"We have more tools than ever to prevent the worst outcomes"

September 13, 2023 9:49 AM

The CDC's Advisory Committee on Immunization Practices (ACIP) met yesterday and recommended everyone 6 months or older get an updated mRNA COVID vaccine dose this fall [gift link]. The non-mRNA Novavax vaccine is still under review in the U.S., though it has approval in Europe, with some evidence suggesting that following mRNA doses with Novavax leads to better protection against breakthrough infections. "ACIP Cliff Notes" from Your Local Epidemiologist. Reminder tweet to swab throat, cheeks and nostrils for best results from rapid at-home testing.
posted by mediareport (93 comments total)

Can someone link to a better source for "throat, cheek, and nostril" swabbing than a random evolutionary biologist?
posted by muddgirl at 9:52 AM on September 13, 2023 [17 favorites]

The linked study in that tweet is only for a single type of test and does not conclude that "throat, cheek, nostrils" is best.
posted by muddgirl at 9:58 AM on September 13, 2023 [3 favorites]

I'll nose around (ha) for more, but that tweet links to a study in an American Society for Microbiology journal that seemed relatively rigorous to me on first look:

The second, more impactful reason is that many early infection time points had detectable virus in saliva or throat swabs, but not ANS*. A nasal swab reference test would miss these infected time points. Therefore, the true performance of an ANS Ag-RDT would be worse than composite infection status based on multiple specimen types than nasal swab alone

*anterior nares swab
posted by mediareport at 9:59 AM on September 13, 2023 [1 favorite]

I was so excited for this booster! Then I got COVID last week. First time! So I'll have to wait until December, at which point I will have SUPER IMMUNITY or whatever.

Ideally they would authorize booster shots every 6 months.
posted by grumpybear69 at 10:05 AM on September 13, 2023 [14 favorites]

I think it's interesting that (for the first time?) we know what the pharmas are charging for these vaccines in the US

For each dose of the vaccine, Moderna is charging $129, and Pfizer is charging $120, company officials said Tuesday. When its shot becomes available, Novavax says it will charge $130. Consumers who have insurance will not have to pay these costs. Private providers, pharmacies and insurers pay the list price or negotiate their own discount. Vaccine makers typically charge the government a discounted rate for doses purchased for programs for the uninsured. Novavax said its contract price with the CDC is $72.50 per dose.

Consumers like you and me don't see these prices. I don't think this cost will be a practical issue for individuals this time around. If insurance doesn't over it there are various state and federal programs to cover the cost, IIRC through the end of 2024. CVS and Walgreens have said the vaccines will be free for everyone in the US.

But the pharma companies are collecting that money from someone. Insurers (and thus us, in aggregate) or governments (again us, in aggregate). If 100M people get a vaccine that's about $12B in payments.

I don't know what these treatments should cost. For comparison, the CDC quotes a wholesale cost of $14 for a flu vaccine. I'm still incredibly grateful for the speed of MRNA vaccine development and am sure that the Covid vaccines have saved an enormous amount of lives, wellbeing, and money. OTOH now there's a number attached to the cost of ongoing vaccination.
posted by Nelson at 10:07 AM on September 13, 2023 [14 favorites]

Here's a JAMA article from January about the nasal vs. nasal and throat swab debate, setting out both "nays" and "yeas" that includes pre-print and published studes on the "yea" side:

For most participants in the studies, viral loads increased in throat and saliva specimens before they did in nasal specimens, leading the authors to conclude that combining specimens may be the way to detect Omicron infections as early as possible.

...Nasal swabs alone detected more PCR-confirmed COVID-19 than throat swabs alone, but the combination picked up the most cases of all, according to an article published in July 2022.

I apologize for overstating the certainty of the throat swab being better. It remains to be seen, although as one person quoted in that article notes, "Manufacturers have little incentive to check whether adding throat swabs is safe and effective because their nasal swab tests are selling just fine."
posted by mediareport at 10:09 AM on September 13, 2023 [4 favorites]

If 100M people get a vaccine that's about $12B in payments

Only about 17% of the U.S. population got the last updated booster, or 56 million people (click "updated bivalent" at the right of the chart). Remains to be seen how many will get this one.
posted by mediareport at 10:14 AM on September 13, 2023 [9 favorites]

Our local Public Health agency has been running pop-up vaccination tents throughout the city during the summer; I got my 4th (?) booster in early July because of it. I kinda wish I had waited for the updated vaccine making its way here in a month or two, but having any coverage is better than none at all. I mentioned it before on the Blue, but when I finally got COVID Xmas Day last year, it was the sickest I've ever been, and I am a pretty dang healthy woman in my mid-40s. I would really really really prefer to not have that happen again so if society isn't gonna watch out for me, I am watching for myself!
posted by Kitteh at 10:17 AM on September 13, 2023 [6 favorites]

I got vaccinated back in early May because I had a conference with a couple thousand people coming up in late June. I dodged any COVID exposure after that show, but my biz partner got hit and was sick for a while.

I didn't see what the recommended wait time was for the next dose. Given my lungs and my wife's job as a public school teacher, I tend to be pretty vigilant about vaccinations.
posted by drewbage1847 at 10:37 AM on September 13, 2023 [3 favorites]

This article from yesterday says

People recently vaccinated should wait two months before getting an updated vaccine, the CDC says. Those who have been recently infected can wait three months, but they can also get it “as soon as they’re feeling better,” Megan Wallace, a CDC official, told the panel.

