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Fall updates- vaccines & viruses (Covid, Flu, RSV)

Hello everyone,

I have gotten a few questions on the new covid vaccine and on the most recent round of covid infections, so I am sending an update to everyone.

The most recent variant is BA.2.86 which makes in a subvariant in the omicron lineage. People who have had omicron covid have some protection. It does have some immune escape (meaning if you have neutralizing antibodies from either vaccine or previous infection, it can surpass this and still cause infection). However, it is not as infectious as scientists thought it was going to be. It is also thankfully more mild than previous versions of covid. It is very difficult to give accurate estimates on how quickly this variant will spread because we have cut down surveillance (formal testing and reporting programs) to about 10% of what they were at the pandemic height. Even home testing is down significantly. Any good scientist knows that without good input (data from testing), we cannot get good output (results). Or simply said, “garbage in, garbage out”. Anecdotally from what I have seen in the ER is that positive testing and cases spiked over the last several weeks, but severe illness was rare and there were almost zero hospitalizations and even fewer deaths. Those who had significant symptoms were likely to never be exposed to covid meaning this was their first infection. Most of the time symptoms were upper respiratory such as cough/cold symptoms. There has been very little hypoxia or respiratory failure. We now have a highly immune community in the US due to either vaccination, previous infection, or both.

As far as the new covid booster vaccine: it does not have the BA.2.86 variant but it does include its cousin XBB. I feel like I’m talking about Elon Musks’ kids with these names. Anyway, BA.2.86 and XBB are both causing less severe disease than previous variants and the new vaccine has XBB which confers some protection against BA.2.86 since they are all related. The CDC recommendation is that anyone 5 and older is eligible for the new covid booster.

Paxlovid is also still an option if you have risk factors for progression to severe disease.

Fall vaccines: covid booster, flu and RSV

There is no combo vaccine for this yet so it would be 3 separate vaccinations if you choose to get all three. I recommend the flu vaccine be in mid-October to get optimal coverage for the long duration of flu season which is until end of March/early April. You need a minimum of about 2 weeks to have immunity after a vaccine, but up to 4 weeks is typical for full immunity. Those with travel plans that are trying to time their vaccines, please keep this in mind. You would want to ideally be vaccinated at least 2, but preferably 4 weeks prior to travel. There is another wave of covid expected this winter (late December – Happy Holidays!), so if you have no travel plans and escaped the most recent mini-wave, you could wait until late October/ early November to get the booster. In other words- when and what are variable depending on your particular situation, but please aim for the flu vaccine in mid-October and then adjust accordingly for RSV and Covid. Please note RSV vaccine for adults will not be added to the CDC guidelines until 2024 so while Medicare does cover the $300 shot, some private insurance may not, and you would need to pay the $300 out of pocket. Based on RSV pattern of spread, RSV should be at its peak in our area in the next two months (mid to late November) so you will want to vaccinate in about a month if you plan to pursue RSV vaccination. Again, you can get covid and RSV vaccines now as well or you can wait until late October or early November. Either choice is good depending on what your history is and what you have going on.

I will be sending out some Fall health recommendations as well soon.

Stay safe and healthy but please also remember – Fall and Winter are prime seasons for viruses as we move indoors.


Dr. Green

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