REGIONAL- The U.S. Food and Drug Administration gave its approval to newly formulated COVID booster shots on Monday, clearing the way for distribution at a time when COVID rates around the country have been rising. But questions remain about who should and who will get the shots.
The U.S. Centers for Disease Control weighed in on Tuesday with its recommendations for who should get the shots, and that would be nearly everyone. CDC Director Mandy Cohen announced that the CDC advisory panel recommends that all Amercans over the age of six months receive the new booster shots, a position in line with what the FDA approved the day before.
“We have more tools than ever to prevent the worst outcomes from COVID-19,” Cohen said.
Some health officials had argued that the recommendation should target those at higher risk of severe illness from the virus, including those over age 65 and those with complicating underlying conditions. CDC advisory board member Beth Bell reinforced that sentiment.
“There are robust benefits of vaccination on severe illness, on death, on long covid,” she said. “The messaging needs to make clear that for older people and those with underlying health conditions, they really need to get a booster.”
The booster could be available at some providers within 48 hours following the CDC’s announcement.
The new boosters were formulated to combat the XBB.1.5 variant of the Omicron COVID strain that was prevalent in the spring and early summer, but now constitutes less than one percent of cases nationwide. Research conducted by Moderna and Pfizer indicates that the boosters should be equally effective against currently circulating variants. Past shots have been shown to provide a short-term boost of immunity against contracting COVID for several months, and long-term protection against the likelihood of severe illness, hospitalization and death from a COVID infection.
However, the dismally low public acceptance of the last COVID booster introduced in Sept. 2022 raises significant doubts about how these new shots will be embraced. Only 20 percent of those who were eligible to receive the 2022 booster actually got one. And that was before the number of cases leading to hospitalization or death fell this summer to a pandemic low. With new COVID variants shown to carry no greater risk for serious illness than past ones and with an estimated 95 percent of the population carrying some level of immunity against COVID from prior shots or infections, the landscape is much different from when the pandemic was at its peak.
Current surge
While the overwhelming shift to home testing for COVID has rendered case counts inaccurate, the CDC’s current standard of using hospitalizations as a measure of COVID activity clearly indicates that COVID is having a significant resurgence.
An uptick in both hospitalizations and deaths nationwide began in July and has continued to advance weekly since then. Data from the last week in August reflected the ongoing trend, with hospitalizations increasing 18 percent from the prior week and deaths increasing by 16 percent. However, the actual numbers were less than half of the same period in August 2022 for hospitalizations and deaths were 80 percent lower.
In St. Louis County, the CDC reported 23 new hospital admissions for COVID for the week ending Sept. 2. a 9.5 percent increase from the prior week. The University of Minnesota wastewater tracking of COVID viral load in northeast Minnesota has been showing a steady increase since late July, although the most recent measurement showed a slight decline. Anecdotally, reports of new COVID infections have been heard through the communities in the North Country – almost everyone, it seems, knows of someone who has had COVID recently.
But the CDC’s national map of county-by-county COVID levels reflects a vastly different picture than during past COVID surges. All counties in Minnesota, Wisconsin, North and South Dakota are rated low for COVID levels, while seven counties in Iowa are rated at moderate or high. The CDC map shows the greatest virus activity in the South and Southeast, with the highest concentration of moderate transmission in Florida.
Noted infectious disease expert Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, offered his take on the current COVID landscape during his regular podcast last week.
“I think that one silver lining has been that the overall numbers remain at just a fraction of what they’ve been throughout the majority of the first three years of the pandemic,” he said. “We are not going back to the pandemic experience of 2020 to 2022, I have no doubt about that when we just look at what happened last summer, in 2022, when nearly 38,000 Americans were hospitalized with COVID compared to 13,000 now. Likewise, weekly deaths last summer reached 3,400, more than five times higher than they are right now. Again, I’m not shrugging off what’s happening. I think it’s a very, very significant public health situation.”
Osterholm noted that schools in Oklahoma and California have been closed due to COVID infections, and school outbreaks have been reported in at least 14 different states.
He also took aim at the increasing chatter among far right COVID detractors that the current increase in cases will be used by liberal politicians to reimpose mask mandates and lockdowns. Osterholm said he doesn’t see that happening.
“Right now, we seem to be stuck in a narrative about is there going to be a national mandate for masking again as case numbers increase,” Osterholm said. “this has become a hot button issue on news media shows. I’m getting lots of emails and reporter questions about this issue and let me just make it clear we should not let that happen again. Do I believe we will ever mandate masking as we’ve talked about in this country? The answer is absolutely no. I just don’t think that’s ever going to be a reality. And I wish we could avoid that whole discussion because it really takes us nowhere except a big black hole.”
Osterholm also emphasized that people will always have the choice to take protective measures against COVID.
“So, you can still wear respiratory protection, i.e. an N95 (mask) appropriately worn -- that’s your choice, you can do that,” he said. “You can get your booster when it comes out, which will be within just the next two weeks. You can figure out if you want to test family members when you get together for family events, just to be sure someone’s not bringing the virus in or at least reducing the likelihood they’d bring the virus in. These are all things that are still in our control. These are with us. No government, no public body is going to tell you you can or can’t do that. We’re learning to live with COVID in all of its unfortunate scenarios that we can imagine. But right now, we have truly an increasing activity. But fortunately, it still is much, much lower than it was over much of the past three years.”
Getting a booster
The new COVID boosters were expected to be available through community health clinics, hospitals and pharmacies that order the new shots. Unlike earlier stages of the pandemic, when the federal government spent over $30 billion to buy millions of doses, distribution and costs for the new booster will be largely borne by the private sector.
Vaccinators will be purchasing the boosters through the regular commercial market, with many having already pre-ordered boosters and shipments beginning after the CDC gave its approval. Doses could be available in some locations by the end of the week, but patients should contact their preferred vaccinator to find out about scheduling arrangements.
Moderna and Pfizer have said they will be charging $130 per dose, far higher than the $30 per dose they charged when the government was the buyer. Demonstrated low demand for the last booster released by the companies is believed to be a driving factor in the price increase.
However, most Americans will still be able to get a booster shot for free. Private insurers should cover the cost as a preventive treatment, unless someone chooses to get their shot from an out-of-network provider. Medicare will continue to pay for COVID shots, and those on Medicare Advantage plans who use in-network providers will also be covered. Uninsured Americans, approximately 35 million, will be able to have the cost of their shots covered at health clinics, local health departments, and pharmacies through the federal government’s Bridge Access Program, which is set up to provide continued free access for the uninsured through 2024.