Should I get the new bivalent booster?

“Now that the second bivalent booster is available to those at risk, I have the usual question about age: It’s always said that those over 65, even without any compromising diseases, are considered at risk. That’s a confusing suggestion for those of us in our 70s who do not have a specific compromising disease. Should a relatively healthy 75-year-old person be in this ‘should get a booster’ category?” — Caren from Florida Age by itself is a significant risk factor for severe outcomes from covid. One CDC analysis found that a person between 75 and 84 years of age has 9.2 times the likelihood of hospitalization from covid compared to someone 18 to 29 years old. They are also 140 times more likely to die. As a result, I would advise my patients in their 70s to get the second bivalent booster now, unless there is a specific reason to hold off. And please make sure to take Paxlovid if you contract covid and are eligible to take it. “I will turn 65 in October. I have received the bivalent booster approximately 10 months ago. I am an open water marathon swimmer training for an ultramarathon swim in the Adriatic Sea in September. I cannot afford to get sick with covid as even a few weeks down would destroy my training and fitness. Can I get a second bivalent booster? Would you recommend it for me?” — Michael from Arizona Because you are not yet 65, you are technically not eligible to receive the second bivalent booster. Even if you were to receive that second shot, its main effects would be to protect you against severe disease; the degree of protection against infection is modest and short-lived. That said, I definitely understand why you would not want to contract the coronavirus . You should take other steps to reduce your risk, including masking in indoor, crowded settings and having meals with others outside rather than inside. Best wishes with your training and your swim! “Should pregnant women get a second booster?” — Judy from Potomac This was a major topic of discussion during the CDC advisers’ last meeting. The reason for pregnant women getting the second booster would not so much be to protect the mother, but to convey additional antibodies to the baby. Thus far, the CDC has not said that pregnant individuals can get the second bivalent booster. But this is an active topic of discussion and debate. “I am 70 years old and recently had a hip replacement. I am a big believer in vaccines and had the bivalent booster last fall. Does my surgery cause any risk in getting another booster?” —Marcia from Virginia It shouldn’t, especially if you are now recovering at home from the operation. It’s always a good idea to check with your primary-care physician just in case.

What’s the optimal timing for getting a second bivalent booster?

“I’m 66 years old and have never had covid. I’ve had all the vaccinations and got a bivalent booster last October. I am planning a summer vacation to Europe to visit a brother who lives there. I want to wait and get the booster about four weeks before I travel (late June). Is this a reasonable approach? I am otherwise in good shape and pretty careful.” — Julie from Pennsylvania Data from the Centers for Disease Control and Prevention shows that for people 65 and older, the vaccine’s effectiveness against emergency department visits because of covid is highest — at 61 percent — in the first 60 days after the shot. By four to six months, it decreases to 25 percent. For people who are on the younger end of the eligibility spectrum and generally healthy, I think it’s fine to time your additional booster for before a major trip so you have maximal protection from infection while traveling. You should get the booster at least two weeks before departing; that will be enough time to reach optimal protection. “I’m in my late 60s and have no chronic health problems. I am eligible for the second covid vaccine booster, having had the first booster in December 2022. I will be traveling internationally (Iceland) in August. Should I delay getting the second booster until July so I’ll have better immunity when I travel?” — Kitty from Atlanta I think this is reasonable, as long as you are okay not getting the updated shot after that until later in the fall. (The covid vaccines should be spaced at least four months apart.) “I’m 85 with no medical conditions other than controlled mild hypertension and am planning a trip to Scotland in August. My second bivalent booster was in October. My plan is to get the newly approved booster about three weeks before traveling. Does that make sense?” — Linda from Washington You will be optimally protected during your trip if you wait two weeks or so before your travel to get the booster. If you wait until then, though, there are two potential downsides: The first is that, if you get your next bivalent booster in July or August, you’ll probably have to wait until November or December to get the updated fall booster. The second is that by virtue of your age, you are vulnerable until you get your next booster. You could consider reducing risk in the meantime and choosing outdoor gatherings instead of indoor ones and masking in crowded settings. And be sure to have a plan for what happens if you contract the coronavirus. If you are eligible for Paxlovid, know where you can get it and be ready to take it soon after symptoms emerge. “My husband and I are both in our 70s and received the first bivalent booster in early September 2022. We still take precautions to avoid covid. With summer vacations and visitors looming plus recent hospitalizations for other health issues, we want to remain protected. However, we also need to be covered for a trip to Australia in January 2024. If we get the second bivalent booster now, will we be able to get a third booster closer to our Australia trip?” — Jeanne from Florida Yes. You could get your second bivalent booster now and then wait until December — closer to your Australia trip — to receive the updated vaccine that is expected to be released this fall. “I’ve had five Pfizer covid vaccinations including the second bivalent in September 2022. I just turned 76 and had a relatively mild case of covid the first week of January 2021. I’m headed to a trade show convention for four days and wonder if I should get another bivalent shot now or wait.” — Rafe from California I want to be sure that I read your message correctly. If you had covid in 2021, you are probably not protected from infection based on the immunity you acquired through infection two years ago. If you had covid in January 2023, though, you probably still have good protection. Also, when is your convention? If it’s in a few days, getting the booster now probably wouldn’t do much good, as it takes about two weeks to reach maximal protection. On the other hand, if the convention is in at least two weeks’ time, and you last had covid in 2021, it would probably be worth getting your second bivalent booster now (in consultation with your physician). “I am 71 years old. My husband has conditions that make him vulnerable to covid. We were exposed recently when our daughter visited and then tested positive. I tested positive, isolated and started Paxlovid. Then, I had several repeat negative tests. My husband never tested positive. So now, with the new guidance and me not knowing if I actually had a covid infection and then having taken a five-day course of Paxlovid, should I get the second bivalent booster? Should I wait? I will be doing extensive traveling in the next few months.” — Alice from Minnesota The chance of a false positive test is very low. If you had several negative tests but one that’s positive, after a known high-risk exposure, I think you could presume that you had covid. Your husband, assuming he is a similar age to you, should get the bivalent booster now. You could consider waiting, since you probably just had covid. You and your husband might consider taking additional precautions during the upcoming travels, including masking in crowded indoor settings. “ My wife and I, both over 80 with underlying medical conditions, received our last covid shots in September 2022. I got covid (very mild) in October 2022. Should we get new boosters now or wait for (hopefully) enhanced boosters in the fall?” — Ward from New York Given your age and risk factors, and the fact that your last experience with covid was more than six months ago, I think you should consider getting a second bivalent booster now, knowing that you can get another dose in the fall. You should discuss this with your physician, of course, in case there are specific reasons you shouldn’t get the booster now.

