BP2C Executive Director Dr. Scott Ratzan was featured in a BuzzFeed article by Daryl Austin titled, “42 Doctors Told Us What They Think Of Boosters And Masks In The Face Of Omicron And Everyone Should Hear Their Answers” on January 11.
In the article, Dr. Ratzan — a medical doctor in New York City and the editor-in-chief of the Journal of Health Communication: International Perspectives — says the definition of what it means to be considered vaccinated against COVID-19 has changed. “Fully vaxxed now means three doses, not two,” he explained.
Read below for the full article or visit BuzzFeed.
In 2021, I, a health journalist, interviewed 203 doctors about the pandemic, vaccines, and masks. Now, as Omicron and other variants continue to spread around the world, I followed up with 42 experts about our current state of affairs.
The world, after all, looks different today than it did last year: Namely, there were 4 million new COVID cases reported in America last week — a caseload it took the country a whopping 6 months to amass in 2020.
That six-months-to-one-week compression of new cases has already overwhelmed some hospitals to the point that the National Guard has been deployed to assist medical personnel in some cities.
Experts I interviewed told me they’re alarmed that “COVID response fatigue” — as one doctor put it — has caused Americans to become complacent against the virus when vigilance is as needful as ever.
They told me their thoughts on the seriousness of Omicron, the efficacy of masks in preventing the spread of this and other variants, and how booster shots have changed the game.
By now, we all know that COVID-19 is relentless and refuses to give any of us the chance to catch our breath. Having already endured new waves of the virus crashing immediately behind previous ones and witnessing the devastating effects from variants such as Delta, the country is now battling the most contagious strain of the virus yet: Omicron.
Omicron wants to get with everyone.
“Omicron appears to be much more infectious than prior variants,” said Dr. Scott Wetstone, an associate professor of public health sciences at UConn Health at the University of Connecticut.
Indeed, former CDC director Dr. Tom Frieden recently posted to Twitter that in his 30 years of studying infectious disease outbreaks, “I’ve NEVER seen anything like the speed of Omicron.”
Despite its unprecedented spread and danger, a whopping 37.4% of the country remains unvaccinated, with those unvaccinated individuals making up the vast majority of COVID-related hospitalizations.
Omicron is overwhelming some hospitals so much that they’ve had to turn away patients needing care for emergencies unrelated to COVID.
Dr. Julie Smith-Gagen, an epidemiologist at the University of Nevada, Reno, told me her sister-in-law’s father couldn’t receive adequate treatment for the chest pains he was experiencing because his hospital was “overwhelmed with unvaccinated sick people.” She said, “He spent time in the hospital hallway and passed away a few days later.”
Wetstone lamented that Omicron could push our healthcare system “past its breaking point” and that “patients needing care for matters other than COVID won’t get it.”
“The fatigue, frustration, and burnout of healthcare workers is a serious concern of mine,” said Dr. Sydney Pettygrove, an associate professor of public health at the University of Arizona. “This would really not be a good time to be in a car accident.”
“It’s unfortunate that people with various illnesses including cancers have to delay their care because unvaccinated patients with COVID are overwhelming the system,” said Dr. Josef Neu, a professor of pediatrics at the University of Florida. “This is unacceptable when in most cases vaccination could have prevented this.”
“A more transmissible virus like Omicron will lead to more cases, hospitalizations, and unfortunately more deaths,” warned Dr. Katrine Wallace, an epidemiologist at the University of Illinois at Chicago, School of Public Health. “We should try to use as many mitigation layers as possible in light of a more transmissible variant.”
Masks are actually awesome against Omicron.
While there are many proven layers of mitigation in the fight against this virus, few are more effective (or controversial) than face masks. Despite bungled messaging by authorities early on, masks have continually proven to be one of the best tools we have at our disposal.
“Masks are highly effective at preventing spread when worn appropriately,” explained Dr. Alison Abraham, an epidemiologist at the University of Colorado School of Public Health. “COVID is spread through airborne transmission so anything that gets in the way of the virus distributing through the air in high-enough concentrations to get nearby people sick is going to be key in preventing spread.”
