1 00:00:02,000 --> 00:00:04,066 AMNA NAWAZ: The government has just approved a second dose of the COVID booster for the 2 00:00:04,066 --> 00:00:08,866 elderly and immunocompromised. The bivalent booster shot targets the Omicron variants. 3 00:00:08,866 --> 00:00:13,066 Seniors 65 years and older can now receive the updated booster 4 00:00:13,066 --> 00:00:16,900 four months after their first dose. Meanwhile, people with weak immune 5 00:00:16,900 --> 00:00:20,400 systems can get an additional shot of the vaccine after two months. 6 00:00:20,400 --> 00:00:24,333 To help us understand why this is a significant move in the fight against 7 00:00:24,333 --> 00:00:29,333 COVID-19, I'm joined by Dr. Jeremy Faust, emergency physician at Brigham 8 00:00:31,266 --> 00:00:34,433 and Women's Hospital in Boston and the author of Inside Medicine on Substack. 9 00:00:35,666 --> 00:00:37,166 Dr. Faust, welcome and thanks for joining us. 10 00:00:37,166 --> 00:00:40,166 These steps are very targeted to vulnerable populations, 11 00:00:40,166 --> 00:00:45,133 to seniors and the immunocompromised. Does this make sense to you as the 12 00:00:46,966 --> 00:00:50,000 right move, given where we are in this pseudo-post-pandemic world right now? 13 00:00:50,000 --> 00:00:51,566 DR. JEREMY FAUST, Brigham and Women's Hospital: Thank you for having me. 14 00:00:51,566 --> 00:00:54,566 This move does make sense, because it acknowledges 15 00:00:54,566 --> 00:00:59,533 that there is a large spectrum of risk out there. It is -- a one-size-fits-all 16 00:01:02,066 --> 00:01:04,900 approach really wouldn't make sense, treating a 10-year-old with no medical problems with the 17 00:01:04,900 --> 00:01:09,333 same vaccine strategy as a 70-year-old who has cancer and is on chemotherapy. 18 00:01:09,333 --> 00:01:14,333 So I think that today's move really addresses that discrepancy and allows 19 00:01:16,366 --> 00:01:19,100 for a little -- a little bit of nuance, in terms of how we approach the next phase. 20 00:01:19,100 --> 00:01:22,300 AMNA NAWAZ: At the same time, we should note booster uptake has 21 00:01:22,300 --> 00:01:26,500 been very low. These shots do no good just sitting on the shelves. Only about 22 00:01:26,500 --> 00:01:30,933 20 percent of all adults have gotten that updated booster since September. 23 00:01:30,933 --> 00:01:34,733 So, isn't that an argument for just opening it up to anyone who wants it? 24 00:01:34,733 --> 00:01:37,966 DR. JEREMY FAUST: Well, there are downsides overboosting. 25 00:01:37,966 --> 00:01:42,266 But in the high-risk population, what wins the day are the upsides. 26 00:01:42,266 --> 00:01:47,233 So, in terms of short-term prevention against severe hospitalizations and mortality, deaths, 27 00:01:49,533 --> 00:01:52,700 the benefit for that higher-risk group, the severely immunocompromised, older populations 28 00:01:52,700 --> 00:01:57,433 in general, does make it worthwhile, because there could be a downside of overboosting, 29 00:01:57,433 --> 00:02:02,100 which is that we are training our immune system to expect a particular virus. 30 00:02:02,100 --> 00:02:05,200 And if we -- if we keep showing it the same thing over and over again, 31 00:02:05,200 --> 00:02:10,000 including half of this vaccine, which still has half of the Wuhan virus in it, 32 00:02:10,000 --> 00:02:15,000 we actually risk a longer-term increase in infections. So I really support the 33 00:02:16,866 --> 00:02:20,333 idea of zeroing in on the people who need that protection from the serious outcomes, 34 00:02:22,333 --> 00:02:24,366 because we know that, in a short period of time, it works very, very well. 35 00:02:24,366 --> 00:02:28,233 AMNA NAWAZ: What about what's ahead, especially for younger and healthy people? 36 00:02:28,233 --> 00:02:30,833 Could we be seeing another shot being offered for 37 00:02:30,833 --> 00:02:34,100 them as we move through the summer and into another fall and winter season? 