>> The government has just
approved a second dose of the
covid booster for the elderly
and immunocompromised.
The bivalent booster shot
targets the omicron variant.
Seniors 65 years and older can
receive the updated booster four
months after their first dose.
People with weak immune systems
can get additional shots of the
vaccine after two months.
To help us understand why this
is a significant move in the
fight against covid-19, I am
joined by Dr. Jeremy Faust,
emergency physician at your
command women's hospital in
Boston and the author of inside
medicine on substate.
Welcome and thanks for joining
us.
These are targeted to seniors
and the immunocompromised.
Does this make sense to you as
the right move in this
pseudo-post-pandemic world right
now?
>> Thank you for having me.
This move does make sense
because it acknowledges there is
a large spectrum of risk out
there.
It is a one-size-fits-all
approach.
It would not make sense treating
a 10-year-old with no medical
problems with the same vaccine
strategy as a 70-year-old who
has cancer and is on
chemotherapy.
I think today's move addresses
that discrepancy and allows for
a little bit of nuance in terms
of how we approach the next
phase.
>> At that same time we should
note booster uptick has been
very low.
These shots do no good sitting
on the shelves.
Isn't that an argument for
opening it up to anyone who
wants it?
>> There are downsides to over
boosting.
In the high-risk population,
what wins the day are the
upsides.
In terms of a short term
prevention against severe
hospitalizations and mortality,
the benefit for the high-risk
group, the severely immuno
compromise, older populations in
general does make it worthwhile
because there could be a
downside of over boosting which
is we are training our immune
system to expect a particular
virus and if we keep showing at
the same thing over and over
including half of this vaccine
which still has half of the
Wuhan virus in it, we actually
risk a longer-term increase in
infections.
I support the idea of zeroing in
on the people who need that
protection from the serious
outcomes because we know that in
short time it works very well.
>> What about what is ahead
especially for younger and
healthy people?
Could we be seeing another shot
being offered for them as we
move through the summer and into
another fall and winter season?
>> The CDC and fda is signaling
an annual kind of cycle for the
general population, the younger
healthier populations.
I think that is appropriate.
I think the value added of a
booster for younger healthier
populations has not always been
that clear.
We have always lumped in young
and healthy with older and
sicker when making the booster
for all argument.
Nowadays we are being more
nuanced and offering it less
often for the lower risk makes a
ton of sense.
I do think in June we are going
to hear more about what they're
going to put into a full booster
and I suspect and I hope that it
will be a booster that only
contains virus that is currently
circulating.
The original virus really is not
out there anymore.
We are in an omicron world and
we should be boosting against
that virus.
>> There has been and continues
to be some debate over how we
are counting covid
hospitalizations and deaths.
Not necessarily people alleging
nefarious intent that saying
there is a difference between
people who die with covid versus
people who die of covid.
They say we are counting both
and that could be an over count.
What do you say to that?
>> The concent to understand is
excess mortality.
To understand not just are there
covid dents but are there more
deaths than there should be?
We have seen their is constant
excess mortality that goes way
up when we have a wave and comes
down after the wave.
We have very rarely seen a time
where there were more covid
deaths being counted than there
were all excess deaths.
If that were to happen you would
start to think there is
something to that argument but
for the most part it has not
happened.
It happened at times.
In terms of hospitalizations and
other outcomes, it is very
difficult people don't agree
when they look at medical charts
but actually when we do that
kind of work I think we do see
if anything we are probably
undercounting covid deaths that
happened that do not look like
covid deaths.
Someone who dies at home but
they never got a covid test but
or someone who died of
heart failure exacerbation and
it is chalked up to heart
failure or diabetes they never
would've had the exacerbation
had they not contracted
coronavirus the week before it
as long as we have excess
mortality and covid deaths going
hand-in-hand, it is pretty hard
to make an epidemiological
argument that would support the
over counting approach.
>> Still striking.
Over 250 people a day.
That is Dr. Jeremy Faust,
emergency physician at egham and
women's hospital in Boston and
author of inside medicine on sub
stack.
Thank you.
>> Thank you.
♪♪