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Opinion The Checkup With Dr. Wen: Will we repeat the same mistake we made on boosters?

A nurse holds a vial of the Pfizer coronavirus booster vaccine at an inoculation station next to Jackson State University in Mississippi on Nov. 18. (Rogelio V. Solis/AP)

You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. Click here to get it in your inbox.

For weeks, Checkup readers have been writing with increasing urgency about their desire to receive a second bivalent booster.

“I am begging the Centers for Disease Control and Prevention to allow doctors to give a second bivalent booster to the elderly and immunocompromised,” wrote Janet from California. “Even though my doctor wrote a letter and I was given an appointment for a second booster, they wouldn’t give it to me due to the current CDC recommendations.”

Luisa from Florida had a similar experience. “I am 81 years of age and a lung cancer survivor,” she wrote. “I went to Walgreens for a second bivalent booster. But the pharmacist refused to vaccinate me, claiming that I am not eligible. I am very disturbed by this.”

These stories have convinced me that federal health officials need to allow vulnerable individuals desperate to receive their second bivalent booster to do so. This would be in line with what Canadian and British officials have already decided, as I wrote in my column this week. With so many vaccine doses in our supply, why not let Americans who want an extra one get it?

The delay by the Food and Drug Administration and CDC is reminiscent of what happened a year and a half ago, when the United States lagged Israel, Germany, Britain and other countries in recommending initial boosters to high-risk groups. At that point, the booster guidance inexplicably did not include recipients of the one-dose Johnson & Johnson vaccine. J&J recipients were left in the dark for so long that the city of San Francisco overrode federal health authorities to give boosters to this group.

The FDA and CDC shouldn’t make the same mistake again. Readers are already sharing anecdotes of how they accessed a second bivalent dose.

Susan from Utah wrote that she and her husband are both in their 70s. They are taking several trips this spring and summer and decided to get an extra coronavirus vaccine shot. They tried going to their local health department, but though the employees agreed that second bivalent shots should be allowed, they couldn’t give them.

“They advised us to try our local pharmacy,” Susan wrote. “We did exactly that, and we were able to [get] the second shot, because we lied and said we hadn’t had a booster since March of 2022.”

Other readers used similar approaches. They went to a different pharmacy than the one they went to for previous shots and claimed they were seeking their first bivalent vaccine. If asked to present their vaccine card, they’d say they lost it.

“Talk to people you know and see if they know of pharmacies or grocery stores with more lax procedures,” Christina from Florida advises. Janet from D.C. says her doctor’s office was giving second boosters to patients deemed particularly high-risk. And Evelyn from Virginia didn’t have luck with her local pharmacy, but then crossed the border to Maryland and got a booster at a county health department.

I recommend speaking with your physician first to see if they agree that you are particularly vulnerable to severe outcomes from covid-19. If so, make sure to have a plan for what happens if you contract the coronavirus, including whether you can take Paxlovid (and if not, how you can access the antiviral injection remdesivir).

Also ask if you can get a second bivalent booster. Some physicians interpret the federal guidance differently; even though the “off-label” use of boosters is technically not allowed, they believe in tailoring medical recommendations to their patient’s specific circumstances. They might have vaccines in the office, or they might know of nearby pharmacies that would accept a letter from them.

Of course, this is not the way it should be. Patients shouldn’t have to jump through so many hoops to get the additional protection they desire. For better or worse, until there is official guidance permitting second boosters, many will take matters into their own hands.

To them, it’s a personal medical decision — just as it is a personal choice to mask and take other precautions for those who wish to avoid contracting the coronavirus.

Ask Dr. Wen

Newsletter subscribers are invited to submit questions to Dr. Wen. Not a subscriber yet? Click here to sign up.

