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The Dose Transcript for September 7, 2023

Host: Dr. Brian Goldman

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. There are signs that COVID is making a comeback with some new sub variants. And if you're due for a booster, whether to roll up your sleeves now or wait for one that protects against those new strains is a question that you probably want to answer. So this week we are asking, should I get a COVID booster now or wait for one that is more up to date? Hi, Allison. Welcome back to The Dose.

ALLISON MCGEER: Hi Brian, pleasure to be here.

BRIAN GOLDMAN: When did you get your last COVID booster?

ALLISON MCGEER: I had to look it up. You know, it's getting harder and harder to remember it. April, March 2023, Second Bivalent booster. Because I'm old, right?

BRIAN GOLDMAN: Oh, so my. You're a vintage. We're not going to call you old. So. Okay, so you got a decision. You've got a personal decision. And in addition to dispensing advice and we certainly want to hear all about that. But before we begin, can you give us a hi, my name is tell us what you do and where you do it so that everybody knows all of your amazing qualifications.

ALLISON MCGEER: Well, hi, my name is Allison McGeer, and I'm an adult infectious disease physician and infectious disease epidemiologist at Sinai Health System in Toronto.

BRIAN GOLDMAN: Great. Here we go. So how active is COVID right now? It's still warm outside. And people kids are just going back to school now. So how active is COVID right now?

ALLISON MCGEER: So more active than the beginning of July, but less active than last April and May. So it's it's starting to creep back up again. But there's still not a lot of activity in Canada.

BRIAN GOLDMAN: And, you know, what are we waiting for? Are we waiting for the weather to get colder, too, for kids to be entrenched in school? What are we waiting for?

ALLISON MCGEER: Well, don't we wish we know now that there's it's disappointing after so long and certainly disappointing for someone like me, you know, my whole career trying to answer some of these questions. But we don't know precisely what all the pieces are. We just know that, you know, as we go back inside in the winter. So going inside the summer doesn't seem to be a problem. Going inside in the winter may be a problem as kids get back to school and have more contact as we get further and further from our last vaccine dose, as this virus changes more and more to move away. So it's the combination of things together and probably still honestly, as we all still kind of get back to normal. It's been this long, slow process of returning to all of our activities as we know them. And I think those of us who are older and more vulnerable have been slower than other people to do that. So all of those things layered together is what's going to get us the fall activity. It's just really hard to predict at the moment how bad it's going to be.

BRIAN GOLDMAN: But the trend lines are up and they're going to go up a lot faster in the weeks, in the weeks and months to come. Have I got that right?

ALLISON MCGEER: You got that right. For sure we're going to have a COVID activity this winter that is greater than it is now. It's a question of whether it's going to be not as bad as the flu. As bad as the flu you worse than the flu.

BRIAN GOLDMAN: I've been paying a lot of attention lately to a new sub variant called BA286, also known in some circles as Pirola. Now, that's an interesting name. What do we know so far about this new sub variant?

ALLISON MCGEER: Well, it's it's academically interesting for a variety of reasons. So first of all, if you've been tracking it as painfully as I have, you'll know that it's popped up in many places around the world. So it's not just in one country or one general area, but in all those places so far it's really uncommon. You know, one in Canada, two in Denmark, one in South Africa. So, you know, three or four in (indistint). So remarkable for being widespread but not increasing dramatically over the last month or so that people have now been tracking it and not taking off in any one place before it's seen everywhere. So it's different than what we've seen before, and that makes it a little harder to parse what's going on with it. The good news is about it is that so far and there's we're just beginning to get the data on how far away it is from an immune system perspective, from other variants. And the very first data came out last week and suggested that maybe it was farther than you would like. But three other labs have weighed in since and said, no, I don't think so. So that the good. News about it is that initially people looked at the sequences and they said, Oh, this is going to be (indistinct) a long way away. Not sure the boosters are going to cover it. But that's looking like that's not correct. It really is looking like the boosters will cover it well. And even without the boosters, even without these most recent boosters, people are probably still pretty well protected against it.

