As the number of COVID-19 infections rises in several states in the US, many people have questions about how best to protect themselves and their loved ones from the virus.
With the holidays approaching, Jodie Guest, PhD, professor and vice chair of the division of epidemiology at the Rollins School of Public Health, and Carlos del Rio, MD, distinguished professor of medicine, epidemiology, and global health and executive associate dean of Emory University School of Medicine at Grady Health System, teamed up to answer questions about the latest developments related to COVID-19 vaccines, treatments, and safety precautions for the holiday season.
Their talk is part of an online video series hosted by Guest, who also leads the Emory COVID-19 Outbreak Response Team and answers questions related to the COVID-19 pandemic. Watch the full conversation between Guest and del Rio here.
Q: What’s the latest on COVID-19 vaccines for children?
AN: Pfizer’s COVID-19 vaccines are now available for children as young as 5 years old. On Nov. 2, the Centers for Disease Control and Prevention (CDC) approved their advisory committee’s recommendation that children ages 5 to 11 be eligible for Pfizer’s vaccine. , after previously recommending the vaccine for children ages 12 and older last spring.
In the US, more than 1.9 million children aged 5-11 are infected with COVID-19; of those children, 8,300 have been hospitalized and 94 have died, making COVID-19 the eighth leading cause of death for children in this age group, Guest says. Vaccinating children significantly reduces the risk of serious illness or death from COVID-19.
“We vaccinate against diseases that have far fewer deaths and hospitalizations than COVID-19, such as hepatitis A,” Guest notes. “Before the hepatitis A vaccines, there were an average of three pediatric deaths per year, and we compare that to COVID-19 with an annual average of 66 deaths in this pre-vaccine age group.”
Vaccination also reduces the risk of children transmitting the virus to other members of their household and community.
Q: What is the difference between vaccination and natural immunity?
AN: Natural immunity to COVID-19 is “something we have yet to understand,” says del Rio, noting that older people and those hospitalized with severe COVID-19 disease are more likely to have a robust immune response against natural infection. Data suggests that this natural immune defense lasts for about six months.
“If someone in their 60s who had COVID and was in the hospital says to me, ‘Should I get vaccinated?’ I say, “You can wait six months.” You’re probably better off waiting than getting vaccinated right away. For kids, it’s a little different, as many of those kids were probably asymptomatic or minimally symptomatic with their infection. It’s very unlikely they’ll have the level of robust immunity you need , which can produce the vaccine,” says del Rio.
Both experts recommend vaccination against COVID-19 regardless of age or potential natural immunity. “With the amount of COVID in our communities, you will encounter COVID,” says del Rio. “If COVID finds you, you’ll be better off being vaccinated than unvaccinated.”
Q: Who needs a COVID-19 booster injection?
AN: The CDC recommends booster shots for people age 65 and older, people living in long-term care facilities, and people ages 50 to 64 with underlying medical conditions such as diabetes, hypertension, or HIV disease. For those who have received a primary vaccination course (two doses) of Pfizer or Moderna vaccines, boosters should be administered at least six months after the second dose.
The CDC also recommends booster shots for anyone who has received the Johnson & Johnson vaccine. Boosters for these individuals should be administered two months after the first injection.
Adults under the age of 50 with underlying medical conditions are also eligible for booster shots, along with those at high risk of exposure to COVID-19, such as health professionals, grocers, and teachers.
Some people may not need boosters to stay well protected from COVID-19. “While the efficacy declines over time, the efficacy of these vaccines in preventing serious illness, hospitalization and death — even if you don’t get a boost — remains extremely good,” emphasizes del Rio.
Q: Which vaccine is the best booster?
AN: The CDC has approved the “mixing and matching” of COVID-19 vaccines, meaning any of the three COVID-19 vaccines currently available in the US can be safely administered as a booster dose. del Rio notes that he and colleagues at Emory participated in a clinical trial that showed that all combinations of the three vaccines are safe and generate immune responses.
“The important thing about the mix and match study is that you don’t have to go looking for the vaccine you have” for your primary series, he says. “You can get a boost with whatever is available.”