There's a second way to think of when to get the vaccine, which is that you want to get it a bit before a high risk time in your life like travel or a major Covid surge.

The most important thing is to get vaccinated again at some time. Don't let worrying about which day you do that stop you from getting it!
posted by Nelson at 10:44 AM on September 13, 2023 [9 favorites]

Oooh, thanks, Nelson. I have a girls' trip planned in late October in Toronto. Good to know I could probably get it in early October beforehand.
posted by Kitteh at 10:46 AM on September 13, 2023 [1 favorite]

Anecdotally, I had heard from a friend that a throat swab first then nostril picked up more cases. She'd been testing daily (with symptoms) but didn't test positive until she added the throat swab. The instructions on the box still just say nostril and should be updated.
posted by subdee at 10:49 AM on September 13, 2023 [1 favorite]

Just waiting for new vaccines to drop, and it sounds like we can vaccinate the baby too (awesome). The high cost for the vaccines - especially compared to the flu vaccine cost - will probably feed into the conspiracy theories that boosters aren't necessary and are a Big Pharma scam tho.
posted by subdee at 10:51 AM on September 13, 2023 [1 favorite]

Has there been any serious talk of adjusting the timing of the yearly process for getting the new COVID vaccine ready? It seems obvious at this point that COVID seasonality is not the same as flu seasonality and getting a COVID booster in early August seems more beneficial than having to wait until October.
posted by rhymedirective at 10:53 AM on September 13, 2023 [5 favorites]

I think from a public health perspective it's better to have more people come in to get a combined flu + COVID shot than to have fewer people come in August for a COVID shot alone.

Also in our area, the waves appear to start around July and then in November (admittedly based on just 2 years of data). I'm not sure an August booster helps either of those.
posted by muddgirl at 11:11 AM on September 13, 2023 [4 favorites]

Derailing, I know, but the ever-growing practice of acronymal reduction of the critical term(s) in a sentence is worth far less than the ink and time cost they spare. This language disease is onerous and widely distributed and in the end, not much more than a PF. [1]

[1] Professional Flex
posted by Fupped Duck at 11:27 AM on September 13, 2023 [7 favorites]

If 100M people get a vaccine that's about $12B in payments.

I don't know what these treatments should cost.

Here's an estimate of $14T total cost from the pandemic to date.

1% of that on prevention of serious illness sounds like a good investment, even as an annual expenditure.
posted by stevis23 at 11:42 AM on September 13, 2023 [5 favorites]

Someone I know in their early 30s who's vaccinated and (I think) boosted last year just caught covid and had it bad enough to seek out paxlovid.

I've started masking again. I can't wait for the updated booster.
posted by RonButNotStupid at 11:51 AM on September 13, 2023 [5 favorites]

Ideally they would authorize booster shots every 6 months.

Yep. The CDC and the Biden admin (led by its ex-Bain Capital "let's get back to business ASAP" COVID czar and now Biden chief of staff Jeff Zients), is asking us to ignore the mountain of evidence that vaccine immunity fades dramatically after 6 months. From a meta-analysis of 40 studies published May 2023:

the estimated vaccine effectiveness against both laboratory-confirmed Omicron infection and symptomatic disease was lower than 20% at 6 months from the administration of the primary vaccination cycle and less than 30% at 9 months from the administration of a booster dose. Compared with the Delta variant, a more prominent and quicker waning of protection was found.

Here's a quick summary in Time as well.

The once-a-year strategy is based on pure convenience and economics rather than current science about the vaccines.

Those who have been recently infected can wait three months, but they can also get it “as soon as they’re feeling better,”

The issue with the "as soon as you're feeling better" bit is that you may not get much of a boost beyond the temporary immunity conferred by the infection if you get a vaccine too soon after having COVID. It's *safe* to get the vaccine soon after you're no longer infectious, but it may not be *effective* unless you wait a few months.
posted by mediareport at 11:56 AM on September 13, 2023 [9 favorites]

I'm a trifle concerned about this wave. My sister and her husband - early 60s, healthy and active, up-to-date vax - were clobbered by it recently, and they were pretty sick for a couple of weeks. This new one seems more likely to get through even in the previously vaccinated. And I remain convinced that a high percentage of people have lasting effects from even a mild bout of COVID, though they are often not that bad.

I cannot recall the source, but I believe I saw something that said that the existing home test kits were not as effective as before at detecting the current variant of concern.

The new Moderna mRNA version has just been approved for use here in Canada and will supposedly be available in Canada in October. Canada's "top doc" Dr Theresa Tam has recommended the resumption of public masking, especially to protect the most at-risk, but it's not a mandate or an order. But of course the usual suspects have gone ballistic. With sprinkles of misinformation about mask efficacy.

