling this week?

You’re not alone! The number of people flying for Thanksgiving will “without a doubt” break pandemic-era air travel records, TSA Administrator David Pekoske told CNN.

“The pandemic record right now stands at about 2.2 million people (on a single day) and I would expect that we will definitely exceed that,” Pekoske said. Already, the TSA has announced it screened more than 2.2 million people on Friday.

If that sounds overwhelming, the CNN Travel team put together a few ways to travel safely.

Try to fly off-hours and on less busy days. If you can travel to and from your destination on less busy travel days, you and your family will encounter fewer people and may be more successful at social distancing, said Linsey Marr, a professor of civil and environmental engineering at Virginia Tech, who is a leading expert in aerosol transmission of viruses.

Book window seats. Experts suggest booking window seats for children (or adults) who are not vaccinated, partly due to the air vents along the inside panels of most planes.

“We think that the seat with the lowest risk is the window seat, as air circulation patterns may be better for the window seat,” Marr said.

Wear well-fitting, high quality filtration masks. Invest in a high quality mask for travel, one that will trap around 95% of virus-size particles when fitted to the face properly, experts say. Fit is critical, Marr said, as is comfort. Look for a mask that fits each unique face and is comfortable enough that you or your child can wear it for hours.

Stay in your seat if you can. Getting up and moving around puts you closer to others on the plane, who may or may not be vaccinated or following mask guidance. While the risk of Covid-19 from such exposures may be small, there are other concerns.

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