Should You Get a Second Booster?

The skeptical cardiologist has been pondering the possibility of getting a fourth jab.

I received my first booster shot in August of 2021. The second booster of COVID-19 vaccine for those who are severely immunocompromised and fully vaxxed was recommended a while back.

While I am not moderately to severely immunocompromised I’m probably mildly immunocompromised like all my fellow Americans who are fortunate enough to have aged sufficiently to exceed age 65 years.

I’ve got reasons to be believe I’m going to get more exposure to coronavirus than typical because I’m going to be making inpatient rounds on cardiology patients starting in mid-April at SAINT LOUIS UNIVERSITY Hospital. In addition, the former eternal fiancee’ will return from a business trip to Kentucky where gathering and eating indoors will have been the norm.

There is not a unanimity of the experts whose opinion I respect on whether oldish people like me should get a 4th jab.

As a result I have been searching feverishly, far and wide for information, commentary, and/or studies that can help me make a better decision and I have made, canceled and rescheduled an appointment for the Moderna booster 3 times.

Last week we heard that the Biden administration was planning on recommending a second COVID-19 booster for all individuals over age 50 years.

Eric Topol (the legendary cardiologist of social media) has tweeted out his explanation for why this decision was made.

It is based on 3 studies of the 4th vaccine. For those of you without twitter accounts or a fear of treading into twitterland here is a PDF summary of his tweetorial.
ThreadReader_0_erictopol_1507900089611681794

This graph is from a preprint report on the Israeli program of providing a 4th jab to health care workers over age 60 years.

It shows that beginning at 12 days after the 4th jab there was a dramatic reduction in high risk individuals over age 60.

The study also showed a 78% reduction in mortality for 4 versus 3 jabs.

Several colleagues who are similarly oldish and contemplating jab#4 sent me this Wall Street Journal article from yesterday which argues against a 4th jab or even a booster:

The New York State Health Department’s large database shows the effectiveness of full vaccination (that is, at least two mRNA doses) remained above 90% against hospitalization, including during the recent Omicron surge. A study from Sweden found the same. Studies from Qatar and California showed no decline in protection against severe disease with Omicron.

Their recommendations are:

If you’ve had two doses of vaccine, you have a lot of protection against severe Covid. Likewise if you’ve been infected with the virus, including with Omicron. If you’re over 65 or otherwise at high risk of severe disease, it’s reasonable to get a third dose. A fourth dose is already authorized for the immunocompromised. For everyone else, the data haven’t shown meaningful benefit of three doses, never mind four.

The authors are experts are not charlatans:

Dr. Krause is a consultant to the World Health Organization and was deputy director of FDA’s Office of Vaccines Research and Review, 2011-21. Dr. Borio is a senior fellow for global health at the Council on Foreign Relations and was director for medical and biodefense preparedness policy at the National Security Council, 2017-19.

So what should the skeptical cardiologist and his fellow oldish triply vaccinated readers, friends and patients do? What are you going to do?

Keep in mind that anecdotes about how you know a guy who had a stroke after getting a jab are not helpful. Likewise anecdotes about how mild COVID-19 was for you and your wife are not helpful. We need RCT data with detailed breakdowns of side effects and COVID-19 illness by # of doses, age, gender and co-morbidities.

Right now I have an appointment at 9 AM at CVS for the vaccine but between now and then I’m going to keep on researching the question and feel free to reschedule my date with jab#4 if I change my mind.

I will keep you posted on the outcome.

Ambivalently Yours,

-ACP

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34 thoughts on “Should You Get a Second Booster?”

  1. I received the first jab of the Moderna COVID vaccine at the end of Dec 2020 (the first kid on my block), with the second 28 days later at the end of Jan 2021. I was 67 at that time. By the summer of 2021 there was talk of a third (booster) shot, but it had not yet been officially approved for any but immunocompromised folks (I am not one). I had an ICD generator change surgery scheduled for September 2021 and wanted to be maximally protected for that (presumably brief) hospital visit. So I got a third shot (a DIY “booster”… another “full strength” 100 mcg Moderna shot) in early August 2021 by walking into a pharmacy and simply telling them “I need my COVID shot… Moderna, please”. No questions asked or answered. Fast forward to January 2022, and I find that I’m about to attend the Daytona 500 with 150,000 other race fans in mid-February, and again wanted maximal protection for that presumably high-risk event. So I obtained my fourth Moderna shot (this time a legitimate 50 mcg Moderna booster) in early January 2022. As we approach the fall of 2022 I’ll watch to see if there’s a new Moderna vaccine that picks up additional variants, and will probably seek out that fifth jab when it become available.