Should I take Paxlovid?

“I am 74 years old. I have irritable bowel syndrome and asthma. I have been given Paxlovid by my doctor in case I get covid. My concern is I am likely to get diarrhea if I take it. (I have gotten diarrhea when I have taken Augmentin and had stomach issues when I took Tamiflu). I asked my doctor about getting remdesivir instead. She said I might be able to get it at urgent care. However, the pharmacist at CVS says urgent care probably doesn’t have it on hand. Would you suggest my going to a hospital ER to get the injection?” — Anita from California It’s great that you are thinking through a plan for what happens if you get covid. Your age is a major risk factor for severe outcomes, and I’d definitely advise you to obtain early treatment. That said, I don’t think you should discount Paxlovid. There are people who can’t take the medication because of interactions with other drugs they are taking and certain medical conditions. In your case, you are anticipating stomach upset. That’s certainly possible; diarrhea, vomiting and abdominal cramps are among the known side effects for this antiviral and many other therapeutics. But these symptoms are generally mild and don’t last long, and many people would consider them preferable to becoming more ill if they didn’t take Paxlovid. Remdesivir is an alternative for those who really can’t take Paxlovid. As you have found in your research, it’s much more difficult to obtain, as it requires infusions or injections. Remdesivir also has gastrointestinal-related possible side effects, including nausea, vomiting and light-colored stools. Given the benefits of Paxlovid, I’d advise that you reconsider it as the primary choice, in consultation with your physician. “I am continually surprised when you mention Paxlovid without the caveat that it’s not recommended for people on statins and other medications. Molnupiravir is prescribed instead. Since the over-65 population has a high percentage of people taking statins, this strikes me as important. I was prescribed Paxlovid despite contraindications because I asked for it (and the on-call doctor apparently didn’t check my medications on the computer). So it makes a difference for consumers to know about alternatives.” — Anne from New York Anne, I agree with you that people need to be aware of contraindications. And if Paxlovid is not an option for them, they should know what other therapeutics they can access. It’s also crucial to know the comparative effectiveness. The data is accumulating that molnupiravir is less effective than Paxlovid. One large study from Britain, published in the Lancet, found that molnupiravir doesn’t prevent covid-19 hospitalization or deaths in high-risk patients, though it can reduce the total number of sick days. Another Lancet paper , using research from Hong Kong, reported some effectiveness of molnupiravir in reducing severe illness but concluded there was additional benefit with Paxlovid. (Remdesivir is another effective antiviral option, but as mentioned above, it is more cumbersome to administer as it requires injections or an infusion.) My recommendation is for everyone to assess whether they are at high risk for severe illness. If they are, they should first see whether they are eligible for Paxlovid. Some patients have an absolute contraindication (for instance, severe kidney impairment) and cannot take it. Others, though, might be on medications that they can hold off on while on Paxlovid. That includes the medications you use, statins, which treat high cholesterol. The Food and Drug Administration says patients on atorvastatin and rosuvastatin should consider temporary discontinuation during their five-day Paxlovid course. And those on lovastatin and simvastatin should discontinue use of the statin 12 hours before starting Paxlovid, then restart five days after finishing it. If stopping a medication for a short time is possible to allow you to safely take Paxlovid, you should consider that option to access a more effective treatment.

