Dr. Eric Topol Answers Your Questions About Boosters

Welcome, everyone. I'm Dr. John Whyte, the Chief Medical Officer at WebMD, and you're watching Coronavirus in Context. Have you got your COVID booster? Do I mean the first one, the second one, third one? Is it the original one? Is it this new bivalent one? Who exactly should get boosted, and when? Well, joining me to answer all of those questions and more is my good friend, COVID expert Dr. Eric Topol. Well, Dr. Topol, thanks for joining me today.

Always a pleasure, John. Great to be with you again.

You know, I mentioned about boosters. But some people are saying, what booster are we talking about? Are we talking about the first booster, the second booster, the third booster? So what's the framework that people need to be thinking about today when we say patients need to get boosted?

Right. Well, if you haven't had a booster, whether it's the first, second, third, it's time to get one. And especially, if you're age 50 and older, because there, in that group it's a 90% reduction plus, 90% beyond of deaths, and over 80% reduction of hospitalizations.

So younger than age 50, you know, the protection jump is not nearly as marked as that. But if you're 50 and older and you haven't had a booster in the last four to six months, time to get one. So the last four to six months. So if you've had a booster a year ago, it's time to get reboosted. Is that right?

Yes. And don't be misled that this is going to protect you from infection. The boosters, ever since Omicron came on the scene in November, December of last year, we've lost a lot of that protection against infections. It's not the vaccine's fault. It's the fact that the virus evolved so extraordinarily to--

Unvaccinated people. Let's be honest. That's how it's survived and circulated, correct?

Yes, yes.

It played a large role.

We never got control or containment around the world, and the virus kept evolving as a result of that. And then, of course, as you know, John, we had people within immunocompromised folks who could have the virus go through accelerated evolution within them, and we had animal spillovers. And so we had all these things because of lack of containment of the virus, as you said.

The main thing is that once Omicron, and now all of its subsequent variants, lineages that we've seen, and we've seen lots of them now, we just don't have that kind of infection protection. You know, it may be 30%, 40% for a month or two, and then it basically falls off. The reason for a booster is just about prevention of hospitalizations and deaths, and to some extent also, The chance of preventing long COVID.

Dr. Topol, I want to ask you some questions that we've been getting at WebMD. So going straight to the source of all knowledge of COVID, and if you could help answer it for people. And the first question is around what do we mean by "bivalent," and how is it different than the previous ones?

When the booster in September, early September, was released in the United States the new booster, so-called "bivalent," it had a half-and-half recipe. Half of the booster was directed against the BA.5 spike, and half was the same as the original. So that bivalent means it had two. It was directed to two different spike proteins of the virus.

What about these new variants that are coming out? Have you heard people have been calling them the Scrabble variants, because they have letters that have high scores, X, you know, Q? Have you heard that? That's what they--

Yeah, no. That's my friend Peter Hotez who came up with the Scrabble, but you know.

So what about these new variants? Is it protecting against these new variants? That's what people want to know, Dr. Topol.

I know. I'm with you. The two most worrisome are BQ.1.1 and XBB. And we've learned a lot about these two. They're also picking up new mutations. So it's not just BQ.1.1 now. There's BQ.1.1.10, and XBB.1 or XBB.4. So basically, the virus is going through pretty rapid add-on mutation evolution.

Now, there is only one country that suffered a wave, a new wave from one of these two most worrisome variants. That was Singapore. But it actually handled it quite well. Now, Singapore is one of the most vaccinated and boosted countries in the world. And they had a wave, but not much in the way of hospitalizations or deaths. So they weathered it.

No other country-- in India and Bangladesh, they have a lot of XBB, but they didn't have any wave at all. And as far as the BQ.1.1, the worst country in the world for the most growth of that is France, and it's looking quite good right now. Basically, there's some ray of hope here, John, that even though these variants look terrible in the lab, with lots of immune escape, more than we've ever seen, what we're seeing in people doesn't yet correlate with that level of deep concern.

In a few weeks, we'll know, because the US is less protected. We have a much lower booster rate, particularly of our older folks here, compared to these other countries like France or Singapore, or you name the country. We're in a poor shape for boosters. But on the other hand, we have a very high prior infection rate, particularly with Omicron and all of its variants.

What about the fact that a lot of people got COVID this summer? They're wondering, OK, Dr. Topol, they might be open to the idea of getting a booster, but when do they get it done, recognizing the immunity wanes in a lot of areas? The country, almost 90% of counties are in low transmission, so it depends where you live. How do they factor into that timing? They don't want to get it too soon, but they don't want to get it too late. Is now the time to get it?