    I guess I’m “all in” on the COVID vaccine… but so far that program is working out well (along with appropriate N95 mask wearing… thanks for the tip on Kimberly Clark).

    Immunologically yours,
    Dan

    Reply
    • Dan,
      Your should be well protected against “severe Covid” for the race. Something about your phrasing ( I find that I’m about to attend the Daytona 500 with 150,000 other race fans in mid-February) implies your are being dragged to the Daytona 500 kicking and screaming. Good news, it is outdoors. Bad news, its Florida.
      Dr P

      Reply
    • AG,
      I did. I’ll probably be able to post details of my last minute research and the experience.
      It was at CVS and other than a request to see my vaccine card ( showed them my Pfizer initial 2 shot card)
      they didn’t inquire as to my eligibility.
      No problems so far!
      Dr P

      Reply
  2. Hi Dr. P and others,
    I am a physician and certainly not an “anti-vaccer”, however, I did have a strange reaction to my Moderna booster in December 2021 – (All 3 were Moderna, the first two without problems). Not even a day later I had the onset of ectopy (very erratic heart rhythm) that persisted for nearly 3 weeks. My Kardia showed PVCs, PACs, with runs of bigeminy and trigeminy. I am a 70 y.o. male and relatively healthy otherwise (exercise daily and have a clean diet). I am concerned about receiving the 4th dose and wonder if I had a mild myocarditis to the third dose. Paul Fournier, M.D.

    Reply
    • Paul,
      It is possible you had a mild form of myocarditis. Without troponin, full ECG, etc. hard to know for sure. Risks for that post-Moderna in your age group is really low, however, I share your concern about the 4th dose.
      Dr. P

      Reply
  3. You can reduce your near term mortality risk more by reducing your driving than by a 4th vaccine dose. Humans do many things more dangerous than not taking a 4th “jab”.

    Reply
    • Robert,
      I was thinking about that same analogy this morning. I can reduce my mortality risk from flying to zero with a maneuver that is totally free of risk: not flying. But I have accepted the very minimal risk of dying in an airplane accident and fly regularly as it is often the best way to get to places I want to be.
      Dr P

      Reply
  4. Anthony,
    I am curious to know whether you have had a documented previous Covid infection? That would change my calculation. I have had double Pfizer’s, then was positive (probably for delta), and then got a booster because it was required for work. I would say that if you had one or more previous infections p[lus 1 booster, the benefit of a fourth jab would be infinitesimal. another strategy would be to wait until you got an infection and then take Paxlovid to give you that 90% protection from death and hospitalization.

    Reply
    • Dan,
      I haven’t had a documented COVID infection and I agree that changes calculations on risk.
      I agree with you that a second booster would be of little value after 3 jabs although little data exist in this area.
      It is reassuring also to know that we have an effective therapy to prevent serious illness although I have concern for availability of paxlovid and question whether just being >65 would qualify for its use.
      Dr P

      Reply
  5. Jim and I are thinking about a 4th shot as well..hope you are doing well..Miss you ..Jim and Linda previous Winghaven Patients.

    Reply
    • Linda.
      I’m doing very well and hope you and Jim are prospering under the care of my replacement.
      Dr P

      Reply
  6. Wife (69) and I (72) got our 4th Pfizer tonight at our local Rite Aid in Morro Bay, CA without any difficulty. Choose Pfizer as we both have not had any side effects and would rather not try a different vaccine until an updated polyvalent vaccine is produced. Oh, welcome to California. We could have found a better place to retire and be active. Robert Radin MD

    Reply
  7. >
    It shows that beginning at 12 days after the 4th jab there was a dramatic reduction in high risk individuals over age 60.

    The study also showed a 78% reduction in mortality for 4 versus 3 jabs.

    >

    I read a report of that study in Ha’Aretz. As a 76-year-old “in good health for my age”, what more do I need to know? I’ll be first in line when Canadian powers-that-be approve the fourth shot.

