COVID-19 Update 3/2: Omicron Decline, Vaccines for Children, and Boosters

On this COVID-19 update, Dr. Bishop provides an update on the Omicron surge, vaccine effectiveness in children, and boosters. 

The Omicron Surge

I want to update you guys about continuing trends on cases, both in Virginia and across the U.S. As you guys have probably heard and seen in the news, cases have pretty much collapsed by significant percentages, and we've really only got small numbers of active new cases going on across the board.

If we look across the United States, we're down to 40,000 cases a day-ish. About a little over a month ago, we were tracking a million cases a day.

We've had quite the collapse, a 90% plus collapse, in cases over the last few weeks, which is great. The Omicron surge is essentially complete, and we're on the tail end of that.

What's interesting, though, and concerning to me is that even though the cases have dropped off by 90% or so, we haven't seen the same drop-off in fatalities. There has been a drop-off to be sure, but not by 90%.

Daily deaths are down by about half, so we're still having about 2,000 people a day die of COVID in this country.

I think that's really concerning for a lot of reasons, and I think it probably mostly reflects the fact that we still have a fairly sizable unvaccinated population, especially in the higher risk groups.

So this is just yet another opportunity for me to say, hey:

• There are a lot of good things happening with COVID;
• The case numbers are dropping;
• There's a lot of good news in the fact that Omicron is not as severe as the other variants that came before;
• But for older people and for unvaccinated people, Omicron is still a serious threat and we still have a significant number of people dying from COVID on a daily basis at this point.

Again, it's good news that the numbers are coming down and transmission is dropping, and I think along with that we can talk about the fact that we're starting to see the CDC drop off its mask guidelines.

We're getting rid of masks in schools in most places, Virginia included as of yesterday, masks are optional for students and teachers, and according to the CDC's new updated guidance, about 70 or more percent of counties and areas, population centers in the country, really don't need to mask anymore based on the CDC's updated guidance because the transmission has dropped off.

And I think that's good news. It's just also good to keep in mind and remember that even though the transmission has dropped off and that's great, if you haven't been vaccinated and you're an adult — especially if you are an older adult, and I mean 40s, 50s, 60s — then you really need to think about going ahead and getting it done now because you are eventually going to get exposed.

And we are still having a lot of people die every day. Do please keep that in mind.

Vaccine Effectiveness in Kids

On the other side of that coin, we've got some interesting information coming out about vaccine effectiveness in kids. The Pfizer vaccine effectiveness in kids five to 11 — a big article came out last couple days — showing that the effectiveness is not great in that age group.

Now, the effectiveness dropped from 68% in the initial few weeks to 12% by the end of January for the five- to 11-year-olds.

There's a good reason for why this is happening and a large part of it is the fact that for that age group, Pfizer's having to use a lower dose of the vaccine, which they have to do for a couple of reasons.

They're younger and smaller, which is just a practicality, but they're also having to use a lower dose because whenever you're designing trials and designing medications, you have to think about the risk-benefit profile.

If you've got a population of people who are very low-risk for a bad outcome from an illness — say, COVID being an example, younger people are at lower risk, we all know this at this point — your treatment or your prevention or your vaccine for that can not have very many side effects.

So you have a low tolerance of side effects when your risk of the illness causing death or hospitalization is also low. You have to have a vaccine that's very, very, very, very safe.

And to do that and to minimize the risk of side effects, Pfizer has to lower the dose of the vaccine that they're using in the trials and are using out in the real world for this reason.

So, because of that, we're seeing lower efficacy. It's not working as well on a large group of people because we're having to use lower doses because we can't really tolerate too many side effects in the younger kids, because it wouldn't make sense. The math doesn't work out.

If you are comparing, say, the risks of the myocarditis or the rash or the pericarditis or whatever compared to the risk of getting COVID and being in the hospital, that risk-benefit equation really gets very closely balanced, and so you have to really minimize the risk of side effects from the vaccine in order to make it sort of worth it to do it.

I think that's the trouble we've run into. I think that's probably why you're going to continue to not see the vaccine come out for the under five-year-olds either. I think we're hitting up against that wall where the risk-benefit equation just is so closely balanced that it may not make sense in many cases because the efficacy is going to be too low at these low doses.

So, we'll see. More to come. That's my view on it and we'll see what happens as more data comes out. They may be able to tweak the formula or tweak the vaccine, or I think what they would do better even to do is to try to target the vaccine uptake amongst kids amongst the high-risk kids.

So kids with chronic illnesses like cystic fibrosis or cancers or things of that nature, where they really, really, really do need the COVID vaccine, because they're at high risk. We could maybe tolerate a little bit more of a side effect profile because it's worth it for those kids to get the vaccine, which means we could use slightly higher doses of the vaccine so they would be more efficacious.

A little bit of complexity there, but I think that that's what's going on with the vaccine in those age groups, and so I think you're going to continue to see this be an issue for as long as they're trying to make a vaccine for the general healthy population.

I think that their risk from bad outcomes from COVID is just so low that they're going to have a really hard time getting a vaccine dose that's got a side effect profile that's acceptable while also being efficacious at the same time. 

Boosters for Children 5 to 11? 

"Do you think boosters will be suggested for the five to 11 population?"

Possibly. I don't know. I think part of the problem, even with boosters, we saw the efficacy drop off from 68% to 12% in just a very brief period of time, and I'm not sure if they're going to come out with recommendations for boosters because the first couple of doses just didn't last very long at all.

I don't know what the utility's going to be of a booster in that age group, especially if it's potentially only going to last a couple of months again. I think they're going to have to do some extension studies, and I suspect they are going to do some studies on booster doses in that age group, and see if that can help improve the efficacy long-term.

But I think for now, you're not going to see a recommendation for boosters anytime in the next couple of months for that age group.

Boosters with J&J

"Last week you said a healthy person who got two J&J should get an mRNA booster. So why can't someone who received one J&J and an mRNA booster get a third shot? I'm 60 with some underlying health issues and had one J&J last March and Moderna in late October. How protected am I? Can my physician allow a third shot?"

Yeah, your physician can allow a third shot. And the CDC does have guidelines and guidance that your physician can allow a third dose at their discretion based on their clinical judgment if they feel like you could potentially benefit.

And I think that would be — I don't know all of your underlying medical history and such — but that could be a very reasonable thing to do. So I would ask your doctor about it and see if they are comfortable with you doing that, because it may make quite a lot of good sense.

When is the next update? 

Because things are slowing down in the news cycles related to COVID and everything of that nature and the transmission rates are dropping, we are going to scale back these updates a little bit, at least for a while, to every other week.

We won't have one next week, but then the following week, we will have one on the 16th. And I was informed by one of our marketing people that that's the two-year anniversary of these updates, believe it or not. So that's kind of wild to think about.

But at any rate, we'll be back in two weeks and see if there is more to talk about.