BRIAN GOLDMAN: And I gather that you're referring to the most recent studies, the most recent data that's come out. There were a couple of groups of scientists in the United States who reported that the antibodies that are produced by a recent by Bivalent vaccine or by an infection with Omicron, reacted against this new sub variant, suggesting that that if you have those antibodies, you're likely to be reasonably protected against against the new one.

ALLISON MCGEER: That's right. And, you know, everybody has their own way of doing these tests and each of the assays is a little bit different. And of course, we're not far enough into this to have standardization of assays to know exactly how to translate them. So it's really important that you that you weigh all of them together and there's a bit of a range in in people's findings. But overall the answer is that it looks like people's antibody levels were more protective against the strain than we thought they were going to be by just looking at the sequence, which is what people origionally saw.

BRIAN GOLDMAN: So that's good news. There's another sub variant that I've been watching, e.g. five, also known as Eris. The WHO calls it a variant of interest. What do we know about that?

ALLISON MCGEER: Well, you know, same thing. There's a every time you'd think, you know what's going on, somebody says, Oh no, you need to worry about and you know, outcomes the letters numbers again of, of new variants sort of thing. But as expected, you know, as coronaviruses do, this virus is evolving and there are new variants arising. And every time we notice one that seems to be taking over, meaning it's more transmissible. Every time we notice one that has a lot of mutations, meaning it might be further away from the immune system, people, you know, perk their ears up and start focusing on what we know about. But so far, EG 5.1 and FL.1.. might be 15 now I've forgotten. So far all of the new ones that are out are, you know, really don't look like anything. So they're just COVID doing what COVID does. And none of them are going to have a big impact on the effectiveness of the booster dose this fall or like the what's happening before we get that booster dose.

BRIAN GOLDMAN: So and, you know, these are questions that you probably don't want to answer because who has all the information right now anyway? But these are questions that doctors and nurse practitioners are being asked all the time. To what extent do the current bivalent vaccines protect against these new sub variants?

ALLISON MCGEER: It's going to depend on how long it is since you've had them. So if you're just talking about any protection and what we know is that once you get to about six months after booster dose, you're not very well protected. Notice me couching that? I'm not saying nothing. I'm just saying not very well protected against getting an upper respiratory tract illness from SARS-CoV-2, which can be miserable but is not dangerous. If you've had an infection in addition to that booster, you're probably better protected at that even past six months. But still, the protection is not great from any infection. The protection from severe infection, however, is really different. I can't I can't put a number on the protection from severe infection until we see it. None of us can. But everything we know suggests that people who have been well vaccinated and or have been vaccinated and have had at least one infection are going to be substantially protected from the severe disease. That does not mean that those of us who are older and people were immunocompromised and people who have multiple underlying co-morbidities are aren't going to be at some risk of severe disease. But just at the moment, with not really very much activity, people's boosters are probably holding fairly well.

BRIAN GOLDMAN: Okay. Let's let's try to drill down a little bit. Let's start with people of average risk who maybe have been waiting eight, nine, ten months or a year since their last booster. So they need one. So you've said that that immunity drops off and the magic number seems to be six months. Of course, I'm sure there's a range, but but would you be telling people, advising people if it's been that long since you've had a booster to get one now, regardless, and not wait for the new one? What's your thinking on that?