Yeah, I go back to that. If you had a BA.5 infection, which was the summer wave, and it was quite prevalent, and you are now beyond three months from that infection, which hey, it's November now, right, it's time to get a booster, particularly if your age 50 and older, because it will help against any new variant.

Boosters just basically rev up our immune system for several months, four to six months. So that's why I recommend, if you're 50 and over and you're past three months from that summer infection, which likely you are, get it, because you'll benefit from it. You'll get an extra layer of protection.

And by the way, just today, John, was an important paper in Science Immunology that basically showed it's the neutralizing antibodies that are tied to boosters, and that's of course what, in people who are at risk, the aged, that's what is giving them this durable protection. It doesn't come from the primary vaccines. That difference is related to getting our antibodies amped up.

How long do you wait after a previous infection with COVID? Is it three months?

Three months. three months Yeah, I mean I think the data--

That's somewhat an art, to be fair, isn't it?

Well, no, if you go too early, it's not good. And we have some data. Within two months, it's not a good idea.

Dr. Topol, what if they say, well, that's their booster, so they don't need another one, because we hear that a lot?

Yeah, well, a lot of-- by default, since the booster uptake is so poor in this country, since the virus--

Why is it so poor? It is. I mean, in the current one, some areas of the country, it's single digits.

Yeah, well, we only have for the over age 65, 20%. And for over 50, it's less than 15% total. The highest risk, 85% of the people now are past four and six months. They haven't had a booster. They're sitting ducks for potential trouble.

So over 50, you said they definitely get the bivalent vaccine. And if you're over 18 and you haven't gotten any, or is it over 12?

If you're over 18 and you're past six months from when you got your primary shot, get it. Get a boost.

JOHN WHYTE: What about the mindset, Dr. Topol, that people will say, you know what, I know plenty of people that got fully vaccinated, that got boosted, and they still got COVID, and they did fine? So I'm going to take my chance.

Yeah, well that goes back to what I said earlier, is what about long COVID. That's the biggest concern. It's unpredictable. As you know, it's much more common in younger people, healthy, completely healthy people with good, intact immune systems. So you just don't want to take that chance. The booster will reduce that 30% to 50%, as best we know, from all the data that's out there. So that's the reason to get it.

Now, I don't say-- you know, it shouldn't be mandated I'm just saying these are the data. You make a decision. But I don't think there's any question that when you get to advanced age groups, you know, it's a big deal. Younger than 50, there's different issues at stake here. But if you never got a boost and you're relying on those two shots, that's a problem. I mean, I think you are going to be-- it's not the infection protection again. I can't emphasize that enough.

And the people who keep saying that the vaccines are worthless or don't work, that is a bunch of malarkey, if you will. The reason I say that is because, yeah, they don't do the infection protection like we saw up through Delta., but that's not the vaccine's fault. It's because the virus evolved. And luckily, we still have protection that is afforded against hospitalizations and deaths and long COVID. So let's take advantage of that.

Are they going to need to be boosted every four months?

Yeah, there's no way I want to be part of that program, as I reviewed, nor do I wish that on anybody, because getting a shot every four to six months, particularly since there's a lot of reactions there, and it becomes untenable as a strategy.

What's late fall and early winter going to look like? So right now, we're kind of concerned with RSV.

Yeah.

We're starting to see more influenza, particularly in the Southeast. But what are we going to see relating to COVID? What's your prediction?

Well, I'm a little optimistic. The reason I say that is, even though the new variants, as we talked about, XBB, BQ.1.1, which is in the US, especially, growing quickly, the lab results look really scary, but the people results so far around the world don't correlate yet. And if that continues in the next few weeks, that's really great.

And yeah, we'll have some increase because of behavior and the waning of immunity. People that don't get their boosters, you know, lack of any mitigation, we'll see a little bump in cases and hospitalizations and deaths, especially in the people of advanced age. But if we don't have a variant that causes trouble like we've had, BA.5, BA.2, Delta, blah, blah, blah, it won't be that bad. But the thing we can do right now is don't have waning immunity. We have a tool for that.

And we should be getting boosted.

Yeah, I mean, that's our best shot. I call it, the play on words, the best shot to get through the winter, the rest of the fall and winter, is to be as protected as you can. And that's why if you get a booster, that's as good as you can do against severe illness or long COVID protection.

There you have it from the expert. Dr. Topol, thank you as always for taking the time to educate us about what we can do to protect ourselves, our families, and our communities.

Much appreciated, John, as always. Thank you.