    Reply
  8. I will wait until there’s an omicron specific booster, as Moderna is working on, and possibly get Novavax as a booster which is also being studied. I’d like some more lasting benefit rather than just getting a 4th of the original recipe.

    Reply
  9. Eric Topol also recommended switching mRNA vaccines. If your last was Moderna, then get Pfizer etc.

    Also those who don’t really think the boosters are necessary are really referring to the risk of hospitalization etc. If you’re also worried about just infection or mild disease then you are also probably concerned about Long Covid, and such weird problems as lack of smell, change of smell which makes everything smell like rotting food etc.

    As far as I know, the potential side effects of the vaccine are much less probable than the same effects if we get infected.

    Reply
  10. I’m 73. I’ve had three Moderna shots. If they approve it for those over 65, I will probably get a 4th. I got my booster last year before we traveled across country by car to New York City for my daughter’s wedding. We felt there was going to be a lot of exposure since we were staying in hotels and we didn’t want to risk it. As far as I know they only risk factor I have is my age.

    Reply
  11. I’m a 72 yo male with a hx of CAD, prostate CA(RALP) and CABG surgery 6 months ago. In the same conundrum as you.

    Reply
  12. Here’s what Rite Aid here in Santa Cruz, CA, has this moment on its web site (https://www.riteaid.com/covid-19)

    COVID-19 Vaccine

    The best way to protect yourself from COVID-19 is to get vaccinated. Adults ages 50+, certain immunocompromised individuals, and those who received a J&J booster may now receive a second COVID-19 booster. Online scheduling available; walk-ins welcome.

    Reply
      • We left CVS some time ago and have found Rite Aid much better–here. You never know elsewhere. Making an appointment online at Rite Aid was extremely easy. Pharmacist was super in administering the shot. My only complaint in recent days is problems getting branded medications I take, which I greatly prefer after reading Bottle of Lies. And I suspect the problems are supply chain or manufacturer related and not those of Rite Aid. Staff is exceedingly well trained and friendly and the lines there are among the shortest pharmacy lines in town. If you try it, please let us know your experience.

        P.S. I recall reading somewhere a while ago on either an FDA or CDC web site that anyone who checks immunocompromised cannot be questioned about that status by pharmacy staff. Can’t put my finger on that right now though.

        Reply
        • DG,
          Good to know.
          I just don’t think there is any way the pharmacy staff is qualified to determine who is immunocompromised. Even if they had complete accurate data on meds and medical conditions from the patient’s chart it would be difficult. They don’t have this data and have to rely completely on what the patient is telling them which could be utter balderdash . So it’s a losing proposition to begin to screen.
          Dr P

          Reply
      • And yet, when I just looked at Rite Aid’s site’s vaccine scheduler, and filled the form honestly, it says: “Sorry! At this time, the CDC is not recommending more than 3 doses of the COVID-19 vaccine for you.”

        Reply
  13. Hmm. I’ve been pondering this myself. My vaxxes and booster were Moderna. I may be embarking on another disease modifying drug for MS, which will really suppress my immune system. So if I need a booster, it should be prior the new drug. They are advising not to do both. I’ll be interested to hear what you find.

    Reply
  14. My husband (67) and I (almost 69) got the initial 2 Moderna shots in Feb and March 2021. Got the booster precisely 6 months later. We have some health issues, so we continue to mask, lead a quiet life, etc. However, we will be traveling overseas in October. Should we get the 2nd booster now? Or wait until a little closer to our trip—perhaps August or September?

    Reply
    • Jamie,
      If I had the capability to delay my significant exposures I would delay getting #4.
      Dr P

      Reply
  15. I just went to CVS after scheduling a 4th shot (second booster) and was told they will not give it yet, not until the CDC position is the same as the FDA’s. So, your appointment may be cancelled on arrival.

    Reply
    • AG,
      What did you tell them about your status? I received jab#3 prior to the official rollout to everyone. I may have clicked that I was immunocompromised in the screening questions. At the site I wasn’t asked about any illnesses and I didn’t have my prior vaccine documentation. I’ll be interested if others have experienced that.
      dr P

      Reply
      • I did not click immunocompromised, as I am not per the CDC definition, but I got through the online booking and got an appointment. Once there, the pharmacist told me, not yet. When I retuned home and checked the site, it now says waiting on CDC for approval re over 50.

        Reply

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