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Q&A: Omicron-specific booster and other COVID-19 news

A man receives a COVID-19 vaccine in Julian, Calif. Feb. 3, 2021.
Matt Hoffman
A man getting the COVID-19 vaccine at the Grossmont Center Mall vaccination "super station" in La Mesa, Feb. 2, 2021.

Americans may soon be able to receive an omicron-specific booster to bolster their immunity against the dominant strain of the COVID-19 virus. The FDA gave emergency use authorization to the booster Wednesday, and a CDC panel is set to review the findings Thursday. While health officials say a booster targeting the most dominant strain of the COVID-19 virus available just weeks before an expected Fall wave of the disease is great news, others are concerned that because this vaccine has not gone through human trials its effectiveness is still uncertain.

Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, joined Midday Edition on Wednesday to share his thoughts on the latest booster dose. The interview below has been lightly edited for clarity.

Does this booster target the BA.5 variant of COVID, and is that still the most dominant strain?

Yes, BA.5 accounts for about 90% of the cases in the U.S. And it's been a really tough road these last several weeks. Fortunately, we're in a descent right now, but there is no other variant besides this one called BA.4.6. that's troublesome. And that should also be protected by the BA.5 booster vaccine.

If the CDC does authorize the booster, do you think they'll only authorize it for, say, people over 65 or the immunocompromised?

Dr. Topol: Well, what they're asking for — the approval by FDA — is for all people aged 12 and up, at least for Pfizer, which is the first one to be out, likely next week. So they haven't differentiated regarding age and immunocompromised status. That would be the logical thing, of course, they should be the first ones to get a booster. If they haven't had either a booster in recent months or an infection. I mean, I think that's really important. A lot of people were hit by BA.5 in the last couple of months. They should wait at least two months before they get a shot.

What about if you've had a booster shot somewhat recently? How long should you wait then?

Dr. Topol: Yes, that should be four months, because we don't know yet whether the booster directed to BA.5, which is half the BA.5 spike and half the original ancestral spike. So we don't know that's going to be better than the original booster. There's hope for that. But right now, if you've had a recent booster, there's no reason to go out right away. A good three or four months would be prudent.

Now, one thing about the new omicron booster that may sound strange to the general public is that this booster has not been given human trials. It's only been tested on mice. Is that problem?

Dr. Topol: Yes, this is the first vaccine that's updated COVID, and it's the first time, of course, without human data. We are used to that with flu shots. Each year there's a flu shot that's updated based on mouse data, and that's been going on for quite a while. This is different because it's a different virus and it would be nice that we would have some data from people. We'll have that soon. But there is some uncertainty because we don't know with this BA.5 variant whether we're going to be able to induce very high levels of antibodies. Because of course, mice are different than people. A lot of people, as we've already touched on, have already had a few boosters, so that's uncertain right now. It would be nice to have that nailed down and hopefully we will soon.

How soon? How many people have to get this shot and be studied before we'll know?

Dr. Topol: I really think we could have had this by now if they had enough of the BA.5 booster to test it in mice. That means they could have tested in some humans, but these studies can be done pretty quickly, within a few weeks. So hopefully there is a commitment by the companies to get these results. So hopefully within a month we'll have some good data on the immune response, which is likely to be very robust, but we just don't know for sure.

It sounds like children under 12 won't be eligible for the booster, so it's not going to help any potential outbreaks in school, will it?

Dr. Topol: Well, that's a really important issue because there is hope that when you go after the variants like this specifically — because the original virus versus this strain are just so different— and so there's hope that you'll be reducing infections and transmission among all those people who get it aged 12 and older. So the transmission chain — if that really works, which we don't know yet — but if it works, that will help everybody, including children. But you're right, because children are against this booster, at least right now, that may change in the months ahead. The United States purchased over 175 million of these shots from the two companies, so there'll be more than enough to give to kids under 12 over the months ahead. But for now it's banking on an unknown about infection transmission reduction in people over age 12.

Q. The San Diego Unified School District, which just got back in session this week, is not mandating indoor mask wearing, but it's encouraging it. Is that enough?

Dr. Topol: This is a tough call because obviously we want to have as natural conditions as possible for kids in school. And encouraging it of course, has got mixed response. We also know that with the kind of masks that children typically use, they're not N95 or KN94, so they're not really high grade quality and omicron and all these variants like BA.5, they're just so hype transmissible that regular cost masks don't do that much. They were something, but they're not nearly as good as medical grade. So it's a tough one. I mean, it would be much better if all the kids were vaccinated, but our biggest problem right now is that we have such a low rate of vaccination among children of all ages, from six months all the way through to 11 and older. So this is the biggest hole in our prevention.

What's your overall assessment of the potential for a fall wave of the virus?

Dr. Topol: Right now, as opposed to previous sessions I've had with you and your colleagues, this is a favorable situation we're in right now. We're in the descent of BA.5. There's no scary variant that's imminent. We may have a couple of good months here where we have low levels of circulating virus, certainly more of that in the weeks ahead, and relative containment perhaps as good as we've seen for the whole pandemic. And it's possible that this booster vaccine will help to some degree. The only question that remains, though, is what's next after this lull? Will there be a new family of variants or will there be another derivative of omicron that causes trouble? That is looming out there. It's an unknown. We should be planning for that because even though we're going to get a respite for a stretch, it's unlikely that we're going to see smooth sailing from here on in.

There is another COVID lockdown going on in China. How is the rest of the world doing?

Dr. Topol: Pretty much the whole world is coming down from this BA.5, which was dominant virtually everywhere. There are parts like, for example, in Asia — Japan has been hit extremely hard, the worst part of the pandemic for them, but they are one of the best managed countries. There will be a bit more of the BA.5 around the world, but for the most part it's run its course throughout Europe, now in North America, South America. So I think, again, throughout the world, we should be getting to a good level of containment. The only real question is how long will that last? I only hope it will last a long time, as all of us would like to see now.

The National Centers for Health Statistics says COVID has caused a drop in life expectancy in the US for the second year in a row. It's down from 77 years to just over 76 years. Is that surprising to you?

Dr. Topol: Well, it's really horrible because we're the lowest of all of peer countries. We have dropped nearly three years over this period. It's driven by the pandemic, but also with drug overdoses and accidents, and there's a lot of disparities. The level of life expectancy in the mid-60 years for American natives is at the level of 1944. This is the worst we've seen and dropped for almost 100 years. And the 76 years of life expectancy is the lowest it's been for 25 years. We've been on steady decline, so this really deserves a lot of attention. It's not just the pandemic, although that's a dominant factor. We don't have a universal health system with the access that we need, and this is showing up in our results.

You say we're in this period where we're seeing falling numbers of COVID cases. I'm wondering about the new COVID vaccine, if it's available next week, should people rush out to get it or maybe wait until we're closer to a fall-winter surge?

Dr. Topol: That's a really important issue, which is unsettled. It's perfectly fine for eager beavers to go and get this, especially people over age 50 or 65, even people who are immunocompromised and haven't had either an infection or a booster in recent months. That's perfectly fine and reasonable. But for a lot of people waiting a month to get the data to nail this down, it might be a wise move. It's not as straightforward as the FDA and CDC may make it when they release this right after Labor Day next week. So it's really an individual choice. I'm going to be a little more cautious and wait a few weeks, see what the data shows. And I really like to see that immune response data.

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