One of the most recent global studies found that masks are linked to a whopping 53% decrease in transmission when worn properly. N95 masks or surgical masks have proven to be especially effective. “Several studies have found that surgical masks are between 66% and 70% effective,” Dr. Smith-Gagen said.
Dr. Linda Cottler, a dean’s professor in the department of epidemiology at the University of Florida, said that anyone doubting whether masks work only needs to look at how much lower COVID case numbers are in counties with high mask compliance. “Countless studies show that areas with masking mandates vs. those without had lower COVID positive rates, fewer COVID hospitalizations, and consequently fewer deaths,” she said.
Dr. Hyung Chun, an associate professor of medicine at Yale School of Medicine, said he can speak from firsthand experience about how effective face masks are in protecting against COVID transmission. “I rode in a car for almost an hour with someone who tested positive for COVID-19 the next day but I did not catch the virus,” he said. “We were both masked with regular surgical masks throughout our ride.”
And while limiting the burden on hospitals continues to remain a priority, face masks may also mitigate the transmission of other airborne viruses.
“Not only does masking prevent the spread of COVID, but also many other infectious diseases that are spread during this time of year,” said Dr. Joseph Larkin, a microbiologist at the University of Florida. He also pointed out that wearing masks in crowds is nothing new: “In countries such as Japan, masks have been respectfully used to prevent the spread of infectious agents for many years.”
As effective as masks are, they aren’t the most important layer of protection against COVID-19.
While masks are useful, vaccines and boosters remain the most important layer of protection against COVID and its variants. “I would strongly recommend vaccination for anyone who is indicated for it,” Dr. Abraham said. “Without vaccinations in the US, some estimates suggest greater than one million more people would have died during the beginning of the pandemic,” said Dr. Neu.
Regarding the safety of COVID vaccines, every public health official I interviewed praised the data and said they heartily recommend vaccination.
“Nearly 8.47 billion and 495 million doses have been administered across the world and the United States, respectively. At this point, the vaccine has been proven to be safe and effective across multiple situations and demographics including in older adults, children/adolescents, pregnant women, individuals who are immunocompromised, and individuals with chronic medical conditions,” said Dr. Richard Dang, a pharmacist and assistant professor of clinical pharmacy at the University of Southern California.
Dr. Lorinda Riley, an assistant professor of indigenous health at the University of Hawaiʻi at Mānoa, said she is concerned about the way Americans talk about vaccines “working” or using “breakthrough” infections as a justification not to get the shots.
“Think of it this way,” she said, “putting gas into a 12-year-old Hyundai sedan will make it work, but won’t turn the car into a brand-new Ferrari. Just because we are vaccinated doesn’t necessarily mean that we won’t get COVID; it just means our body has more tools to fight the virus if we do.”
And while breakthrough infections have become somewhat more common among individuals who have only received two doses of the vaccine, every expert told me that boosters are a game changer.
“The overall vaccine effectiveness of the COVID-19 vaccines against Alpha and Delta ranged from 80% to 100%,” Dang said. “Based on some data that just came out of the United Kingdom, vaccine effectiveness against Omicron infection was reduced to 30%–40% after only 2 doses, but increased back up to 70%–80% after a booster dose.”
Dr. Luisa Borrell, a distinguished professor of epidemiology and biostatistics at the CUNY Graduate School of Public Health & Health Policy, shared similar findings. “The booster or third dose is important because it will increase the vaccine efficacy against Omicron back up to 80% and 83% for the Pfizer and Moderna vaccines, respectively,” she said.
Dr. Megan Quinn, an associate professor in the department of biostatistics and epidemiology at the College of Public Health at East Tennessee State University explained that anyone concerned about vaccines should keep rare side effects in proper perspective alongside the risks of contracting the diseases they protect against. Generally, only 1 in 200,000 people have a serious adverse — though nonlethal — reaction to COVID-19 vaccines compared to 1 in 150 who die after contracting the virus. “The benefits of vaccines have been found to far outweigh the risks,” she said.
