WEBVTT

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AMNA NAWAZ: The government has
just approved a second dose
of the COVID booster for the

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elderly and immunocompromised.
The bivalent booster shot
targets the Omicron variants.

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Seniors 65 years and older can
now receive the updated booster

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four months after their
first dose. Meanwhile,
people with weak immune

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systems can get an
additional shot of the
vaccine after two months.

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To help us understand
why this is a significant
move in the fight against

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COVID-19, I'm joined by
Dr. Jeremy Faust, emergency
physician at Brigham

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and Women's Hospital in
Boston and the author of
Inside Medicine on Substack.

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Dr. Faust, welcome and
thanks for joining us.

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These steps are very targeted
to vulnerable populations,

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to seniors and the
immunocompromised. Does this
make sense to you as the

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right move, given where we are
in this pseudo-post-pandemic
world right now?

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DR. JEREMY FAUST, Brigham
and Women's Hospital:
Thank you for having me.

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This move does make sense,
because it acknowledges

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that there is a large
spectrum of risk out there.
It is -- a one-size-fits-all

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approach really wouldn't
make sense, treating
a 10-year-old with no
medical problems with the

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same vaccine strategy as a
70-year-old who has cancer
and is on chemotherapy.

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So I think that today's
move really addresses that
discrepancy and allows

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for a little -- a little bit
of nuance, in terms of how
we approach the next phase.

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AMNA NAWAZ: At the same time, we
should note booster uptake has

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been very low. These shots
do no good just sitting
on the shelves. Only about

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20 percent of all adults
have gotten that updated
booster since September.

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So, isn't that an argument
for just opening it up
to anyone who wants it?

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DR. JEREMY FAUST: Well, there
are downsides overboosting.

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But in the high-risk
population, what wins
the day are the upsides.

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So, in terms of short-term
prevention against
severe hospitalizations
and mortality, deaths,

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the benefit for that
higher-risk group, the
severely immunocompromised,
older populations

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in general, does make it
worthwhile, because there could
be a downside of overboosting,

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which is that we are
training our immune system
to expect a particular virus.

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And if we -- if we keep
showing it the same thing
over and over again,

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including half of this
vaccine, which still has half
of the Wuhan virus in it,

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we actually risk a longer-term
increase in infections.
So I really support the

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idea of zeroing in on the
people who need that protection
from the serious outcomes,

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because we know that, in
a short period of time,
it works very, very well.

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AMNA NAWAZ: What about
what's ahead, especially for
younger and healthy people?

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Could we be seeing another
shot being offered for

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them as we move through
the summer and into another
fall and winter season?

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DR. JEREMY FAUST: I think the
CDC and the FDA signaling an
annual kind of cycle for the

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general population, the
younger, healthier populations,
I think that's appropriate.

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I think that the value-add
of a booster for younger,
healthy populations hasn't

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always been that clear.
We have always lumped in
young and healthy with older

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and sicker when making the
booster-for-all argument.
Nowadays, I think we're being a

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little bit more nuanced. And so
offering it less often for the
lower-risk makes a ton of sense.

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I do think that, in June, we're
going to hear more about what
they're going to put into a

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fall booster. And I suspect and
I hope that it will be a booster
that only contains virus that

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is currently circulating. In
other words, the original virus,
the Wuhan strain, really isn't

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out there anymore. We are in
an Omicron world, and we should
be boosting against that virus.

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AMNA NAWAZ: Dr. Faust, there
has been and continues to be
some debate over how we're

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counting COVID hospitalizations
and deaths, not
necessarily people alleging
nefarious intent here,

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but saying there's a
difference between people
who die with COVID versus
people who die of COVID.

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They say we're counting both
and that could be an overcount.
What do you say to that?

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DR. JEREMY FAUST: The
concept to understand is
called excess mortality.

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And the idea is, not just
are there COVID deaths,

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but are there more deaths
of all causes combined
than there should be? And
throughout the pandemic,

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we have seen, for the most
part, there have been --
there's been constant excess

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mortality that goes way
up when we have a wave and
comes down after the wave.

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And we have very, very
rarely seen a time where
there were more COVID
deaths being counted than

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there were all excess deaths. If
that were to happen, you would
start to think, oh, there's

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something to that argument.
But, for the most part,
it hasn't happened.
It's happened at times.

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And, in terms of
hospitalizations and
other outcomes, again,

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it's very difficult. People
don't agree when they look
at medical charts. But,

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actually, when we do that
kind of work, I think we
do see that, if anything,

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we're probably undercounting
COVID deaths that happen that
don't look like COVID deaths,

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so someone who dies at home,
but they never got a COVID
test, or someone who died of a

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diabetic crisis or heart failure
exacerbation, and it's chalked
up to heart failure or diabetes.

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But they never would have had
that exacerbation had they not

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contracted coronavirus
the week before. And so,

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as long as we have excess
mortality and COVID deaths going
hand in hand, step by step, it's

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pretty hard to make an
epidemiological argument
that would support the
overcounting approach.

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AMNA NAWAZ: Still striking,
over 250 people a day.

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That is Dr. Jeremy Faust,
emergency physician at Brigham
and Women's Hospital in Boston,

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and author of Inside
Medicine on Substack.

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Dr. Faust, thank you.

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DR. JEREMY FAUST: Thank you.