Do you need RSV vaccine, flu shot or COVID booster? How to sort through vaccination noise.
With the Thanksgiving turkey a memory (with leftovers) and the gravy gone, thoughts turn to the winter ahead. One of the most frequent queries I hear is what to do about vaccinations. Given the recent COVID-19 pandemic, confusion is not surprising. What is surprising is the confusion in the advice. So let’s sort out some of the chaos.
First of all, I need to review how advice is supposed to work. There are national experts; they do really important work in really faraway places. The places and work seem so distant as to be irrelevant; they are, at the individual-application level.
These national experts are supposed to get information to the state level, full stop. State-level people then interact with county-level people; given that circumstances differ by county, the state cannot reasonably give precise advice to the county.
People at the county level, knowing the needs of the population, are the spokespersons for advice on what to do. The county level then advises local practitioners on what is needed and available.
At least that’s the way it’s supposed to work. Until the wheels came off the pandemic bus.
With all the discussion of a "tripledemic," it is useful to see first where we are before deciding where to go, sorting the old and the new.
What is RSV and how serious is it?
Old: RSV, or respiratory syncytial virus, has been around a long time. We’ve known for decades not to visit old sick people when we are sick ourselves. We know not to hold newborn babies without cleaning ourselves and certainly not when we are sick ourselves. This is not new.
What is new: We now have a vaccine for RSV. Given to pregnant Mom, she produces antibodies that Baby gets, just like all the others: tetanus, whooping cough, diphtheria – names that still frightened the grandmas that experienced these preventable diseases.
If Mom doesn’t or can’t get the jab (I like that better than “shot”) herself, there are preformed antibodies that can be given to Baby, like those given to Rh-negative moms to keep their immune systems from killing their babies in the womb (erythroblastosis fetalis – I’ve only seen one case and don’t want to see another).
Old: Flu. Been around forever. Most people that get the flu do just fine; they are miserable for a while. It especially affects men; we get it much worse than women. (Don’t believe me? Search: BMJ man flu. BMJ is a respected journal, the British Medical Journal.)
Flu shots generally work pretty well. They decrease the severity of three types of flu; there are many others. No, you can’t get the flu from a flu shot, but you certainly get all the other things (“flu-like illness,” whatever that is) that circulate in the same season as flu shots are given. Correlation; not causation; mice don’t come from cheese. (Look up “spontaneous generation.”)
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COVID is still around – and everyone will eventually get it
Old: COVID-19. You read that right. It’s not just that we’re sick of COVID-19 (sorry, bad pun) but coronaviruses have been with and in us for hundreds of years. A former president was not incorrect in calling it “just a cold.” The wording might have been slightly clumsy, but there were already four coronaviruses that caused seasonal colds. This was just the fifth.
Because of advances in basic sciences, we could watch the virus change; it was fascinating, like watching bread rise. And it was mostly meaningless, at least at the county/personal level. Everyone will eventually get COVID-19, just like everyone had the first four coronaviruses when you were young.
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And the same rules apply as with any cold: Keep it to yourself; no one else wants it! If you are immune-suppressed, you are back where you were, immune-suppressed.
You can get any of the numerous viruses that cause flu-like symptoms in people. The people around you are your protection. This again is nothing new. We used ring vaccination to control smallpox.
For those who can’t be very ill, there is a jab that will help your immune system get a head start; the effectiveness doesn’t last quite as long as the disease; that’s not surprising. And the disease (coronavirus infections, any of the five) doesn’t give lifelong immunity anyway, not before 2019, not after 2023. Nothing new; you get seasonal colds every season; these are often coronaviruses.
Paxlovid doesn’t do much; it is not an antibiotic (which act only against bacteria anyway; it’s hard for you to get better on therapy for a disease which you don’t have). Paxlovid only makes it more difficult for the virus to hijack your cells and then only for the five days you take it; your immune system has to do the heavy lifting, which takes a few weeks.
So what should you do?
Pay attention to the people closest to you, the ones who know what they’re doing and, more important, share your risk pool (same town, county). Ask your medical provider what you should do. They are advised by the county, which gets information from the state, which gathers patient CDC data.
Your family doctor is who knows you and knows all this and a whole. Lot. More.
Dr. Tom Benzoni is an emergency physician, practicing locally in Iowa. This column first published in the Des Moines Register.
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This article originally appeared on Des Moines Register: Do I need flu shot? COVID vaccine? How to prevent illness this winter