Yes we will get as soon as available. As well as the flu shot.
posted by Artful Codger at 12:01 PM on September 13, 2023 [7 favorites]

Meant to add: Given the stingy approach to allowing boosters, folks may have to fight at the pharmacy if they want full protection. Last spring I was about to spend a week visiting an elderly relative in a retirement community where residents don't have to mask; the pharmacist pushed back on my request for a 2nd bivalent booster since I'd had the first 5 months before and was under 65 so "the CDC didn't recommend it." I pushed back harder and got the shot, after they admitted they knew that vax immunity waned significantly over time, but it bugged me that I had to argue with them about it.
posted by mediareport at 12:04 PM on September 13, 2023 [4 favorites]

So since I'm traveling every month for the next six months I should...wait until after then?
posted by corb at 12:04 PM on September 13, 2023

Ugh, yes, I really wish “I have someone in my life who is at higher risk, and I want to minimize the chance of passing COVID on to them” was an accepted justification for more frequent boosters beyond people who work with at-risk populations as part of their job.
posted by eviemath at 12:12 PM on September 13, 2023 [10 favorites]

I've been waiting for this, because getting an older booster would have required waiting to get this one, and if/when I get Covid again I'd prefer to limit the symptoms. So I'm looking forward to my shot, whatever it costs.
posted by They sucked his brains out! at 12:23 PM on September 13, 2023

I haven't been masking generally, but was at a convention last weekend and did, and also tried to avoid crowded areas when possible. Maybe about 10-15% of other people were wearing masks regularly. Sure enough, I've seen on social media that some folks who were there tested positive afterwards.

I really wish the booster had been about 3 weeks ago.
posted by Foosnark at 12:26 PM on September 13, 2023

I hope that the CDC or whoever is actually administering it gets the bridge program thing figured out soon. At present, vaccines.gov has no participating providers listed near me. I am glad to have been corrected that it will be lasting through the end of next year, not just this year, though. Something like 30 million people in the US still have no health insurance or other health coverage.
posted by wierdo at 12:27 PM on September 13, 2023 [1 favorite]

My wife and I COVID in late July (2nd time for each), and our Doctor suggested waiting until the latter part of October to get the COVID booster. So I'll get the flu shot in early October as I always do, then COVID at the end of the month.
posted by COD at 12:28 PM on September 13, 2023

Kitteh: I have a girls' trip planned in late October in Toronto. Good to know I could probably get it in early October beforehand.

It can take up to 2 weeks for a COVID vaccine dose to reach full protection, if that helps with your planning. From NPR a couple of weeks ago:

"It takes up to two weeks for you to have the best protection [from a vaccine]," says Dr. Javaid. Andrew Pekosz says for COVID the vaccines may even work a bit faster because of prior immunity people have from vaccines and from having had the virus. "Within ten days you would detect increases in your immunity and by two weeks you should be at pretty good levels that would be protecting you from a COVID-19 infection and particularly severe COVID-19," Pekosz says.

Artful Codger: I cannot recall the source, but I believe I saw something that said that the existing home test kits were not as effective as before at detecting the current variant of concern.

I recently read the opposite, that the mutations in the spike protein that characterize XBB variants generally have not been affecting the proteins that rapid antigen tests look for. Can't recall the exact source, but here's one from April:

As the prevalence of XBB.1.16 grows, experts don't anticipate the accuracy of at-home tests to be affected, since most are designed to recognize the virus' nucleocapsid protein, not the spike protein. Health officials have said XBB.1.16 has a very similar profile to XBB.1.15 — the dominant strain in the U.S. — with one additional mutation in the spike protein that has shown increased infectivity and a potential increase in pathogenicity in lab studies.

"The majority of SARS-CoV-2 variant mutations occur in that spike protein and so thus far, the ability of at-home [tests] to detect the virus has not been affected, through many interactions of changing variants, because the nucleocapsid protein has not changed much as the virus has evolved," Amy Karger, MD, PhD, clinical pathologist and associate professor at the University of Minnesota Medical School in Minneapolis, told Becker's.
posted by mediareport at 12:35 PM on September 13, 2023 [3 favorites]

Adding to the anecdata that I've seen many more people sick with covid recently, including people who have never had it before. I've never fully stopped masking, but if you have, now may be the time to start up again.
posted by tofu_crouton at 12:36 PM on September 13, 2023 [8 favorites]

The high cost for the vaccines

Obviously high compared to flu but is it high on the spectrum of vaccine costs? The only vaccine I've had to pay for (well my insurance) recently was shingles at $300 per (2 doses) and hepatitis at $78 per (2 doses).
posted by Mitheral at 12:36 PM on September 13, 2023 [2 favorites]

Have a trip at the end of the year, and now wondering how far in advance CVS.com will let me snag an appointment for the booster, four weeks before I leave...
posted by wenestvedt at 12:41 PM on September 13, 2023 [1 favorite]

I’m certainly looking forward to being able to book this shot. And glad to see people talking about re-masking. The surge we’re in is really running through people, and masking works. One way masking works to protect you when you wear an N95 or higher mask that fits you! For people with rounder face shapes or lower nose bridges kn95 or kf94 masks may fit your face better. Upgrading from a cloth or surgical mask is one of the best ways to protect yourself, and to get a low viral load if you do have a leak. Elastomeric masks tend to have a more forgiving fit, and bonus, don’t create as much waste with many only needing their filters changed once or twice a year. Especially if you are planning on waiting to get booster, wear your mask so an infection doesn’t screw with your vaccine schedule.
posted by Bottlecap at 1:03 PM on September 13, 2023 [8 favorites]

I was going to get my booster (+flu) next weekend, but this one looks crappy weather-wise, so I'm now scheduled for Saturday. I usually wait until October/early November for flu but I've already had one coworker out with it and stories of other hospitals having employee outbreaks, so earlier seems prudent this year.

wenestvedt, CVS is scheduling through September 30th right now (I'm in approximately the same geographic area you are).
posted by smangosbubbles at 1:22 PM on September 13, 2023 [1 favorite]

I've been digging deep into the mRNA vaccine manufacturing process for reasons of academic and professional interest. I haven't seen a complete cost analysis yet, but based on what I know, this pricing isn't ridiculous. Manufacturing throughput is pretty low and hard to scale.
posted by mr_roboto at 1:25 PM on September 13, 2023 [2 favorites]

My rheumatologist told me in the spring to wait until the new vaccine was out to get my COVID booster and my wait is over!
posted by gentlyepigrams at 1:39 PM on September 13, 2023

FWIW it looks like new vaccines will be available in the US later this week, possibly as early as tomorrow. CVS in Grass Valley, CA was showing first appointments on Saturday and specified "2023-2024" vaccine. Walgreens was showing first appointment next Monday. A local mom & pop pharmacy looked like they might have some on Friday.

