The right thing? Who is right? When you discuss issues with friends, family or colleagues and you disagree with their conclusions, do you get angry? Or do you choose to have a healthy debate, perhaps see their view and re-think?

Some people have a compulsion to be right all the time. To some extent, it is part of our biology to fight for our slice of the pie, defend ourselves, convince others that our views are right. Sadly, if we are proven wrong, we feel lessened, defeated, or even humiliated and angry. Not a good place to be. "When you find out you've made a mistake, take it as a sign you've just discovered something new. Don't be afraid to laugh at yourself. It helps you focus less on proving yourself and more on improving yourself."*

*from Think Again by Adam Grant

And since I do not need to be right, let me share my view on the 4th booster, a hot debate topic.

Background

In January 2021, we were surging with Covid, the mRNA vaccine had been approved and most of us were pinning to get it. As it rolled out and was more and more available, we started to see a rapid decline in prevalence positivity. By June 2021, the positivity rate was very low (<3%) and we all relaxed. Maybe we were out of the woods? Not so fast folks. A very warm July in the South moved people into air conditioning and boom - a surge.

September ushered in Delta; November brought Omicron. In January 2022, our prevalence rate was 31%. Yet currently, in Maryland, we are at 1.5% and 65% of the population is fully vaccinated; further, many people have natural immunity from recent Omicron infections.

We seem to be less vulnerable to future surges, but are we? A new Omicron variant, BA.2, is here and it is almost as contagious as measles, which is the most contagious virus known. If you have been vaccinated and/or had Omicron, it is highly likely that if you get BA.2, it will be a mild cold.

About the mRNA Vaccines

The mRNA vaccines were effective in decreasing hospitalizations, respiratory failure with subsequent ventilator support, and death. If you got the primary vaccinations (doses 1 and 2) you reduced your risk of hospitalization and death by 10-fold. In the late fall, as we saw the Omicron surge, I recommended that most people (>50) or with co-morbidities (diabetes, obesity, heart, lung disease) get the booster (3rd vaccine).

Problems and issues with the current mRNA vaccines

• They are not durable, the neutralizing antibody levels fall at 4 to 6 months; for this reason, Israel is now using a sub-unit vaccine for boosters.

• The current mRNA vaccines are targeted for the original infection; they have limited efficacy for variants.

• Myocarditis is a low risk, those affected are mainly adolescent males.

• There are increasing reports that the mRNA vaccines may exacerbate pre-existing inflammatory conditions.

•  There are reports of hearing loss, gross hematuria, tinnitus and menstrual abnormalities.

• As time goes on, undoubtedly more issues will surface; keep in mind that these may be found to be associated, but that does not mean causality.

Should you get a second booster?

• For most healthy people who have received the first two shots plus a booster, or have had Covid recently, I do not recommend it now in the absence of a surge.

• For people over the age of 75, particularly if you are immunosuppressed or have other issues, maybe; feel free to reach out to me.

• Here is an article, published in The New York Times that reviews many of the issues.

Thoughts about the future of the pandemic

• Covid is not gone; we will be dealing with this for many years to come.

• New generation sub-unit vaccines may have better efficacy for Delta and Omicron.

• The protein sub-unit vaccine is not associated with myocarditis or any other significant adverse effects yet.

• The protein sub-unit vaccine is waiting for approval by the FDA now; it is currently available in >175 countries.

•  This sub-unit vaccine may be the booster of the future that will be given annually just like the flu vaccine.

• Other second-generation vaccines are under development.

• Anti-viral compounds that are given promptly at the beginning of the infection are promising.

• Building mitigation to improve and purify air is slowly being adapted (filters, UV lights, etc.).

On a musical note:

On a musical note: We Just Disagree by Dave Mason

"So, let's leave it alone, 'cause we can't see eye to eye

There ain't no good guy, there ain't no bad guy

There's only you and me and we just disagree"

On a lighter note:

As a reminder, I'm updating you periodically. I continue to enjoy writing these updates. Initially, these were only sent to my patients, however, I've been humbled to learn that, through social media, these writings have been forwarded and re-forwarded to many. This has brought me great joy to know that this simple act of sharing facts, thoughts, opinions, and hopes have touched you in some way. Hopefully I've been able to reassure you, maybe make you smile and laugh, soothe your worries, and comfort you. And maybe, just maybe, I've helped you to be in the moment!

Reach out. Stay connected. Stay home. Save lives. The power of one. Be well.

Feel free to forward this on: spread the word, not the virus.

HAO

24/7

Harry Oken, M.D.

Adjunct Professor of Medicine

University of Maryland, School of Medicine

Office 410-910-7500

Fax   410-910-2310 

Cell   443-324-0823