Covid update

Gino Bottino, MD

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What will happen this fall?

People love to predict what will happen, and the media loves to find experts to predict the future. I’ll tell you what I “predict” based on my understanding from

  • an inherent knowledge base,
  • study of COVID epidemiologic patterns,
  • review of available data from a plethora of sources,
  • surfing Twitter posts from expert epidemiologists (Tim
  • Lahey, Michael Calderwood, Eric Topol) and expert celebrities (Kim Kardashian), and
  • a magic 8-ball game

However, I’d call it using a “plausible assessment to provide guidance and
shape expectations.” Here are my predictions:

  • As school resumes and colder weather keeps us indoors, cases and hospitalizations will increase this fall.
  • Kids will return to school on day six after infection. About half will still be contagious. And although students will wear masks, some schools will have problems separating students during lunch, leading to increased transmission.
  • College students and other adults will emerge from infection on day six with the intent of wearing a mask but will be inconsistent in adherence, finding it more difficult today than a year ago due to cultural change.
  • In some schools, periods of anxiety will occur among leaders, staff, and parents when outbreaks occur, but as the fall progresses, most will learn to roll with it, suffering inefficiencies due to the absenteeism of students and teachers.
  • In some businesses, periods of anxiety will occur among management and employees when outbreaks occur, but as the fall progresses, most will learn to roll with it, suffering inefficiencies due to the absenteeism of employees.
  • Schools and businesses requiring or promoting boosters will experience fewer negative impacts on staff health and financial performance.
  • Unless a variant emerges with significant immune evading properties leading to an increase in morbidity and mortality, we’ll see between 400 and 600 deaths per day in the U.S., and deaths gradually decreasing to influenza levels—about 100 per day with variation.
  • And society will go on.

Vaccination operations

Every single media outlet has written a nearly daily piece on boosters with
headlines that imply new information. However, the articles have rarely
provided updates of value. On top of that time-wasting activity, I regularly
review other sources, such as government, academics, industry, and tons-o-
tweets before the sun rises each day. Yes, I know, I have no one to blame
but myself.

Here’s the latest information on boosters at this writing.

Authorization

ACIP will review modified, bivalent vaccines on Sept. 1 and 2, and the
the committee is expected to vote on Sept. 2 to recommend that the CDC
authorize the use of

  • Moderna for those 18 and above, and
  • Pfizer for those 12 and above.

Availability

Vaccines will begin shipping in limited quantities immediately and may be
available in some areas a week later.

Cost

Federal dollars will likely cover the cost of the vaccines, but many sites may
assess an administration fee to cover staffing and resources.

Who gets it?

Although it’s not clear yet, I imagine anyone older than 12 who has not
received a dose of vaccine within the past 3 months will be eligible. Experts
will probably recommend waiting three months after prior infection to get
vaccinated. However, the immunocompromised will likely be advised not to
wait three months.

Benefits

Boosters should provide some benefit with no downside for most people.
The benefits will be greater for higher-risk individuals, but when everyone
gets boosters, our entire society benefits.

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