Some of the websites aren't entirely clear whether you're getting the new vaccine. OTOH I've heard from several friends that the old one is now withdrawn. So presumably any vaccine you get now will be new and in fashion.
posted by Nelson at 2:00 PM on September 13, 2023 [3 favorites]

I have an appointment at a CVS for Monday.
posted by Dashy at 2:30 PM on September 13, 2023 [5 favorites]

I still cannot figure out how much it will cost me (in the US) if my crappy health insurance policy will not cover it. Hopefully this will be resolved soon and insurers will be pushing folks to get vaccinations.
posted by mightshould at 2:33 PM on September 13, 2023

CVS seems to be most on the ball with quickly updating their website with appointments for the new formulation. Walmart will not currently let you book one because they’re still updating their system but I’d imagine they’ll be up and running soon. I’ve got my appointment made for next week when I go into work, there’s a CVS a few blocks away. I never stopped masking but several of my coworkers have had it recently so I’m trying to be even more vigilant.
posted by skycrashesdown at 2:58 PM on September 13, 2023 [3 favorites]

Just made my appointment for Sunday afternoon at CVS! The website made numerous references to the 2023-2024 vaccine, but the vaccine facts PDF on the website was dated April 2023. However, there was a QR code on that PDF for the 'latest updates' and that took me to a PDF dated September 2023. I'll ask when checking in, though.

My records at CVS.com show my last boost was September 2022, so I'm happy getting this every September for the rest of my life. Hooray for science!
posted by kimberussell at 3:11 PM on September 13, 2023 [3 favorites]

I've never stopped masking, and likely will not stop anytime in the near future. I’m pulling out all the stops to avoid getting a 1st infection* (*that I know of, anyway.) Getting boosted and a flu shot ASAP. Thank you for the post!
posted by edithkeeler at 3:29 PM on September 13, 2023 [5 favorites]

It seems obvious at this point that COVID seasonality is not the same as flu seasonality

I’m not sure it’s really settled into a predictable seasonality thus far (this is not disagreeing with you, obviously).

Ideally they would authorize booster shots every 6 months.

Dosing schedule to account for antibody dropoff is one thing, but it also feels like we should be able to do a little better than targeting the hot variant of six months ago? I understand that even with the mRNA tech there’s a lot to the logistics of actually getting a vaccine approved but still…
posted by atoxyl at 4:08 PM on September 13, 2023 [2 favorites]

Dosing schedule to account for antibody dropoff is one thing, but it also feels like we should be able to do a little better than targeting the hot variant of six months ago? I understand that even with the mRNA tech there’s a lot to the logistics of actually getting a vaccine approved but still…

What makes COVID different than virtually all other viruses we vaccinate for is how quickly it has continued to mutate. Factor in that we have to detect the mutation, develop a vaccine that we think works, and then test it broadly and it’s a modern miracle that we have what we have today when we have it.
posted by openhearted at 4:37 PM on September 13, 2023

Welp, I've now signed up with CVS 2 weekends from now, which is when they finally start offering them in my town. Looks like my HMO won't offer shots until god knows when anyway, so there you go. Thanks for mentioning they're ready to go at CVS!
posted by jenfullmoon at 4:40 PM on September 13, 2023 [2 favorites]

The COVID vaccines are also historically incredible for their efficacy - the flu shot is generally about 50% effective or less for people under 65, and that’s after decades of experience with it.

When the first two shot vaccines came out with an efficacy of like 90-95%, most of the people I know who work with viral disease were beyond impressed.

We should always be skeptical of pharmaceutical companies, their motivations, and their profits, but the investments made in mRNA development will pay dividends well past COVID. So on the list of things I’m personally concerned about they are doing, this is not the top.
posted by openhearted at 4:46 PM on September 13, 2023 [9 favorites]

Thank you, wenestvedt and smangosbubbles for the CVS tip! I managed to get appointments for me and my spousal human for Saturday, and I wouldn't have known I could without your help.
posted by lauranesson at 5:07 PM on September 13, 2023 [6 favorites]

Nthing the thanks to all for the CVS tip - I booked my appointments for “Pfizer 2023-2024” and Flu for this Saturday morning.
posted by edithkeeler at 6:35 PM on September 13, 2023 [2 favorites]

I’m getting mine tomorrow, boosters have been available to everyone in France since the first of September (I’ve been in the UK) but they haven’t publicised this at all, I had asked my pharmacist if I could get one before I went home and he told me I should wait for the updated version in September. In the UK they’re only available to high risk and over 65 people which is just stupid.
posted by ellieBOA at 7:04 PM on September 13, 2023 [2 favorites]

In the UK [boosters are] only available to high risk and over 65 people which is just stupid.

