Today’s briefing featured Health Minister Adrian Dix, Dr. Penny Ballum (who is in charge of the vaccination program), and Dr. Martin Lavoie, (B.C.’s acting provincial health officer).
I’m not going to summarize it in as much detail as I have given in the past: the main thrust was pretty low-information-content and the Q&A was stupid.
Here are the main points to what they said, I’ll comment below. I HAVE OPINIONS.
- Seventh Wave: Yeah, BA.5 is coming, yeah we’re going to have more cases, but we expected cases to go up and down, that’s normal. We probably aren’t going to institute any mitigation measures. Just keep masking and washing your hands and staying home when you’re sick. And if you haven’t all of your vaxes, get them!
- NACI Recommendations: NACI says that we should give second boosters to everyone over 12 in the fall.
- Fall: Fall is the right time to give boosters. Fall is respiratory virus season, it’s when the hospitals are slammed hardest. The boosters are most effective shortly after you get them, so you want your boosters in the fall.
- New fall vax: We’ll have new vaccines in the fall — probably bivalent boosters, COVID Classic plus Omicron. The bivalent boosters are better.
- Need: If you REEEEAALLY want a fourth dose now because somehow you are special, then okay, we will let you have one, but seriously, you don’t need one. if you have three doses of COVID Classic-based boosters, a fourth isn’t going to really do you much good.
- We’re going to send out
invitationsnotifications starting on Monday telling you that you can get a fourth dose if you REEEEEALLY think you are somehow special, but really you don’t need one. We’ll do this in reverse age-cohort order, like we did before, about 40K per day.
- In September, we’ll do the boosters in reverse age-cohort order, like we did before.
- If you haven’t gotten three doses GO GET YOUR VAX!
- If you reeeeeeally want Novavax, call us and we’ll make it happen. Editorial: there are about 20-25K doses left in the province.
The province sure seems to have a “yeah, whatever, it won’t be that bad” attitude towards the BA.5 wave. Dix even said something about, “well, we just went through a BA.2 wave, and we came through that pretty well”.
HOWEVER, a bunch of people got sick in the recent BA.2 wave. A lot are going to get Long COVID! A lot died! (I’m not sure how many, because of BC’s stupid death reporting, but it was a lot.) Anecdotally, I heard that hospitals got really busy. (The peak hospitalization rate of the BA.2 was about half the peak rate during the January wave and about 40% higher than the Delta hospitalization rate.)
The initial NACI recommendations (see p5) did not recommend boosters for people under 70 except for certain classes. The June 29 NACI update did in fact say that the general adult population should get boosters in the fall. So, to my surprise, BC is following NACI guidelines while all the other provinces are not.
Public health is really wedded to the idea that COVID-19 is a seasonal virus. I believe that COVID-19 is not particularly seasonal: what matters is when variants show up. BC’s prior waves peaked in March, November, April, September, January, April, and now we are at the beginnings of a wave which will probably peak in FRICKING AUGUST. How is that seasonal? How is that autumnal? (Reminder: case counts started getting even more dramatically undercounted during January 2022.)
For more evidence, I show you South Africa’s COVID-19 history, with peaks in July, January, July, December, and May. How are July and January at all similar?
Also, respiratory season used to be in the fall/winter, but it’s all messed up now. This article from June says that there were a lot of kids (in the US) admitted to one hospital in MAY with seven respiratory illnesses: adenovirus, rhinovirus, respiratory syncytial virus, human metapneumovirus, influenza, parainfluenza, as well as the coronavirus
Here’s a chart from the US CDC’s most recent influenza surveillance report. The current year is in red/triangles. It was high around NYE, then dropped well below baseline, then came up again. We are not having normal respiratory seasons these days.
New Fall Vax
It is absolutely true that the vax in the fall is likely to be different, and I would be really surprised if it’s not a bivalent COVID Classic-based plus BA.5-based shot.
HOWEVER, the BA.5 wave will probably be mostly over by September. The leading candidate to be the next wave is BA.2.75, which is circulating in India. (See this thread.) We have very little data on BA.2.75, but this tweet says that BA.5 might not be a good match to BA.2.75.
(Now, any Omicron vax ought to give better protection against any rando Omicron than the old vax. Not only will it be more closely related, but just having a diversity should (if I understand right) goose your immune system to be more creative about how it reacts. So if you have a choice between
- a COVID Classic booster of the same brand as what you’ve had and
- a booster with targets literally any other strain of the same brand as you’ve had
Then take the any other strain.
HOWEVER, there is another option, which we is already in BC, already available, which give very broad protection, and that’s Novavax. They reported really good effectiveness against BA.5 at the US FDA vaccine subcommittee meeting a few weeks ago (you can watch the presentation). This thread estimates that two doses of Novavax (with no other vax) is probably 66% effective against BA.5. (This thread suggests why that might be, and I find it entirely believable.)
Me, I would rather get Novavax’ good broad protection than an mRNA vax which gives excellent narrow protection against a variant that probably won’t be circulating by the time I get the vax.
Note: While my opinion is based on the best available evidence I could find, it does still involve some guesswork. We do not know what 3 mRNAs plus a Novavax booster looks like. We just flat do not have the data; something really strange could happen. Novavax is doing some clinical trials of 2 mRNA + Novavax, but they only started in May 2022; there probably will not be full evidence until too late to help with this decision.
For what pub health is trying to do, I agree that a fourth dose isn’t needed. But what pub health is trying to optimize for is not what I am trying to optimize for.
Pub health wants to not crash the health care system. That is their overriding goal. From that standpoint, I think they are absolutely correct: a fourth dose for people under 70 without significant comorbidities probably won’t drop your risk of hospitalizations by much.
HOWEVER, that’s not what I want to optimize for. I want to optimize for not getting sick. If I don’t get sick, I don’t die, I don’t get hospitalized, I don’t get laid out on my posterior for a week feeling like death warmed over, I don’t have to isolate, and (very important!), I don’t get Long COVID.
And I don’t want to get sick with BA.5, BA.2, BA.2.75… I don’t want to get sick from ANY of them. So I’d like a broadly effective fourth dose (i.e. Novavax) NOW.
Note: you need to call 1-833-838-2323 to book a non-mRNA appointment.
My buddy Jeff’s wastewater charts sure look like they are going up.