ALLISON MCGEER: So what Nancy and public health are telling us is that we should be waiting. And that's premised on the fact that there's still not very much activity. And it's almost certainly true that the booster, in the same way that the Bivalent boosters protected people better last year than the old vaccine. Almost certainly true that the new boosters is going to protect us better against the SARS-CoV-2 viruses, viral strains that are around this fall. So waiting is good. The question to me is one of the things that would make you not wait and one of the challenges that you might get into if you decide not to, and the things that would make me not wait are circumstances where you know that your exposure to COVID is likely to be significant and you have an underlying condition that means that you're at greater risk of severe disease. For instance, the extreme example to my view is in long term care homes. We know that residents are highly vulnerable if an outbreak starts in a long term care home. In my view, every resident of that long term care home should be getting a booster now and we'll deal with what comes later. Later. If you have an immunocompromising illness and are going to be traveling a lot by air in the next six weeks, that's another good reason for thinking about getting a booster now. But for most of us, waiting and watching is a reasonable thing to do for the moment. Remember that it's a little bit irritating because you kind of like to make a decision to not worry about it. But I can make the decision today that I'm not going to get a break any booster and change my mind tomorrow. So the fact that I'm deciding today not to get the old booster because I'm waiting for a new one doesn't mean I can't change my mind a week or two weeks or three weeks from now if things change in terms of activity. And so that that's what I'm thinking about. And so that's what I'm saying to other people in general. Makes sense to wait. But it's a good idea to just have half a mind on what's going on because you can change your mind.

BRIAN GOLDMAN: So one exception would be people who have severe underlying diseases or exist, you know, are living in conditions that put them at greater risk of outbreaks, for example, long term care. Are you saying that somebody of average risk who's traveling to a COVID, a place where there's high rates of COVID, that they should get a booster in advance, regardless of of whether it's a new booster or not?

ALLISON MCGEER: The challenge here for them is what's the downside of getting boosters? So from a from a straight out, you know, protection against disease, you know, individual level balance. To me, those people getting these boosters is enormously sensitive. Right? The last thing you want to be is in your hotel with COVID in a country where you don't speak the language well. So it would make sense. The downside, however, is that our current guidance for when you can get a booster is six months, and we still don't know the extent to which people are going to enforce that. You know, obviously, if if there's a huge amount of activity, it's likely that people are going to walk that back a little bit. But you you are expecting some risk at the moment. If you live in Canada and you choose to get a dose now that you may not be able to get a dose until December or January of of the new Bivalent booster.

BRIAN GOLDMAN: Okay. Let's go to a completely different category. How about kids going back to school?

ALLISON MCGEER: So what again, what Nassy is saying is that those kids should be waiting for their booster, that it's still likely to take six or eight weeks of time for COVID to start to build again as it starts. And so Nassy is recommending that all children of the six months get to get a booster, but that they wait for the bivalent booster to come because kids in particular aren't, healthy children are not at that high risk of COVID. And most of them have had a dose or two of vaccine and the infection so far. And so waiting for kids makes a lot of sense.

BRIAN GOLDMAN: Assuming most of us should wait for an updated booster, how well will that updated booster protect us against these new sub variants, do you think?

ALLISON MCGEER: That's that's a that's a just a lot of thin ice to go out on. Yeah. So, you know, I think that it's important to remember here that now we're talking about, you know, benefits over previous years. So everything is getting a little more marginal. I think it'll boost us probably 50 or 60% against severe disease for a period of 4 to 6 months. This is this is straight out opinion, right? The you know, where we'll not know for sure until we see it. But there is there is good cross-protection against all of the variants that we have seen so far, which means that for the people that the people that we're particularly worried about are older adults who have not yet had an infection. Even if they've had all their booster doses. Those are the people where protection is waning and where protection against severe disease from what they've had so far may be down around, you know, 70, maybe even a little bit below. And those people will get boosted back up to somewhere above 90%, I think, And most of the rest of us will get at least a 50% reduction in risk of severe disease whatever our baseline is.

BRIAN GOLDMAN: This may be an easier question, but again, you know, it it requires knowing something about the behavior of Health Canada and vaccine manufacturers. When is the updated booster expected?

ALLISON MCGEER: Now, the only safe answer to that question is that I know with absolute confidence that everybody is scrambling to get as fast as they can. That's, I think still likely to mean that it will be the middle of October before we get there. And when we get the first doses again, we're not likely to get them all at once because vaccine manufacturing plants just have the capacity limits. They can't do 24 million doses a day. I will. The first people we will needs to offer protection to will be those who are most vulnerable. So as with our first set of vaccines will go for residents of long term care, older adults, health care workers first, in all likelihood. And so it may be November some time before the rest of us to get that vaccine.

