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Do New Boosters Work Against Latest Coronavirus Subvariants?

COVID czar Ashish Jha answers this question and others as virus activity starts to pick up

spinner image illustration of a man with a covid vaccine bandage on his arm
Malte Mueller / Getty Images

With public health experts expecting the approaching holiday season to bring an uptick in respiratory illnesses, including COVID-19, they are urging everyone who is eligible — especially older adults — to get the new coronavirus booster before the gatherings and merrymaking begin.

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We are now at a point where if you are up to date on your vaccines and if you get infected and you take Paxlovid, you are just not going to die of this virus. We are at a point where the mortality from this virus is close to zero in that context.

— Ashish Jha, M.D., White House COVID-19 response coordinator

These retooled shots target some of the latest versions of the virus that are circulating and that experts say could become a problem this winter. Still, only a small share of Americans have rolled up their sleeves for the bivalent booster — just over 7 percent of the eligible population, according to data from the Centers for Disease Control and Prevention (CDC).​​

Ashish Jha, M.D., head of the White House COVID-19 task force, talked to AARP about the importance of these new bivalent boosters as we head into the cold-weather months. He cleared up some common misconceptions about lifesaving COVID-19 treatments and had a few tips for how to safely navigate the holidays.

Jha’s responses have been edited for length and clarity.

The virus has changed so much in the last two and a half years — and it’s still changing, with new strains cropping up. Do we expect the new booster will still work against the latest omicron subvariants circulating?

The virus continues to evolve rapidly — every couple of months we see new variants or subvariants emerge. 

In the U.S., there are a couple of specific subvariants that we are tracking. The one that I think we’re tracking most closely is called BQ.1.1 [an omicron subvariant that as of Oct. 28 is behind about 13 percent of new COVID-19 cases in the U.S.]. And BQ.1.1 has a very high degree of immune escape. [This means it’s better at getting past some of the protections put in place by the vaccine or a prior infection.]

spinner image covid czar giving a press conference in the white house briefing room
White House COVID-19 Response Coordinator Dr. Ashish Jha speaks at the daily press briefing at the White House
Kevin Dietsch / Staff

Here’s what people need to know: If you’re relying on a prior infection from nine months ago, or if you’re relying on your vaccine from a year ago, you’re not going to have very much protection against BQ.1.1 because of its immune escape.

However, BQ.1.1 is a derivative of BA.5 and we updated our vaccines this fall to include BA.5 in the formula. [BA.4 is also included in the bivalent boosters, as is the original strain of the coronavirus.] And therefore, based on everything we know right now, we believe that the brand new updated COVID vaccines should provide a high degree of protection against BQ.1.1 and other subvariants that emerge.

What would you say to someone who is hesitant to go back for another COVID shot?

We are now at a point where, for the vast majority of people, this is a once-a-year shot. So when people think about the flu shot, they don’t say to themselves, ‘Oh, am I getting my 23rd shot or 35th shot?’ They just say this is my annual flu shot. And that’s how people need to start thinking about their COVID shot: it’s just an annual COVID shot. You go get it every year and it makes a big difference in keeping you healthy during the fall and winter.

I do think for some very high-risk people, an additional shot — maybe in the spring — may be helpful. But we don’t know if that’s going to be necessary.

If you’re relying on a prior infection from nine months ago, or if you’re relying on your vaccine from a year ago, you’re not going to have very much protection against BQ.1.1.

— Ashish Jha, M.D., White House COVID-19 response coordinator

If you do get COVID-19 this winter and you are 50 or older, should you be calling your doctor and asking about treatments?

Short answer, yes. Long answer, absolutely yes.

The treatments, particularly Paxlovid [an oral antiviral], do a remarkable job of keeping people out of the hospital, keeping people out of the ICU and preventing deaths. We are now at a point where if you are up to date on your vaccines and if you get infected and you take Paxlovid, you are just not going to die of this virus. We are at a point where the mortality from this virus is close to zero in that context.

