Lingering COVID-19 questions answered by Dr. Eric Topol
San Diego parents are now able to seek out COVID-19 vaccines for their children aged 6 months to 5 years old. At the same time, the county this week reported a seven-day low in cases as hospitalizations continue to drop.
Despite the promising signs, health officials are wary of a jump in cases over the summer as eager Americans seek to travel and socialize. Dr. Eric Topol, director and founder of the Scripps Research Translational Institute in La Jolla, joined KPBS Midday Edition to talk about the latest news and research on COVID-19. The conversation below has been lightly edited for clarity.
Q: This is the last major age group to be granted approval for the vaccine. How significant is this in the fight against COVID?
A: It is quite significant. It's not getting enough of the sense of its importance because the children aged 6 months to 5 years have had a lot of trouble during the omicron wave. There was a big jump in hospitalizations, and the problem is that Omicron, that was the beginning of this year the big surge, the worst we've had. That BA.1 variant is so different than the variants that we're seeing now on the rise, the so-called BA.4 and BA.5. So that's why it's important to get the kids vaccinated, because the infections that many of them had are not adequately protected, nor are the problems that lie ahead. It's very likely we'll see another significant variant in the months ahead — as you alluded to, Jade — in the summer, late summer, fall or even later than that. And that vaccine protection, now that it's available for young children, would be really helpful.
Q: What do parents need to know before their children receive a dose of the vaccine?
A: Well, there's two choices. Moderna, which is a two-dose vaccine, or Pfizer, which is three doses. I think the two-dose is preferable, I mean, who wants to put a young child through an extra shot? But nonetheless, they protect about 50% or more from infection. But more importantly, is the protection from hospitalizations and serious outcomes. And so the same type of side effects that we see in adults with a sore arm and some fatigue, these are the common side effects that last a day or two. But there aren't any cases of serious side effects that have been seen in the testing and even all the way up through age 11. The chance of anything serious like myocarditis, it just hasn't been seen. And that's why I think it's really a safe alternative and why parents should be very supportive of it.
Q: And as you mentioned, Omicron is still the dominant COVID-19 strain. Is there any movement on an omicron-specific vaccine?
A: Well, yes, there is. We heard just today that Moderna has tested their BA.1 omicron booster against the BA.4 and BA.5 and has seen some reasonable antibody production. So that's a bit encouraging. We're expecting to see a booster going through both Moderna and Pfizer, the FDA, by September, and so it's very likely that sometime in the fall we'll have access to those boosters. But again, to emphasize, we still don't know whether the booster which has BA.1 omicron, is going to hold up well against the variants that we'll be seeing. Already now, in 35% of the country, the cases are BA.4 and BA.5, and it's quite a bit different. So it remains to be seen how effective that booster is going to be. It's better than just continuing to rely on the original spike that was from back in 2019 that we've gone so far beyond. But only by testing the booster in the real world will we know if it's really going to help.
Q: We've heard a lot about Pfizer's COVID-19 antiviral medication Paxlovid and its efficacy. Just how available is that treatment in this country?
A: Yes, well, there were two CDC reports on that just yesterday. It looks like the prescriptions have soared with Paxlovid, which goes along with the fact that we are having a lot of cases under the radar that are not through the traditional PCR central testing and reporting. And Paxlovid is getting the test in the real world, and it's holding up very well. In fact, all the people that took Paxlovid in the report yesterday, less than 1% wind up in the hospital, and that's what you'd expect. Paxlovid has been shown to give very strong protection against hospitalizations and deaths. And so right now, for people that have infections, this is our backup plan. And fortunately, it's pretty widely available, certainly in San Diego County. So whereas a couple of months ago, it was hard to come by, right now most of our pharmacies are stocked, and that hasn't been a problem overall for access.
Q: Breakthrough COVID reinfection has been a major concern recently. What more do we know about the likelihood of reinfection or what causes it?
A: That's a good one, Jade, because we just had a big report this week from the Veterans Affairs, which is the largest healthcare system in the United States, and what they showed with over 30,000 of these reinfections that there was a worse outcome than in people who had only one infection. So that the multiple hits and then three infections worse than two, like a dose-response type of pattern. The point is that up until now we had really thought that reinfections, 'Well, so what? You have immunity, you shouldn't have much of a problem.' But what we're seeing are lingering effects that suggest from this one large report that this is a problem and we need to avoid reinfections. The problem is that the variants we're confronting now, these Omicron sub-variants, are the most immune evasive and transmissible in the whole pandemic. And so the chance of reinfection is much higher. And we're learning that at the same time that there's a liability of having these reinfections. And we're not doing the things we know that could help prevent reinfections.
Q: Where does San Diego stand in this current surge with regards to infections and hospitalizations?
A: Well, so far we're in reasonable shape. We know there's a lot of virus out there from the wastewater pattern, and it's also becoming more BA.4 and BA.5, which are worrisome variants because of their hyper contagiousness and their immune escape. But we aren't seeing a rise in hospitalizations, which is good. We have seen that in Portugal and now in the UK. So we're probably going to be confronting that in the weeks ahead, because BA.4 and BA.5 aren't dominant yet. They're just getting going. And when they get over 50% and 70, 80% here in San Diego will probably see a bump in hospitalizations. Hopefully, it won't be severe, but we have to expect there's going to be a problem ahead because this variant is not something that we would welcome at all.
Q: Will the vaccines available to kids five and under offer protection from those two variants you just mentioned?
A: Yes, as I mentioned, they have been tested in the omicron wave. There was about a 50% reduction or more of infection, at least in the early going of the first few months. And importantly, because they rev up our cellular immunity, children's T-cell immunity, which is often not strong, particularly against Omicron. The vaccine helps to fight all variants to a significant extent, and that's why it's really important whether children have had omicron or not, getting vaccinated will give an important layer of protection for them.