Is it normal for the NHS to allocate care in such an authoritarian manner? I get that as a poor nation they need to save money and their rationale seems similar to their brilliant first-doses-first strategy in the early going, namely to prioritize getting it into the right arms:

The ~26 million people in groups currently eligible for 2023 Autumn Covid vaccine booster account for ~99% of cumulative UK C19 adult hospitalisation risk and those with whom they have high contact (health and social care workers, close family/unpaid carers etc).

...but the lack of a voluntary option for people who are at lower risk seems odd to this outsider.
posted by daveliepmann at 11:28 PM on September 13, 2023 [1 favorite]

Is it normal for the NHS to allocate care in such an authoritarian manner? I get that as a poor nation they need to save money and their rationale seems similar to their brilliant first-doses-first strategy in the early going, namely to prioritize getting it into the right arms:

It is usual for the advisory bodies to the NHS to be quite disciplined about how they carry out vaccination programmes and allocate medical resources.

I think this is more about policy priorities than available nation resources since Dutch GDP/per capita is about as much than German GDP as German is to UK but the former have very similar insurance based systems and traditions of physician / hospital independence and medical autonomy - German and Dutch covid vaccine policy are pretty close despite the wealth gap so I would guess this more driven by that.

What is unusual is that (at present) the vaccines are only available via the NHS and there isn't a private option to buy them. That isn't something that is set via law and there are no objections from anyone to offering them privately (several JCVI members have said that they should be privately available). In general any licensed medicine can be prescribed privately in the UK but in this case the manufacturers have not prioritised doing so, probably because they don't expect high uptake from private citizens.

I.e. Flu vaccines are only funded for high risk groups but are widely used privately purchased, we have them offered for everyone at work.

I don't know that it is "stupid" to prioritise resources. Even though I personally am quite keen to get a vaccine.
posted by atrazine at 2:51 AM on September 14, 2023 [3 favorites]

Thanks, that's exactly the context I was missing. Now with better search terms I'm reading e.g.

“We accept every year that those who are not at high risk of serious complications can access a private flu jab, so why should the Covid jab be any different?"

posted by daveliepmann at 3:08 AM on September 14, 2023

My family just got over it. Our first time was July 2022, we all had symptoms equal to a mid level cold. This last time was very different. We are all fully vaccinated. My 16 year old son and I both had symptoms of a pretty bad cold and add terrible, crushing fatigue that is still very present. My 23 year old daughter landed in the ER for a night. Severe dehydration and her temperature went down. It wouldn’t register on a digital thermometer and her lips and nail beds were blue. She was better after three bags of warm saline and some oxygen but it was a terrible 6 hours in an absolutely slammed hospital, all covid. Patients were lining the hallways and this was three weeks ago. We will get the new vaccine as soon as we hit the two month mark. Stay safe everyone.
posted by pearlybob at 3:46 AM on September 14, 2023 [6 favorites]

This Twitter thread has links to studies about Novavax and brief, clear explainers for laypeople like me.

tl;dr mRNA is great, and also Novavax is even better than mRNA at preventing infection, preventing hospitalization, clearing virus from upper respiratory airway, longer-lasting protection after getting the shot, and protection that applies to more variants.

Sidenote: so much is being lost as the wheels come off Twitter and no single replacement emerges to hold its archive or rebuild its community.
posted by Former Congressional Representative Lenny Lemming at 5:55 AM on September 14, 2023 [8 favorites]

Mod note: Comment and response removed. Be considerate and respectful and do not take someone else's comment and rewrite to twist their words. Just don't.
posted by Brandon Blatcher (staff) at 6:03 AM on September 14, 2023 [1 favorite]

In case anyone is getting their French availability from here, went to get mine today and they told me they’ve pushed the updated booster release to October 15-17 to test it on the new variant, now I just have to try and not get Covid for the next month! Also had a disappointing doctors appointment that spawned two expensive specialist appointments so this has not been a productive day!
posted by ellieBOA at 8:15 AM on September 14, 2023 [1 favorite]

Public health communication awesomeness... and a zillion bonus points (at least for my generation) for using a clip from the Busta Rhymes remix of Ante Up:

Remind. Refine. Re-Up: WHAT COVID BOOSTERS ACTUALLY DO
posted by spamandkimchi at 9:59 AM on September 14, 2023 [2 favorites]

This last time was very different. We are all fully vaccinated.

Yeah, grumpybearbride and I have both lost our sense of smell, which I thought was no longer a thing. We're also fully vaxxed and twice boosted. I'm also dealing with an extremely painful mouth issue, which may or may not be related but was definitely coincident. This latest strain seems more serious.
posted by grumpybear69 at 10:57 AM on September 14, 2023 [3 favorites]

Novavax is even better than mRNA at preventing infection, preventing hospitalization, clearing virus from upper respiratory airway, longer-lasting protection after getting the shot, and protection that applies to more variants

Yeah, I decided a few days ago to wait for the Novavax shot, aka a "heterologous booster" after my mRNA boosters. I'm seeing unconfirmed reports that it may be available within a week or so, but nothing definite. I can mask up and avoid indoor dining until it becomes available, hopefully before my upcoming annual physical. Just left a message with the doctor that I'd like that booster.
posted by mediareport at 11:57 AM on September 14, 2023 [1 favorite]

Some report the Novavax shot as having higher protection, but it seems the CDC is recommending Pfizer or Moderna shots over Novavax. In y'all's opinion, what's up with that?
posted by interbeing at 3:43 PM on September 14, 2023

Looks like I'll have to wait until Sept 25th before any availability information is, um, available from my medical provider.
posted by They sucked his brains out! at 6:13 PM on September 14, 2023

interbeing, Novavax is still under review, we're told. It may just be a timing thing, but I haven't seen the CDC/FDA give a reason for the delay.
posted by mediareport at 7:16 PM on September 14, 2023

Canada has just approved the updated Moderna vaccine 2023-24.

