Anyone 18 or older in Massachusetts is now eligible for a COVID booster shot, as long as six months have passed since the initial vaccination. Gov. Charlie Baker announced the policy change Thursday morning, a week ahead of the Thanksgiving holiday. Tufts Medical Center epidemiologist Dr. Shira Doron joined GBH’s All Things Considered Thursday to discuss the booster shots: bottom line, she says, is to get one.
Dr. Doron also talked about ways to be safe over the holidays, rising COVID cases and capacity problems in Massachusetts hospitals as we head into flu season. What follows is a lightly edited transcript.
Arun Rath: So first, let's talk about the booster announcement. I'm in that category — I feel like I want to sign up for it tomorrow. Should I?
Shira Doron: Well, I have mine and I'm very happy that I have it, especially as I see these cases rising pretty significantly over the last week or so.
Rath: Yeah, and I want to talk about that in detail. But just on the booster, would you advise on the mixing and matching of vaccines? One of the things I've heard about is that that people are maybe wanting to get a different vaccine than they got the first time around — they got Pfizer, and now they want to get Moderna for their booster, or vice versa. Is there any kind of standard advice as far as that goes, or does it matter?
Doron: You know, this is what I tell people: the study on mix-and-match vaccines that was done was not an effectiveness study. We don't know exactly how much benefit you get from mixing and matching in terms of actual prevention of infection. The study was a relatively small one, and it was an antibody level study.
What I think is most clear is that if you're a Johnson & Johnson recipient, you may get some benefit — at least based on antibody levels — from getting Pfizer or Moderna as your booster.
Any other combination, I think, probably you don't need to overthink it. If you've got Pfizer before, it's fine to get Pfizer again. That's what I did. If you go somewhere and they only have Moderna, that's fine, too. And vice versa.
If you're a Johnson & Johnson recipient, I would recommend that you get Pfizer or Moderna, if you would like to. The exception would be, I think, if you're a young male under the age of 30, you may choose to get Johnson & Johnson as your booster, because we do know of that rare side effect of the mRNA vaccines — Pfizer and Moderna — the myocarditis, which, although rare, doesn't exist with Johnson & Johnson.
Rath: But otherwise, for instance, people who had the Pfizer or Moderna, it's not worth getting fussed about — not worth holding out for — one over the other. If you can get your booster, get it, right?
Doron: That's exactly right.
Rath: So getting to these numbers, the just-released numbers, they've been trending in a troubling area and a troubling direction this week. The numbers today are again worse — we’re up over 3% in terms of the infection rate. What do you make of where we are right now?
Doron: Well, let's look at the the good news and the bad news, I guess. A case in November 2021 is very different from a case in November 2020. And so we are seeing rises in cases despite having essentially the highest vaccination rate in the country, and we've seen that countries with very, very high vaccination rates have seen very steep increases in cases as well over the last weeks and months. So vaccination in and of itself isn't going to protect us from cases rising.
But what we do hope to continue to see, and what we have seen in highly vaccinated states and countries, is a continued decoupling between cases and hospitalizations. And that's what I believe will hold. And I think that on an individual level, boosters will help to prevent those rare cases of fully vaccinated individuals becoming sick enough to end up in the hospital.
Rath: And along with that, it does also seem that, for instance, looking at today's numbers, while infection rates are up and case numbers are up, happy to say that at this point, at least, the death rate is not also going up by that same amount. That's still seems at about the same level. Does that track with what your understanding is?
Doron: That's absolutely right. The death rate, although we'd like it to be zero, has been hanging out almost always in the single digit numbers. So that's vaccines working. That's not something we would have seen a year ago today with cases rising.
Rath: And another difference with a year ago today: we're going into a Thanksgiving holiday, but with a lot of people who have been vaccinated. We are hosting Thanksgiving with some family this year — very excited, obviously, to be able to do it after all this. What would be your advice for people who may be traveling or maybe hosting others? How should we be approaching this Thanksgiving, which is again very different from last year?
Doron: Yeah. So, my Thanksgiving this year is going to look pretty normal. My household is fully vaccinated, and I'm going to be spending it with another family that's fully vaccinated.
But everyone's situation is somewhat different. Everyone's risk tolerance is different. So there are ways that you can choose to make that Thanksgiving or holiday gathering safer, particularly if you have unvaccinated adults or immunocompromised adults who may not mount a good response to vaccination. Those things could include wearing masks inside, and distancing during eating, and opening the windows — or taking a test before the gathering.
Rath: So all the things we kind of know fairly well at this point.
Doron: We do.
"We already have hospitals that are completely full — not from COVID, just from everything else right now. We can't afford to have any more patients hospitalized that don't need to be hospitalized."
Rath: Now, throughout the pandemic — and we've talked about this in the past about how COVID has hit certain communities, people of color — harder than others. In this latest uptick of cases, do you have enough data to say if that is the case again now?
Doron: I don't have that data. What I can see in the trends right now is that the younger individuals are driving this latest uptick. And of course, we know that the youngest residents of Massachusetts haven't been eligible long enough to be fully vaccinated at this time.
But we also know that younger individuals have lower rates of vaccination for a variety of reasons. They may consider themselves not vulnerable, and they're not worried about COVID. They may have previously had COVID, and so they're not inclined to be vaccinated. So we are seeing that they are partly driving some of the rising cases. That being said, because younger people are less likely to end up in the hospital, that's another reason that I hope we will continue to see a decoupling between those cases and those hospitalizations.
Rath: And in terms of other things that are going on in public health right now, the flu would be the big one. I know that last year, because of the protocols that were in place, the flu season was far better than it generally was. But with some restrictions rolled back — I know, for instance, in our house, we had a cold in our house for the first time in about a year. How much of that is a factor in terms of how we're thinking about going out and socializing?
Doron: Yeah, I mean, we need to be aware that we do expect to have a flu season this year. We here at Tufts Medical Center, we saw a dramatic uptick in the last week. I looked at the state data. The circulating levels of flu are still considered to be in the low level, but I see quite an uptick even in the state surveillance data for flu. So I think we'll have a flu season, I don't know if it will be that “twindemic” that we prepared for last year and didn't get.
I cannot predict whether we'll see a big flu season — the southern hemisphere did not, so maybe that is going to work in our favor this year. But we already have hospitals that are completely full — not from COVID, just from everything else right now. We can't afford to have any more patients hospitalized that don't need to be hospitalized. So that's why I do recommend that everyone get a flu shot this year and that people consider getting the boosters, which now every adult over the age of 18 is eligible for.
Rath: Good advice to keep in mind. Dr. Doron, it's always good to speak with you. And once again, thank you.
Doron: My pleasure.
Rath: That's Tufts Medical Center epidemiologist Dr. Shira Doron. This is GBH's All Things Considered.