For members of high-risk populations, del Rio says any type of COVID-19 booster shot is better than none; however, he recommends Pfizer or Moderna boosters for those initially vaccinated with Johnson & Johnson.
Q: What drugs are available to treat COVID-19?
AN: Several treatments are available that can reduce the risk of hospitalization and death from COVID-19. Monoclonal antibodies can effectively prevent the progression of COVID-19 disease if administered early after infection, but since they must be injected intravenously in specialty clinics and because patients may be charged treatment costs, del Rio says “they don’t have great opportunities for everyone.”
New drugs are on the way that could make treatment for COVID-19 more accessible, including an oral antiviral pill called molnupiravir. Initially discovered and developed by Emory researchers, molnupiravir has already been approved for COVID-19 treatment in the UK and is currently under consideration for emergency authorization in the US by the Food and Drug Administration.
In clinical trials, molnupiravir reduced the risk of hospitalization and death from COVID-19 by as much as 50%. In addition to an antiviral pill being tested by Pfizer, del Rio says the potential availability of oral treatments will be “a game-changer.”
While these therapies show promise, Guest and del Rio maintain that vaccination is the best way to reduce hospitalizations and deaths from COVID-19. “We always say an ounce of prevention is worth a pound of cure,” Del Rio stresses.
Q: How important is it to continue testing for COVID-19 infection?
AN: As COVID-19 continues to spread at a rapid pace, diagnostic testing remains a critical tool to identify positive cases and prevent transmission. However, availability testing has not always been consistent.
“Access to testing is something we need to keep working on,” says del Rio. Gast also describes that he sees the demand for tests declining over the course of the pandemic.
“I don’t think there’s much urgency to consider getting tested like there was a year and a half ago,” she says. “Every time we had a testing event, we had lines that would start hours before we started testing. Now we can be at a testing event for four hours and see maybe 25 to 50 people coming in to be tested.”
While quick at-home tests can be expensive at drug stores (about $25 for a box of two tests), del Rio recommends keeping some on hand if possible. “If you start snorting, feel unwell, have a sore throat, or cough, you can test yourself right away,” he says. Testing at the first sign of symptoms is important because treatments such as monoclonal antibodies and molnupiravir must be administered early in the disease course.
Q: How should people prepare for holiday gatherings this year?
AN: As the holiday season approaches, del Rio emphasizes the continued importance of COVID-19 mitigation strategies to prevent transmission.
“We are still diagnosing 75,000 people a day. We still have more than 40,000 people hospitalized. More than 1,200 people still die every day in our country,” he says. “So the numbers are going down, but they’re not where I wish I could feel completely safe.”
Guests at holiday gatherings must be fully vaccinated against COVID-19 if age-eligible and should consider getting tested for COVID-19 between 24 and 72 hours in advance. Celebrations should also take place outdoors or with open windows if possible.
“And you have to tell everyone that if someone has symptoms or isn’t feeling well, don’t come,” adds del Rio.
Q: Have we reached an endemic level of COVID-19?
AN: “At one point, we aimed for the eradication of COVID. That’s not going to happen, so we need to understand what endemism is going to look like,” said del Rio.
“In my opinion, having less than 10 cases per 100,000 in the population, a positivity rate in testing of less than 5%, less than 5 cases per 100,000 in the hospital, and less than 100 deaths per day at a national level would likely be a spot.” are where I would feel very comfortable,” he says, adding that countries like Iceland and Denmark have already reached these levels of endemism.
“At 1,200 deaths a day, we are still way too high, and so much above a comfortable level to learn to live with COVID-19,” Guest said.
del Rio likens the current state of the pandemic to the seventh inning of a baseball game. “We didn’t win the game and it’s not the time to say, ‘We’re done; we can now bring in our second team, because this is our game.’ No – we actually have to bring in our best closer, get our best hitters, because to win the game, you have to keep going until the last inning, at the last out’, he says. “We are all tired, we all want this to be over. But the reality is it’s not over yet.”