The updated Phixer and Novavax have not yet been approved .
The old guidance regarding Novavax is:

The National Advisory Committee on Immunization (NACI) strongly recommends mRNA vaccines (Pfizer-BioNTech, Moderna) for all eligible age groups because they are safer and more effective.

In Toronto the older Novavax is available. But you must book an appointment at a City clinic.
At Cloverdale clinic, Novavax is only available on Thursday afternoon.
Different clinics have different days.
Here's a link to book appointment

You can see there are very few appointments available.
Cloverdale for next Thursday has 15 spots available.
---
I've had 6 shots so far. The last bivalent in May so I can get an updated shot in October
I'll take the first updated one available , rather than wait for an updated Novavax
posted by yyz at 6:49 AM on September 15, 2023 [3 favorites]

I got my shot from CVS in California this morning. But not without some anxiety: CVS and others cancel COVID-19 vaccine appointments due to insurance issues. Not sure if this problem is specific to New York or more general. A friend had a Texas appointment from Safeway cancelled for lack of supply. The CVS folks told me they had already allocated all their supply, weren't taking walkins, and in fact were cancelling some appointments. Glad I got mine.

I imagine this is all a temporary snafu related to a very fast rollout; some 48 hours from approval to first appointments. There's probably an early surge of folks who were waiting and then it'll be a more normal thing, possibly undersubscribed.
posted by Nelson at 2:47 PM on September 16, 2023 [2 favorites]

Several friends of mine in the US who got early appointments are now all having them cancelled. Stated reason is lack of vaccine supply. Either there was way more demand than anticipated or early distribution has had a problem.
posted by Nelson at 4:32 PM on September 16, 2023 [1 favorite]

Still testing positive on day 11, still have a heavily compromised sense of smell. This is having a deleterious impact on my opinion of my immune system, which up to this point I thought was pretty robust.
posted by grumpybear69 at 6:32 AM on September 18, 2023 [1 favorite]

Welp, two friends of mine went to concerts within the last week. One just tested positive and I'm just waiting to hear the other say she is too--probably tomorrow would be my guess. I can't even deal with the idea of going to a concert any more.

I hate that my mask fatigue and exhaustion is coming on fairly strong, as is the revival of covid again. I am having issues putting and keeping it on if I do anything involving eating or theater, not so much "pop into a store" since it doesn't have to come off and on, but doing anything semi-impractical to be masked doing is just...my heart is whining, "I don't WANNA any more" and it needs to shut up because I am gonna jinx myself.
posted by jenfullmoon at 2:49 PM on September 18, 2023

Good news for the uninsured and underinsured: CVS and Walgreens are participating in the Bridge Access Program.

Walmart does not yet have the updated vaccine, so no word yet on whether or not they are participating. I'd prefer to use them just because they already have all the required documentation for me. Not having a photo ID can be a pain sometimes.
posted by wierdo at 5:02 PM on September 18, 2023 [1 favorite]

A Game Plan for Timing Your Flu, Covid and RSV Shots This Fall [WSJ gift link]

Flu cases usually start ticking up in November and peak in January before trailing off at the end of March, says Wherry. So far, influenza rates remain low, with less than 1% of tested specimens coming back positive, according to the CDC. Given that protection lasts four to six months after getting a flu shot, it might make more sense to get it in October or early November, Wherry says...

RSV and influenza activity started earlier than usual last year...If you get sick with the flu before you’ve been vaccinated, you should still get the vaccine about a month later, Wherry says. That’s because the flu vaccine typically protects against four types or strains of influenza...

The new RSV vaccines, authorized for seniors and some pregnant women, are recommended sooner rather than later because activity is picking up and RSV tends to peak earlier than the other respiratory viruses, says Wherry. There is also a new RSV drug approved to protect infants. Cases are already starting to increase in the Southeast, according to the CDC.

While it’s fine to get your Covid and flu shots at the same time, doctors suggest getting the RSV shot separately. That’s because there are few studies looking at the effects of getting all three shots at the same time.
posted by mediareport at 6:56 PM on September 19, 2023 [2 favorites]

This CNN article about rapid home test effectiveness "is worth reading all the way through," according to epidemiologist Michael Mina (who I've found to be a reliable COVID Twitter follow, for what that's worth).

It covers the importance of testing 3-5 days after an exposure, since it can take that long for the viral load to build up enough to test positive, even though our immune systems may now react with symptoms sooner than that, due to either previous infection, vaccination, or both. It also covers the need to repeat the test 48 hours after the first one if it's negative:

Rapid home tests were more accurate in people who had symptoms. They caught the infection about 60% of the time when a single test was taken on the first day of infection when a person had symptoms. When the rapid test was repeated two days later, the tests caught an infection with symptoms around 90% of the time.

It also notes unusually high levels of false negatives in young children, which researchers attribute to the difficulty of getting kids to sit still long enough for a good swab in both nostrils.

Finally, it ends on this note from Mina, which may seem counter-intuitive but is eye-opening:

Squirmy toddlers aside, Mina says he’s looking forward to the day when it’s common for rapid home tests not to show a positive result, even with repeat testing.