38 00:02:34,100 --> 00:02:39,100 DR. JEREMY FAUST: I think the CDC and the FDA signaling an annual kind of cycle for the 39 00:02:40,966 --> 00:02:43,433 general population, the younger, healthier populations, I think that's appropriate. 40 00:02:43,433 --> 00:02:48,433 I think that the value-add of a booster for younger, healthy populations hasn't 41 00:02:50,400 --> 00:02:52,700 always been that clear. We have always lumped in young and healthy with older 42 00:02:52,700 --> 00:02:57,433 and sicker when making the booster-for-all argument. Nowadays, I think we're being a 43 00:02:57,433 --> 00:03:02,400 little bit more nuanced. And so offering it less often for the lower-risk makes a ton of sense. 44 00:03:04,366 --> 00:03:07,233 I do think that, in June, we're going to hear more about what they're going to put into a 45 00:03:07,233 --> 00:03:12,233 fall booster. And I suspect and I hope that it will be a booster that only contains virus that 46 00:03:14,200 --> 00:03:18,166 is currently circulating. In other words, the original virus, the Wuhan strain, really isn't 47 00:03:18,166 --> 00:03:22,766 out there anymore. We are in an Omicron world, and we should be boosting against that virus. 48 00:03:22,766 --> 00:03:27,166 AMNA NAWAZ: Dr. Faust, there has been and continues to be some debate over how we're 49 00:03:27,166 --> 00:03:32,166 counting COVID hospitalizations and deaths, not necessarily people alleging nefarious intent here, 50 00:03:34,700 --> 00:03:38,300 but saying there's a difference between people who die with COVID versus people who die of COVID. 51 00:03:40,166 --> 00:03:42,400 They say we're counting both and that could be an overcount. What do you say to that? 52 00:03:42,400 --> 00:03:45,533 DR. JEREMY FAUST: The concept to understand is called excess mortality. 53 00:03:45,533 --> 00:03:48,900 And the idea is, not just are there COVID deaths, 54 00:03:48,900 --> 00:03:53,900 but are there more deaths of all causes combined than there should be? And throughout the pandemic, 55 00:03:55,900 --> 00:03:58,866 we have seen, for the most part, there have been -- there's been constant excess 56 00:03:58,866 --> 00:04:03,600 mortality that goes way up when we have a wave and comes down after the wave. 57 00:04:03,600 --> 00:04:08,600 And we have very, very rarely seen a time where there were more COVID deaths being counted than 58 00:04:10,566 --> 00:04:14,433 there were all excess deaths. If that were to happen, you would start to think, oh, there's 59 00:04:14,433 --> 00:04:18,466 something to that argument. But, for the most part, it hasn't happened. It's happened at times. 60 00:04:18,466 --> 00:04:22,733 And, in terms of hospitalizations and other outcomes, again, 61 00:04:22,733 --> 00:04:26,500 it's very difficult. People don't agree when they look at medical charts. But, 62 00:04:26,500 --> 00:04:31,133 actually, when we do that kind of work, I think we do see that, if anything, 63 00:04:31,133 --> 00:04:36,133 we're probably undercounting COVID deaths that happen that don't look like COVID deaths, 64 00:04:38,100 --> 00:04:40,966 so someone who dies at home, but they never got a COVID test, or someone who died of a 65 00:04:40,966 --> 00:04:45,966 diabetic crisis or heart failure exacerbation, and it's chalked up to heart failure or diabetes. 66 00:04:47,433 --> 00:04:49,500 But they never would have had that exacerbation had they not 67 00:04:49,500 --> 00:04:52,433 contracted coronavirus the week before. And so, 68 00:04:52,433 --> 00:04:57,433 as long as we have excess mortality and COVID deaths going hand in hand, step by step, it's 69 00:04:59,466 --> 00:05:03,533 pretty hard to make an epidemiological argument that would support the overcounting approach. 70 00:05:04,900 --> 00:05:07,433 AMNA NAWAZ: Still striking, over 250 people a day. 71 00:05:07,433 --> 00:05:12,100 That is Dr. Jeremy Faust, emergency physician at Brigham and Women's Hospital in Boston, 72 00:05:12,100 --> 00:05:15,466 and author of Inside Medicine on Substack. 73 00:05:15,466 --> 00:05:16,666 Dr. Faust, thank you. 74 00:05:16,666 --> 00:05:17,700 DR. JEREMY FAUST: Thank you.