The fight against COVID-19 continues in the United States as the Delta variant surges dangerously. The vast majority of new cases, new hospitalizations and deaths are occurring in the unvaccinated, and these numbers are rising everywhere. Some vaccinated Americans have even experienced breakthrough cases, including people with underlying conditions in all age groups. Local governments are considering reinstating mask mandates and other safety protocols as the Delta surge, summer travel and the return to school all converge. Vaccinated seniors and caregivers in San Diego wonder if getting a third shot is the best way to protect themselves and the people around them against the threat of the Delta variant.
According to the New York Times, the Delta variant now accounts for 83 percent of all new COVID-19 cases in the United States. More than 97 percent of people hospitalized for COVID-19 are unvaccinated. No vaccine is 100 percent effective, however, and a small number of vaccinated people are getting breakthrough cases. Nearly all breakthrough cases are either asymptomatic or very mild, but infected people can still spread the virus in the usual ways. And the early data shows that people with the Delta variant carry a thousand times more virus and stay contagious longer, explaining why Delta has spread so fast and so broadly. So how can vaccinated seniors and caregivers in San Diego protect themselves and their loved ones, especially their young children and grandchildren who have no vaccine options yet? Is a booster shot the right solution?
According to the Daily Beast’s review of recent announcements from health officials, vaccine makers and infectious disease specialists, experts are divided at this point on whether a third or booster shot would offer any benefit to vaccinated people. Pfizer, the pharmaceutical company who produces the two-dose Pfizer/BioNTech vaccine, announced this month that they anticipate the need for a booster shot six to 12 months after receiving the second dose. Moderna and Johnson & Johnson, manufacturers of the other two vaccines administered in the U.S., are also considering an additional full or half dose to supplement their original shots. However, the FDA, CDC, and NIH responded to Pfizer’s announcement with a joint statement insisting that fully vaccinated Americans don’t need a booster shot.
How do seniors in San Diego home care and their families decide if pursuing a third shot is a good idea? Unfortunately, there are no studies that evaluate the impact of a third (or second) shot on immunity metrics. Plus, doctors just don’t know what mixing vaccines might do, since two (Pfizer and Moderna) are mRNA vaccines, and the third (Johnson & Johnson) is a viral vector vaccine. According to Dr. Krutika Kuppalli, an infectious-disease physician and assistant professor of medicine at the University of South Carolina, “There are studies indicating that mixing/matching the different types of vaccines (viral vector + mRNA—one dose of each) can lead to a robust immune response, but there haven’t been any great real-world efficacy studies and there is no indication about the level or duration of protection. …There are also safety concerns when doing this in regards to side effects and adverse effects.”
Until there’s a data-based answer to these questions, and in the absence of new direction from the County of San Diego, the best protection is a return to the original safety measures. The vaccinated and unvaccinated alike have enjoyed freedom from masks, social distancing, capacity limits and more, but complete freedom from precautions is a great way to spread this dangerous virus variant. Vaccination will protect seniors and their loved ones over age 12 from serious infection, but the vulnerable, under 12 and unvaccinated around them are now at serious risk. Re-embracing masks while indoors, limiting indoor activity and avoiding large groups of people is the best advice doctors can give right now.