Should we still mask?

“My question is about continued masking. I believe you’ve said that, while it was necessary, masking for young children probably prevented them from building immunity to some common viruses. What about older kids and even adults? Can immunity to common viruses wane over time if we continue to mask, or do we maintain the immunity once we have it?” — Sandy from Pennsylvania Immunity to many common respiratory viruses can and does wane. In the United States and around the world, there was a temporary resurgence of cold-like illnesses after population-level covid mitigation measures ended. Last fall, there were spikes in respiratory syncytial virus (RSV) and the flu, and many people reported multiple rounds of viral symptoms once they ended masking and social distancing. This is not to say there isn’t a benefit to continued mitigation measures. There are some medically frail individuals for whom exposure to any virus could land them in the hospital. They should continue masking and other precautions, even if one of the potential consequences is that immunity to some viruses will wane as a result. “Is it really safe or wise that health-care settings and hospitals no longer require masks? It seems to me that people at higher risk for covid complications will now be very vulnerable to catching covid when they seek health care. Many of these people, of course, are already older or have an underlying medical condition; some may avoid or delay seeking needed care out of fear of infection. Shouldn’t a health-care setting be the one place that higher-risk people do not have to fear catching covid?” — Leila from Virginia This is quite a controversial topic, with prominent physician-epidemiologists on both sides of the debate. One compromise is to consider the setting. It makes sense for hospitals and emergency departments, along with medical offices that treat cancer patients, transplant recipients and other high-risk individuals, to continue mandating masks — and that the mask required has to be at least a surgical mask. Other settings, such as general pediatricians’ practices or physical therapy offices, should have some leeway, though I hope patients can easily and comfortably request their providers to mask when treating them. In the meantime, patients concerned about contracting the coronavirus should keep in mind that one-way masking remains very effective, as long as they are consistently wearing a well-fitting, high-quality N95 mask or something equivalent.

What do we know about asymptomatic transmission of covid?

“What do we know about asymptomatic transmission of covid now, three years into the pandemic? From the beginning, the long runway of possible asymptomatic spread was one of the factors that made covid worse than other respiratory viruses like the flu.” — Kate from Michigan You are right; asymptomatic transmission makes covid much harder to contain compared with diseases that are spread only by symptomatic people. That’s because people who are ill can be told to stay home to prevent from infecting others, whereas those who don’t know they are sick can be unknowingly transmitting the virus to others. One of the best studies I’ve seen on the topic is from 2021 in JAMA Network Open . The researchers found that asymptomatic transmission accounts for more than half of covid spread. This includes people who are infected but have not become symptomatic yet as well as those who remained asymptomatic but capable of infecting others.

How can I exercise safely?

“Recently, you wrote an article about taking swimming lessons . I had started swimming lessons before the pandemic. I would like to continue them now, but wouldn’t it be unsafe if I am in the water with my instructor without masks on and other people are also using the pool at the same time? What is your advice?” — Lorna from Massachusetts If your lessons are outdoors, the risk of contracting covid is exceedingly low. If the lessons are inside, the risk is probably still low, especially if you are able to keep some distance between you and the instructor and other swimmers. Swimming and other fitness activities are good for your overall health. You should weigh the benefits of exercise, especially exercise you enjoy, against the risk of contracting covid, which in this case is low.?

Opinion Your questions about covid-19, answered by Dr. Leana Wen

By Leana S. Wen

Contributing columnist

Updated June 8, 2023 at 12:30 p.m. EDT|Published January 31, 2022 at 1:25 p.m. EST

(Astrid Riecken for The Washington Post)

Public health expert Leana S. Wen answers reader questions about covid-19 every week in her newsletter, The Checkup With Dr. Wen, and in occasional Q&As with readers. We’ve compiled some recent questions below, and will continue to update this page with the latest guidance.

To read more from Wen or to submit a question, sign up to get The Checkup With Dr. Wen.

Expert opinions on covid guidance

HAND CURATED

Opinion|Your questions about covid-19, answered by Dr. Leana Wen
3 hours ago
Opinion|Your questions about covid-19, answered by Dr. Leana Wen
3 hours ago
Opinion|These 7 radical changes would fortify the U.S. against the next pandemic
May 11, 2023
Opinion|These 7 radical changes would fortify the U.S. against the next pandemic
May 11, 2023
Opinion|The Checkup With Dr. Wen: Who should still be tested for the coronavirus?
May 11, 2023
Opinion|The Checkup With Dr. Wen: Who should still be tested for the coronavirus?
May 11, 2023