And though there is much emphasis on the antibody benefits of vaccination, Dr. Larkin said vaccine benefits are even better than some people realize.
“Though T-cell responses aren’t as easy to quantitate as antibodies,” he said, “they are also very important because they help reactivate the antibody response and, when necessary, prevent cells that are infected from infecting other cells.” He explained that our immune system is like a heavyweight boxer that may be capable of beating a virus like COVID, but it still has to train for each specific opponent (getting vaxxed) and remain fit enough to endure multiple rounds and new contenders (boosting against variants).
Because of what we now understand about boosters, Dr. Scott Ratzan — a medical doctor in New York City and the editor-in-chief of the Journal of Health Communication: International Perspectives — says the definition of what it means to be considered vaccinated against COVID-19 has changed. “Fully vaxxed now means three doses, not two,” he explained.
And how soon should I get boosted after vaccination?
In January 2022, the CDC updated its recommendation to shorten the interval between one’s second dose and a booster from 6 months to 5 months for the Pfizer-BioNTech COVID-19 Vaccine. The general rule of thumb now is “the booster shot should be given anytime 5 months or greater after your second shot,” Dr. Borrell said.
However, per the CDC, “for people who received the J&J vaccine (2 months) or the Moderna vaccine (6 months),” the interval has not changed.
Such advice applies to anyone claiming “natural immunity” as well.
“Individuals who have been infected with COVID-19 have likely developed antibodies through natural immunity,” Dang acknowledged. “However, it is currently unknown how long protection through these antibodies may last.” He added that anyone with a previous infection of COVID-19 should still get the shots once their symptoms have abated. “Multiple studies show that individuals who have previously been infected with COVID-19 still benefit from the vaccine and boosters, especially in reducing the risk of reinfections and protection against severe disease or hospitalizations,” he said.
Dr. Jesse Erasmus, a microbiologist at the University of Washington School of Medicine, had similar advice. “Even those who have experienced natural infection should get a booster. These individuals will likely have an ideal immune response to the booster vaccination with potential for an improved breadth of immunity, which could provide better protection against future variants,” he said.
“But I’m young and healthy. Can’t I beat COVID without vaccination?”
Most young people can beat COVID without dying but something as simple as staying up to date with vaccination and boosters could save you a trip to the hospital and a world of hurt. “While there is a general perception that COVID-19 causes severe disease only in the elderly population, we have seen many unvaccinated patients in their 30s to 50s being hospitalized in the intensive care units with COVID-19 infections,” said Dr. Chun.
Multiple experts also pointed out how “long COVID” symptoms affect nearly every age group and some were quick to point out that COVID has killed many younger people as well.
What’s more, Dr. Abraham said, “Another reason to get vaccinated is to protect your neighbors and family, and be a good citizen. Each and every one of us would feel terrible if we passed on COVID to a vulnerable friend or family member.”
Are boosters here to stay? Like, forever??
While the future of COVID-19 is still unknown, most public health officials told me they think it would be wise to recalibrate one’s expectations about COVID vaccines and boosters from the “one and done” mentality to annual doses becoming likely.
“I anticipate seasonal outbreaks and hopefully effective boosters to control the spread and severity of the disease,” said Dr. John Hokanson, a professor of epidemiology at the University of Colorado School of Public Health.
“COVID vaccines will be similar to the flu vaccine,” Dr. Borrell offered. “Every year (or sooner), we may have to get it. Thus, we should get used to it.”
“Until we have effectively wiped out COVID, I expect boosters to be part of our lives,” Dr. Riley explained. “This is not necessarily a bad thing as Americans especially need to get used to preventative healthcare. We shouldn’t think about going to the doctor only when we are sick, but the good news is that because we have so many mitigation tools at our disposal, the panic that gripped the nation in 2020 is preventable. “We should be concerned and remain responsible, but not become irrational due to high anxiety,” Dr. Larkin advised. “Of course, these are challenging, unprecedented times, but we have to continue to do the things we can. This includes getting vaccinated, getting boosters, and masking.”