Another week, another tale of essentially stable, high transmission. Hampshire county wastewater surveillance data is also showing this up-and-down pattern, which is a little different than the overall national pattern, which shows a fairly clear decline in concentration of virus in wastewater. I suspect that the overall trend in the US is that of declining circulating virus, but that it varies by location. The trend is probably driven by large decreases in areas that were quite high and are now dropping substantially.
Infection itself matters, of course (don't forget about long-COVID, generally feeling yucky, and the disruption of isolation), but we can't forget about severe disease. Unfortunately, the trend in hospitalizations and deaths in the US continues to be tragically stable. I'm including a visual of daily hospitalizations and deaths in the US and daily hospitalizations and deaths in MA as a comparison and depiction of the different results due to vaccination rates. As a reminder, vaccinations are generally high in MA and the national average is low, and the vaccine prevents severe disease and death quite well but provides rather low protection against infection. So, what do we see? Daily COVID-19 hospitalizations are stably high both in MA and the US, but daily COVID-19 deaths in MA have remained low, while daily COVID-19 deaths in the US are also stably high. I've also included a map of the US showing the proportion of each state that has had just ONE DOSE of the vaccine. One dose! That's not even completing the prime series, which we used to call "fully vaccinated", and it's definitely not "up-to-date", which is our new term for meeting the CDC recommendation for prime series with boosters. The bottom line from this data? The vaccine matters. A lot.
Speaking of being fully vaccinated or up-to-date on the COVID-19 vaccine, after pulling this information and being reminded again of how much more vaccinated MA is than many other states, I wondered how we're doing in terms of being up-to-date. The visual in the middle of the dashboard this week highlights that while we have high rates of finishing the prime series, and really, even getting a first booster, we are woefully - WOEFULLY! - not up-to-date on our COVID-19 vaccines in Easthampton. An average of only 15% of the city is up-to-date, although the proportion varies by age group. Those who are 30-39 years old are most likely to be up-to-date, with 62%. Our youngest age groups are stunningly low - well less than 25% are up-to-date. And our oldest (and highest risk) age group is slightly more up-to-date, but still well less than 50%! I can't believe I never thought to look at our vaccination rates this way - when we look this way, we can see (and imagine) just how far we have to go until we see COVID-19 as a nuisance endemic disease, rather than the devastating cause of disruption, long-COVID, severe illness, and death that it is right now. I'm including the CDC recommendations for vaccine doses again, and the "up-to-date" definition is on the visual. A major, major note: this visual does not take into account if someone is high-risk / immunocompromised and therefore recommended to have another dose on top of the "usual" recommendation.
I'm going to wrap this up with an update on the fall booster. As background - the CDC and FDA agreed in June 2022 that a fall booster with an updated formula better targeted to the omicron variant would be offered in the US. The vaccine will be a bivalent vaccine, which means it will target both the original Wuhan variant (original formula) and the omicaron variant (new formula - specifically targeted to BA.5). Moderna and Pfizer both have a fall booster, and they both just submitted their application for emergency use to the FDA. The Pfizer booster would be available for anyone age 12 and over. The Moderna booster would be available to anyone age 18 and over. Pfizer has announced that they are working on a booster for the 6 month - 11 year age group, but that application will come later this fall.
The goal is to provide a higher level of protection against both major outcomes, infection and severe disease. Our original formula has maintained high protection against severe disease, but protection against infection waned significantly. We hope that the bivalent booster will boost protection against both, but we know that protection against infection will wane over time. If we want protection against infection that doesn't wane, we need a different type of vaccine (which is being worked on). So this is the approach for now - boosters and attempting to "chase" the variants wrecking havoc and causing severe disease, but it won't be (can't be!) our forever approach. The FDA and CDC are reviewing the data and will meet to give final approval on September 1st and 2nd. The Director of the CDC will then sign off on the decision, and if all goes well, the fall bivalent booster will be available early in September.
Perhaps you've heard that we don't have data from humans on the fall bivalent booster. That's true, but please don't think that's alarming. It's the standard approach for the yearly flu vaccine, and there is no scientific / biologic reason that the updated formula would have a different safety profile in humans than the prior variant. The impact on your immune system will (hopefully!) be different / better, but the delivery system and dosage is the same. It does have animal data, and that data is extremely promising in regards to protection. There are so safety concerns in the animal data. Getting data on humans would take months, at which point the booster is much too late. It's a trade-off, and one that make sense (and that we're used to - flu vaccine). There are human trials ongoing so we have as much data as possible as time goes on.
Finally, it's likely that you will have to have completed the prime series to get the bivalent fall booster, so if you're not through that series yet, this is a great time to get that started or finished. You likely will not need to be "up-to-date" on boosters, however. The advice until a few weeks ago was to go ahead and get your booster if you haven't - and that probably seems like it would be my advice based on the visual on the dashboard this week! - but if you have the prime series, at this point, I would hold off and wait to get the updated fall bivalent booster. If you get a booster now, you'll have to (and want to) wait a few months before getting another booster, for maximum protection. So - for now, hold off! But plan to get that fall booster!
Megan W. Harvey, PhD (she/her)
Epidemiologist