“We could actually call that a victory of our immune system, because it means that our immune system actually kept the virus at bay enough that it never grew up to a high level” to turn the test positive, he said. “I think for a lot of people, that’s actually happening.”
posted by mediareport at 8:37 AM on September 20, 2023 [2 favorites]

Frustrating that even in the third year of this COVID situation it still seems to be a huge trial to get vaccines for kids. I can schedule for adults now but kids under age 6 or 12 have to wait two more weeks at Walgreens. Or they can't go to a regular CVS, they must go to a minute clinic (and pay that copay). Or we have to trek across town to the county vaccine site which is not currently scheduling. Definitely can't just go to their regular pediatrician and get it along with their flu shot.

And by the time I get an appointment for my kid, she will get sick with start of school year colds and I'll have to cancel.

On a second topic it seems to me like Mina is making a whole career out of explaining why rapid tests suck, different excuse every single month. Oh it's actually a GOOD sign that they don't work!
posted by muddgirl at 10:20 AM on September 20, 2023 [1 favorite]

I don't think he's saying rapid tests suck, and I also think it's smart to keep in mind the limitations of the tests and how they're used in the wild.

That rapid testing can lag behind symptoms has been known for years now; Mina is pointing out that newer immunity conferred by previous infections or vaccinations may be adding to that. What part of that seems unscientific to you, muddgirl?
posted by mediareport at 12:08 PM on September 20, 2023

Also, speaking of tests:

Federal government to start providing free covid tests once again [WaPo gift link]

Just as a summer covid wave shows signs of receding, the Biden administration announced Wednesday that it is reviving a program to mail free rapid coronavirus tests to Americans. Starting Sept. 25, people can request four free tests per household through covidtests.org. Officials say the tests are able to detect the latest variants and are intended to be used through the end of the year.

I'm guessing they're older tests near their expiration date, but here's the FDA's page where you can check brands and lot numbers to see if your tests' expiration dates have been extended.

Also, this:

An HHS spokesman did not immediately return a request for comment on why the administration did not restart the program earlier as covid infections were climbing.
posted by mediareport at 12:31 PM on September 20, 2023 [4 favorites]

CDC's Bridge Access program, talking about no-cost Covid vaccines to cover cases that insurance doesn't.

Anecdotally I'm hearing from a lot of people having trouble getting vaccines, a mix of supply problems and insurance problems. One new one to me; a friend with Kaiser, an HMO, told by a Walgreens they'd have to pay out of pocket to get a vaccine. Because Kaiser apparently wants to administer vaccines themselves. But Kaiser is taking their time getting supply.

The first few rounds of Covid vaccines in the US were in this magical world where America almost had universal healthcare. That's apparently fallen apart and now we're back to insurers, providers, and the government squabbling over who is going to pay and when.
posted by Nelson at 12:50 PM on September 20, 2023 [2 favorites]

Well, last year I got my covid shot at Walgreens and they gave it to me just fine, but said they wouldn't give me the flu shot because Kaiser wanted to do it themselves. I'm expecting them to pull that on me again when I hit CVS this year, but since I have to go to Kaiser for another shot anyway during flu shot time in 2 weeks, I don't really care, and also Kaiser takes forever to get the covid shots and that's why I've been going elsewhere. I'm really hoping they don't pull that on me by the time my appointment happens at the end of this week + different pharmacy, but who knows.
posted by jenfullmoon at 1:17 PM on September 20, 2023

What part of that seems unscientific to you, muddgirl?

I didn't say anything about the *science*. Mina has been advocating for relying on rapid tests to control the pandemic since the start, while working for a company that makes rapid tests.
posted by muddgirl at 1:28 PM on September 20, 2023 [1 favorite]

Wait, if your issue is that he works for a company that makes rapid tests, how is your issue also that "Mina is making a whole career out of explaining why rapid tests suck, different excuse every single month"? Those seem in conflict.
posted by mediareport at 2:24 PM on September 20, 2023

I successfully got the Moderna shot on Monday from a CVS. However, I paid $190. Wish I'd known about the bridge thing.
posted by Dashy at 4:55 PM on September 20, 2023 [1 favorite]

I'd call the CVS, Dashy, and talk to them about why they charged you $190 when Moderna is telling folks the cost is $129 per dose. Don't let them rip you off like that.
posted by mediareport at 5:15 PM on September 20, 2023 [1 favorite]

WaPo gift link about the problems folks are having getting their insurance to stop charging them for the new vaccines; one issue is that people aren't going to pharmacies in network, and (apparently) pharmacies aren't helping folks understand that. Another is just standard bureaucratic molasses bullshit, with proper codes not yet available in the insurance company and pharmacy systems. Ugh. Worth a read, might have some helpful info.
posted by mediareport at 6:52 AM on September 22, 2023 [1 favorite]

Oh that WaPo article is good, thank you for linking it. Finally some major national coverage. I've been watching this mess unfold for a week now wondering why there's not more attention to it. About half of 10 people I know have been unable to get a vaccine in the US for supply or insurance reasons. Or in one case, because it was for their kid.

The hiccups reflect a new reality for covid vaccines as they go from being treated as a public good to a commercial product. Now that the federal government is no longer buying and distributing all the shots, Americans must endure the usual headaches of dealing with insurance companies and a for-profit health care system.

That confirms my suspicion from above. Now that we've removed this little shred of universal healthcare coverage we had, it's all a mess.

