University of Virginia immunologist and COVID-19 researcher Dr. William Petri continues to answer reader questions about COVID-19, vaccines and, now, the omicron variant.
My friends were planning a New Year’s Eve party with about 12 vaccinated and boostered friends. But we are all over 70, and I know that some of the group traveled or visited with family members during the holidays. What do we do?
First of all, that is wonderful that you and your friends have all been boosted. This increases protection from symptomatic infection with the now predominant omicron variant from 25% without, to 70% with the booster. This is based on analysis of 147,597 delta and 68,489 omicron cases by the United Kingdom Health Security Agency. Additional good news is that omicron infection is less severe than that from the prior delta infection. Again from the United Kingdom Health Security Agency, this time in an analysis of 114,144 omicron cases and 461,772 Delta cases, the risk of hospital admission with omicron was approximately two-fifths of that for delta.
Not so good news from the United Kingdom Health Security Agency is that protection from the Pfizer booster appears to wane to 45% after 10 weeks time, raising the issue of the need for additional booster shots as the pandemic continues. Another caveat is that age remains the greatest risk factor for a severe outcome for COVID-19, with the 14 deaths known to be from omicron in the UK being between 52-96 years of age.
So what should you do? The vaccine plus booster has substantially reduced risk of a symptomatic omicron infection at your New Year’s Eve party, assuming that the booster has been given within the last two months time, before it starts to lose effectiveness. Also in favor of having the party is the fact that should omicron infection occur, it is somewhere between a half and a third less severe than delta. You could additionally reduce risk by doing the party outdoors or by opening all the windows in your home (it is not supposed to get any colder than 53° F on New Year’s Eve!). Also remind everyone not to come to the party if they have cold or flu symptoms, or if they have been exposed to someone with COVID in the last 5 days.
I was going to also suggest getting everyone tested the day before, but that is so difficult to do because of the lack of access to testing or to rapid at home test kits (I was waiting in the line of cars at Zion Baptist Church Tuesday night when the tests ran out – even so, I am so grateful to the volunteers who are doing all that they can to make testing available in Charlottesville).
We know that omicron produces fewer symptoms and less serious disease in younger people. What does the research show about oldsters?
Also less severe in all of us senior citizens, by about a half to a third, but all of the deaths in the UK (14 to date) have been in people older than 50. Infections in general are worse the older you get, whether due to viruses, bacteria or parasites, but none more so than COVID-19.
There’s a great deal of confusion over the CDC guidelines and omicron. Can you please help clarify?
I find it confusing too, and this is my job! Quarantine is what you do if you have been exposed to someone with COVID-19 (exposed means being within 6 feet for a total of at least 15 minutes in one day). If you are fully vaccinated and boosted, the CDC does not recommend that you quarantine at all, but wear a mask when close to other people outdoors, and indoors in public spaces. If you are not boosted, CDC recommends that you quarantine in your home for 5 days.
Isolation is what you do if you have COVID-19. The new CDC recommendations are that you isolate for five days. The basis for this is that most spread of COVID-19 happens in the 1-2 days before symptoms occur and for 2-3 days from the onset of symptoms. One should still wear a mask when around other people for a total of 10 days, and always when indoors in public spaces.
I have close friends who believe the recent statements from a virologist at a respected European university who states, (paraphrasing): wearing masks “prolongs” the pandemic for those who are vaccinated and for those who’ve recovered from COVID-19. The virologist goes on to say that coming down with COVID-19 after vaccination serves as a natural booster and protects against grave illness since it allows for a more varied immune response. He states in addition to providing better protection, it also reduces the chances the virus will escape the immune system by mutating. Sounds cockamamie to me and no matter what I say, I get a brick wall response. I hope to visit next year but without proper vaccination there, I will have concerns (though I am Pfizered and boostered). What are your thoughts?
I agree with you that vaccination provides added protection from COVID-19 over naturally-acquired immunity. This conclusion is based in part on a study from Kentucky that compared 246 people who were vaccinated after COVID-19 to 492 people who were not vaccinated. The vaccinated group had half the number of reinfections. And of course vaccination is a much safer way to gain immunity than infection. We lost a member of our extended family on Christmas day from COVID-19 who had refused vaccination, and I imagine many reading this have suffered a similar loss, for which I extend my heartfelt sympathy.
I am concerned about my COVID-19 protection against omicron particularly, as my vaccination history is the J&J one shot back in early March 2021, and the half-dose Moderna booster in late October 2021. I am in my early 60s and am overweight but otherwise healthy.
Protection from the J&J vaccine boosted with the Moderna vaccine is about as good as a Moderna boost of the Pfizer or Moderna vaccines. A looming problem is how long will booster protection last, as mentioned above the Pfizer booster may be wearing off by 10 weeks time. Israel is moving forward with a second booster 4 months after the first, and I expect we will see something similar in the U.S. shortly.
I have plans for international travel in mid-January, and am thinking that the risk of breakthrough is a concern (not being able to board that plane home if I test positive, or becoming ill in another country). I am very cautious in daily life—N95 masks, handwashing, social distancing, but there are still the terminals etc. to contend with for travel, so I am just trying to gauge whether my concerns with my vaccination history are valid. I am also concerned about being part of “the spread” if I am not adequately protected against omicron, and that is another part of my question.
It is a great question that revolves around the broader issue of how long do we put our lives on hold, especially as we enter year three of the pandemic. This is a personal decision, as we each weigh the risks differently. I share your concerns of getting stuck overseas for isolation for five to 10 days with a positive PCR test, being sick far from home, and I am also concerned about how long the protection from a booster will last. And omicron has me worried because while less severe is incredibly infectious. One approach is to continue to be prudent, and wait out the omicron wave of the pandemic and see where we are this spring. I am saying this if the international travel is optional for you; taking some risk would be justified in my opinion in order to see family that we have been separated from because of the pandemic, or for essential visits for business (such as my traveling to Bangladesh for our research in child health). But this is the view from someone who in general is less than patient! And thank you for asking a question that is on all of our minds.