Stop with the Sorry's Already

The texts, phone calls and emails from friends, family, acquaintances and even strangers have gone up at the same rate. And Yes, I have received phone calls with voicemails from people I have never met and never heard of, saying they have Covid and had a few questions.

Boosters - There is not a huge downside to getting a booster if you're past 6 months from the second mRNA vaccine. The benefit of the booster against Omicron and Delta, the strains causing the surge, is unclear. Boosters appear to reduce the severity of infections with these strains in pts whose immunity has waned. How much boosters help? We don't know. Remember, getting a booster or vaccination after recently recovering from infection is not recommended. Most doctors recommend waiting for several months between recovering from Covid infection and getting vaccinated. For fully-vaccinated people, who are getting over a very recent infection, the horse is out of the barn regarding the booster. You may want to get a booster in several months, but that remains to be determined.

Current Surge - Most of the people infected in Jersey, some 75%, have been fully vaccinated. Many, who are infected shouldn't be, meaning that several young adults, fully vaccinated and some fully vaccinated with a history of Covid as well, are testing positive. While some of these 20-somethings are symptomatic and feel lousy, they aren't very sick, not by doctors' standards. Older adults, who have received the booster, are also getting infected. These data suggest that the immune response induced by the vaccine is not nearly as effective against the current strains as it is against the original SARS-CoV-2 strain.

Re-Infection - Yes, a person can get re-infected with Covid. But two things, one the current strains appear more mild than the original strain. Two, the person already recovered from Covid, meaning that pt has immunity against the virus. That immunity is very strong against the original strain and almost certainly helps a lot against the current strains. Infection results in cellular and humoral immune responses, which means a person develops cell-mediated immunity (CMI) as well as antibodies after infection. The vaccines appear to primarily induce antibodies.

Infection also results in immune responses to all of the virus' proteins, while the vaccine induces response to the spike protein. Viruses have many proteins, structural and enzymatic. Infection induces responses against all. The new strains have mutations in the spike, but the other proteins don't mutate very often. After infection, a person has an immune response against the structural and enzymatic viral proteins and this immune response cross reacts with the new strains much better than antibodies against the new strains' spike protein. In other words, the immune response after infection works better against new strains, which have mutations in the spike protein, than the immune response induced by vaccination only.

Good news? - Hopefully, as the data so far indicate, the newer strains causing this surge, do not make people nearly as sick. Most infections are mild to asymptomatic. Of course, asymptomatic infection increases spread of the virus, since asymptomatic people continue to interact socially with others. Symptomatic infection causes people to stay home because they feel like crap or worse. So MAYBE, just MAYBE the new strains will act as a form of attenuated viral vaccine. As mentioned in other posts, attenuated or weakened viral vaccines are the best vaccines we have. The Sabin polio vaccine consisted of three, weakened strains of polio virus and was better than the Salk vaccine, which consisted of inactivated or dead virus. Measles, mumps, rubella are all attenuated viral vaccines and they are excellent vaccines. So, maybe, just maybe Omicron will go around, infect a whole bunch of people without causing much disease and lead to so-called "herd immunity" against Omicron and other future strains. Recovery from Omicron will certainly induce CMI against all the virus's proteins.

Going forward - I'd prefer to deal with questions about Covid through this forum. I also prefer to answer generalized questions, not specific ones. Specific ones means I am establishing a physician-patient relationship and while you think Medicine can be practiced by a few texts with a few questions, trust me, when I am your physician, you may have 3 questions, but I will have 30 questions for you. In other words, answering a few general questions is a lot, lot different than becoming your treating physician. For those who really want me to become their physician, a Zoom appointment may be arranged.

I added a new Comment app to this webpage or, at least, I tried to. Please use that Comment app to...you know, make Comments and also to ask generalized questions.

SMS