“Are there labs where a vaccinated person can, without a physician’s order, obtain a nucleocapsid antibody test for covid-19 that enables them to determine whether they have already had it? It would be reassuring to know my body had already beaten the disease without symptoms at least once. I’d be more inclined to go to restaurants and movies more often, and I’d stop masking for short visits to the grocery store.” — Michael from Maryland

The antibody test you are referring to, the SARS-CoV-2 antibody nucleocapsid test, will tell you whether you have ever had covid. It detects a different antibody than the one produced from vaccination. If the test is negative, you have not had covid, and if it’s positive, you have had covid at some point.

The easiest way to obtain the test is with a physician’s order. This test is available at commercial laboratories such as Quest Diagnostics and LabCorp. Your primary-care provider can order the test just as they could order a cholesterol check or a thyroid hormone test.

If you don’t have a primary-care physician or do not wish to go to them, you could visit an urgent care center. There are also some online health-care providers who can order the test for you to obtain at your local laboratory.

The result needs to be interpreted with caution. While it might be reassuring to know that you have had covid, you wouldn’t be able to know when that was. The test also wouldn’t give you a quantitative sense of your level of immunity. You should still consider your other risk factors, including age and preexisting medical conditions, in deciding how much you want to avoid covid and what precautions to maintain.

“Why can’t immunocompromised or older people who have problems wearing masks indoors get curbside delivery of groceries and other items?” — Cindy from California

You might be referring to the readers who write in with questions about what mitigation measures people at high risk for severe illness from covid should continue to take. I think many do make use of curbside and delivery programs. But these options are not be available in all instances. There are also settings that people must go to in-person, including doctors’ offices. And many of these individuals crave human interactions and might want to go back to in-person shopping.

Since the beginning of the pandemic, people have had to gauge their own risk tolerance. Many have now decided that covid is no different for them than other common infectious illnesses. But some are still taking precautions. As I’ve maintained throughout, these are all reasonable choices and should be respected.

“Is it possible to build up immunity to covid-19 or other infections by repeated low-level exposures, none of which result in symptomatic disease? For example, I wonder if in pre-vaccine days, health-care workers inhaled some number of virus particles that were too few to trigger infection, but their immune system gradually got better at preventing covid. After some time, would they test positive for covid antibodies?” — Alfonso from Illinois

People can become infected with covid and be asymptomatic. A CDC study suggested that nearly half of those who thought they never had covid actually had antibodies reflecting prior infection.

It’s possible many health-care workers in the early days of the pandemic contracted covid, developed some level of immunity and then were better protected as a result. They probably were not repeatedly infected, but rather the natural immunity protected them against new infections for at least a short period. If they contracted the coronavirus, regardless of symptoms, they would test positive for coronavirus antibodies.

The Post has also compiled Q&As from my previous newsletters. You can read them here.

What I’m reading

A study in the journal Pediatrics finds that the leading cause of fatal poisoning in children ages 5 years and younger is opioids. Researched examined 731 poisoning-related deaths between 2005 and 2018. Opioids contributed to nearly half of these deaths. Over-the-counter pain, cold and allergy medicines were the second-leading cause of poisoning-related deaths. This study points to how the opioid epidemic has not spared young children. It also shows how parents and caregivers must take steps to prevent children from accessing both illicit drugs and prescription and over-the-counter medicines.

A new well-designed study published in Lancet Infectious Diseases adds to the large body of evidence in favor of Paxlovid in reducing severe disease. The research, which included more than 130,000 patients with covid, found the use of the antiviral treatment was more than 53 percent effective at preventing hospitalization or death. When Paxlovid was administered within five days of symptom onset, it was nearly 90 percent effective. This underscores both the benefit of this antiviral and the importance of early administration.

The number of children considered chronically absent from school has doubled since before the pandemic, according to a sobering report from NPR. As one researcher told NPR, “I think people have been a little bit under the false impression that when covid became more endemic, that that would then result in a significant improvement in attendance. And I’m not seeing that.” There are several potential solutions to address barriers to school attendance, including home visits and conversations with families.