CVS in San Francisco had a sign in their window saying it was insurance or cash, that the vaccine was not free. That is false. CVS participates in the Bridge system; it is supposed to cover people without insurance. But CVS apparently hasn't implemented it correctly and is lying to customers seeking healthcare rather than giving them vaccines.

I'm still hopeful this problem will get sorted out in a few weeks. News coverage helps accelerate that. Google News now shows a bunch of stories in national media, published in the last day. CNBC, CNN, AP (NBC).
posted by Nelson at 7:25 AM on September 22, 2023 [3 favorites]

I have canceled my covid vaccine appointment at CVS on Sunday. GRRRRRRRRRRR but it sounds very likely that they will deny me or hit me up for $200 if I go. Had a friend verify that our mutual HMO is denying you going anywhere else but them.

I have a lot of people saying, "your HMO sucks, why do you use them?" but frankly, I have yet to hear of an insurance provider available to me that doesn't suck? Like literally they all have issues, it just seems like we hear about it more with the current one. I'm usually fine with them (except for mental health, but literally I've read that every HMO sucks at that so I shouldn't expect better), but having to wait weeks because they take forever to get the shots pisses me off.
posted by jenfullmoon at 8:59 AM on September 22, 2023 [1 favorite]

My husband's appointment at CVS today, was cancelled yesterday morning, lack of shots. The Safeway pharmacist confirmed early last week they have no idea the timing on availability.
posted by muddgirl at 9:28 AM on September 22, 2023 [1 favorite]

Yay free markets. I'd love to be a fly on the wall at the company meetings where they're debating whether it's worth it at all to make a lot of doses, given antivax sentiment and the low uptake on the last round.
posted by mediareport at 10:30 AM on September 22, 2023 [3 favorites]

Anecdata: my local CVS didn’t charge me for the Covid & flu shots I got last Saturday, nor for my kids’ shots yesterday. Nor did CVS even ask for my insurance at either of these visits, nor do I have any insurance on file with CVS in the first place because I don’t get prescriptions filled there.

I’m struggling to find a pharmacy or Health Department in Middle Tennessee that has available supply of a 5-11yo dose. Probably a couple weeks’ wait.
posted by edithkeeler at 5:06 AM on September 23, 2023

US may pay 3x more than EU for Moderna’s US-funded COVID shot
posted by Nelson at 12:50 AM on September 29, 2023 [3 favorites]

Health Canada has just approved the updated Pfizer

Updated Novavax is still pending
posted by yyz at 7:50 AM on September 29, 2023 [1 favorite]

Kaiser of Georgia finally has some available, if you're willing and able to drive to the exurbs of Atlanta. All three are vaguely accessible from Atlanta proper if you're willing to spend a couple hours each way on a bus. It's walk-in only, no appointments, so you definitely run the risk of driving/riding a bus all the way out there and finding no shots are actually available when you get there.

And obviously Kaiser members in the entire rest of the state are completely out of luck.
posted by hydropsyche at 3:34 AM on September 30, 2023 [2 favorites]

BC starting rollout of combined (two shots at the same time) flu and Covid vaccination October 10th.
posted by Mitheral at 5:43 AM on September 30, 2023

Update: Getting an ages 5-11 Pfizer 23-24 dose remains an uphill battle. CVS texted and called to cancel the 2 appointments I’ve made in the past week, saying they’ve got no supply, please reschedule.

So I concur with Dr. Katelyn Jetelina’s recent substack post on how Vaccine Rollout Is A Mess Right Now.
posted by edithkeeler at 2:27 AM on October 4, 2023 [1 favorite]

I did get my covid shot yesterday along with all the other shots. I get the feeling Kaiser did a "soft rollout" in my town and the people who were forced to drive a half hour away and sit in their cars for an hour the day before were not happy about finding out that oops, they had shots here after all! Of course, now they're on strike, so.

I possibly actually got messed up from the shot this time, but in all honesty I'm not sure if that's from the shot or that I am just in a sleepless mode already the last few days.
posted by jenfullmoon at 11:26 AM on October 4, 2023

Reuters: Updated Novavax COVID-19 vaccine shipped to distributors, to be available this week

Vaccine maker Novavax Inc on Monday said it has shipped millions of doses of its updated COVID-19 shots to distributors after receiving the go-ahead from U.S. regulators. The U.S. Food and Drug Administration authorized the updated vaccine last week for emergency use in individuals aged 12 years and older, but batches of the shots needed additional clearance from the FDA before they could be released.

Novavax said it expects the shots to be available at U.S. pharmacies this week.

The Maryland-based company, whose COVID vaccine is its lone marketed product, has adopted cost-cutting measures and is counting on commercial sales of its updated shot to help it stay afloat. The company has said it may not be able to remain solvent otherwise.
posted by mediareport at 9:11 PM on October 9, 2023

Find a pharmacy offering the Novavax vaccine

Site says it will be available at CVS, Rite-Aid, Publix and Costco, but when I went through the Costco appointment process Novavax wasn't listed yet (I'm guessing it'll be a while before the chains add it to their online scheduling). It's also likely that only some locations in each chain will be getting Novavax doses, so it'll probably be necessary to call around.

I'm seeing folks online reporting that Walgreen's is telling them it won't have Novavax as it's contracted exclusively for Pfizer, but I haven't confirmed that.
posted by mediareport at 9:32 PM on October 9, 2023

My local Costco got their Novavax doses in yesterday, and the nice pharmacist told me the Novavax option is now up at the online scheduling site.
posted by mediareport at 11:35 AM on October 12, 2023