BRIAN GOLDMAN: And knowing what we know. And you've already said there are a lot there's a lot that we don't know about the behavior of COVID. Are, how hopeful are you that there'll be plenty of vaccine on hand as rates start to rise to the point at which we wish we had the vaccine available as quick as possible?

ALLISON MCGEER: I think all of us should worry that activity is going to move faster and vaccine availability. I don't I just don't know enough about what the circumstances are. And, you know, with health Canada or vaccine supply to be able to talk intelligently. It's one of those things that I'm trying not to lose sleep over because I know people involved are doing the very best they can. So it's not something I can alter. I think it just means that whenever any of us as health care workers get an opportunity to you know, move a little faster, do things a little better, that we'll need to do that this fall. I am worried that activity is going to climb faster than we would like it to, but we're not talking the beginning of the pandemic okay. We're not talking the beginning of Omicron. We're not talking about catastrophe. We are talking about something that we'd all like to avoid.

BRIAN GOLDMAN: You know, I'm mindful of the fact that the two of us are having this conversation. The two of us are pro vaccine. And there's a lot of people who are going to listen to this, who are not or who are ambivalent and and, you know, and maybe have only had three doses of the vaccine. So what do you say to them at this point in the pandemic, in this point, in the in the story of COVID?

ALLISON MCGEER: Well, you know, generally that's a long conversation because it's both about thinking about how you how people would feel about vaccines, why people are hesitant about vaccines. And there's this many reasons to be hesitant about vaccines as there are people in the world. And so, you know, it's about trying to, you know, center those people and help them make decisions. You know, truth is that all of us make different decisions about our individual level of risk, and none of us make the smartest decisions in the world about every level of risk there is. It's okay that people are hesitant. I of course, I worry about them as a health care worker because I know what the risk of COVID is, and I don't want people to be at risk of COVID. But it's you know, it's a conversation that has to be had about why people are weighing that risk public differently than I am.

BRIAN GOLDMAN: Well, Dr. Allison Mcgeer, I always love talking to you about COVID and you have not disappointed. Once again, thank you so much for bringing some clarity to a subject that that is certainly continues to be important to us and will continue to be important this fall.

ALLISON MCGEER: You're most welcome Brian. I don't think you meant it when you said that you always enjoyed talking to me about COVID because I think we're all tired of talking about COVID, but doesn't mean we don't have to get our boosters. Take care.

BRIAN GOLDMAN: You too. Dr. Allison Mcgeer is an infectious disease physician at Sinai Health System and professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto. Here's your dose of smart advice. After a lull, COVID cases and hospitalizations are slowly climbing, though nowhere near what we saw during previous peak times. There's a new sub variant called B.A. 286, also known as Pirola. Public health doctors have been fearful about this variant because it is genetically quite different from the one that until recently was the dominant one. But those fears may have been premature. Very recent studies suggest that people who have either been infected with or vaccinated against Omicron produce antibodies that are likely to protect against the new sub variant. COVID watchers are tracking another new sub variant calledEG five or Eris. So far, there's no evidence that Eris causes severe COVID infections. A new Bivalent vaccine that protects against these sub variants should be available this fall, hopefully at the same time as the annual flu shot. If you need a booster, the National Advisory Committee on Immunization or NACI, says you should wait until the new one arrives. Get a booster now. If you're immunocompromised or live in long term care where you're highly likely to be exposed to the virus, you should also consider getting a booster now and not wait. If you plan on traveling to a part of the world with a high rate of COVID when COVID. Was on the decline. Many of us got out of the habit of wearing masks. Cooler weather and kids going back to school. I mean, we can expect to see many more cases of COVID this fall. Consider wearing a mask when gathering indoors with lots of other people. If you have topics you'd like discussed or questions answered, our email address is the dose at cbc.ca. If you like this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Isabelle Gallant, our senior producers, Colleen Ross. The dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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Should I get a COVID booster now or wait for an updated one? - Transcript

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