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Almost every death that is happening [and the virus is killing, on average, more than 2,600 Americans a week, CDC data shows] is because either the person who died wasn’t up to date on their vaccines or didn’t take treatments when they got an infection. And almost every death is occurring in people over 50, with the majority of deaths right now in people over 70.

What’s been disappointing is seeing that a lot of 75- and 80-year-olds are not being treated [for COVID-19]. To me that’s unconscionable. Paxlovid is easy to get, it’s free, it’s widely available. There are some issues that you have to manage if you are on other medicines, where you may have to stop them or adjust the doses for a few days. That’s an inconvenience, but the alternative is that you could end up getting really sick.

Are there are any common misconceptions or misinformation out there about Paxlovid that you think might be contributing to people not taking it?

I think there are two sets of issues that are misperceptions. One, is the issue of rebounds, which is when you get better and then it looks like you get worse again. That also happens when people don’t take Paxlovid. That’s actually a normal part of this virus and we see this in a lot of people who are not treated — they get better and then they get worse again.

Here’s what we know about what happens with rebound with Paxlovid: The data that we have suggests it happens 10 to 15 percent of the time. So for a majority of people, it doesn’t happen at all. Second, and probably the most important thing: When people get that rebound, they don’t end up in the hospital. So rebound is an annoyance; rebound can be disruptive. But rebound does not end up getting people particularly ill and it certainly doesn’t kill you.

The second [misperception] is this issue around drug-drug interactions. There are lots of medicines that I use in clinical practice, that we all use in clinical practice, that have interactions with other drugs. It’s a normal thing; medicines can interact with each other. And in general, the way you handle it is not to say, ‘We won’t give you a lifesaving drug because it can interact with other drugs.’ We say, ‘We have to manage this.’

It might mean that you need to stop your cholesterol medicine for five days, or you may need to take half the normal dose of another medicine. These are normal things we do in clinical practice all the time. It’s a new medicine, doctors are still learning about how to manage it effectively. But the evidence on how to manage those drug-drug interactions is, at this point, really quite clear.

It looks like we’ll be having another holiday season with COVID-19 in the mix. Any tips or advice on how to safely navigate the holidays?

Absolutely, I’ll use my own family as an example. My elderly parents are actually in India right now traveling, and they’re going to be coming back in a couple of weeks. And travel is a bit more of a risky thing — you can interact with a lot of other people, you’re going through airports. So what I encourage my parents to do while they’re traveling is to wear a high-quality mask. They’re both up to date on their vaccines, but [a mask] just adds one more layer of protection.

We’re all gathering for Thanksgiving — my brother and his family, my wife and our kids, my parents. We think it’s a really good thing because the last couple of years, those gatherings have been disrupted, and it’s just really important to be able to spend time with family and friends.

One thing that we’re doing that first morning we all get together is taking an at-home rapid antigen test. Is it absolutely necessary that we do that? No, not at all. But it is helpful because it adds one more layer of protection. It reduces the likelihood that you’re going to end up having the virus come into your family gathering and getting someone sick and being disruptive.

The way we’re going to manage being able to spend time together and being able to do all the things we love without people getting sick is to put in these layers of protection and to use them when they’re appropriate. It’s important to remember that no one measure is unto itself perfect, but if you add them together, they can make a big difference.

Any other advice for older adults ahead of winter?

We are no longer at a point where we need to think about restriction of activities. We are at a point where we just need to think smartly about doing them in a way that’s not going to be disruptive. And in my mind, there are a few key things:

1. Get the vaccine. It’s going to make a big difference and it’s going to protect you at a high level this fall and winter.

2. If you feel sick, test.

3. Because if you’re positive, you want to get treated.

If people do those simple things, you can feel very confident you’re not going to end up in the hospital, you’re not going to end up in the ICU, you’re not going to end up having a really disrupted holiday. 

Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.​​

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