Patients have asked me whether we will see the need for a 4th booster dose. Well with everything going on not only in the country but in the world there has been virtually no news about COVID. There has been lifting of mask mandates and allowing everyone to move around more freely especially since we are coming into nicer weather. And in the background there has been an increase of COVID cases especially as it related to the Omicron Stealth variant BA.2.
While it presents more like the FLU, and not as lethal as DELTA or the original COVID-19 it is still problematic for those who are immunocompromised and have risk factors. The same as the FLU if you are at risk and not careful and not vaccinated you may end up in the hospital, on a ventilator and possibly dying. Vaccinations and boosters have been shown to work especially in this compromised group not only in this country but others as well.
By the numbers: 42% of the US fully vaccinated with 3 doses, 58.2% with 2 doses, 67% with one dose. We have not reached herd immunity (85-90%) with vaccines so it will take a while longer as the virus spreads among us to get a point where we can build up enough natural immunity amongst all of us to peacefully co-exist. As of March 18,2022 there are 81,388,590 positive cases and 997,136 deaths. Sobering number as we approach 1 million dead from this pandemic. We have to be respectful that it is not over and we still need to exercise caution and common sense
Will Everyone Need a Fourth Dose of a COVID-19 Vaccine?: While protection from a third COVID-19 vaccine dose seems to wane after four months, experts aren't so sure that a fourth dose will be necessary for all. Though a third dose of an mRNA vaccine has been shown to provide a boost of protection against COVID-19—even from the Omicron variant—new research shows that protection wanes by the fourth month after vaccination.
The study, released by the Centers for Disease Control and Prevention (CDC) last week, brings up questions about if (and when) all Americans may need a fourth dose of a COVID-19 vaccine in order to remain protected as the pandemic wears on.
The CDC currently recommends most Americans ages 12 and older who received an mRNA primary series receive a third dose (booster) of the COVID vaccine to stay up to date. This booster dose should come five months after the second dose of a primary series.
That third dose is beneficial—the new CDC study shows that during both the Delta and Omicron waves, vaccine effectiveness was greater after three doses of an mRNA vaccine versus two doses. That data aligns with previous findings from the CDC, published in January, that a third mRNA dose was highly effective at preventing emergency department and urgent care visits (94% during the Delta wave; 82% during the Omicron wave) and hospitalizations (94% during Delta, 90% during Omicron).
In people who received a third dose—either as a third primary dose or a booster dose—the vaccine was 87% effective against emergency department or urgent care visits in the two months after the shot. That number dropped to 66% effective after four to five months. The same trend was seen in hospitalizations: A third dose was shown to be 91% effective against hospitalizations from COVID-19 up to two months after the shot; the effectiveness dropped to 78% after four months or more.
The new research—combined with past reports—emphasizes the importance of remaining up to date on your COVID-19 vaccinations. Though protection does seem to wane after a certain amount of time, it's still highly protective against serious illness. "COVID-19 vaccines [and] booster shots can keep you out of the hospital and certainly can save your life," Dr. Fauci said
"If you haven't gotten a booster shot at all, then you should definitely get one, says" David Dowdy, MD, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. However, if you caught COVID-19 during the most recent, Omicron-dominant phase of the pandemic, you should wait three months after full recovery to get a booster, he says.
Pfizer and Moderna have each asked the Food and Drug Administration (FDA) to authorize a second booster dose of their COVID-19 vaccines — essentially a fourth COVID-19 shot — for certain adults.
Five things to know about a possible fourth COVID-19 shot:
1. Pfizer CEO Albert Bourla said earlier this week that a fourth dose of the COVID-19 vaccine will be “necessary,” though the push for another vaccine dose has reignited debate over booster shots. Pfizer asked the FDA for emergency use authorization to administer a second booster of its two-shot vaccine to those over the age of 65. The company said a pair of real-world data sets indicated a fourth dose lowered rates of infection and severe illness, including one study of adults in Israel that measured antibodies in the blood. Moderna’s request to the FDA applies to all adults who have received an initial two-shot immunization and a booster, not just the elderly. Gigi Gronvall, senior scholar at the Johns Hopkins Center for Health Security, said it was a “good idea” for people in high-risk groups like the elderly and immunocompromised to get a fourth dose. Gronvall added there could possibly be “diminishing returns” for administering a fourth dose to people outside of these high-risk groups.
2. The White House can’t afford boosters for everyone. On Tuesday, the White House said that if another booster shot is needed, it would not be able to fund enough doses for everyone due to continued pandemic funding being stalled in Congress.
3. Several countries are already administering fourth doses. Countries like Israel, Denmark and Chile have already been administering fourth COVID-19 doses to vulnerable groups. Though only a few countries have taken part in offering a second booster to their citizens, these rollouts have given researchers the opportunity to study the effects and potential benefits of another shot. A small pre-print study published last month from Israel found that a fourth COVID-19 jab only offered a small bump in protection from the first three doses, possibly only restoring the level of immunity that was lost from waning over time.
4. Many people haven’t gotten boosted at all. According to the Centers for Disease Control and Prevention, 44 percent of fully vaccinated people in the U.S. have received a booster dose, with 2 out of 3 people over the age of 65 getting a third dose. About half the U.S. population that is eligible to receive a booster has yet to get one, accounting for nearly 89 million people.
5. Some health experts are still on the fence about a fourth shot: “There are just a lot of unknown unknowns here,” said Philip Landrigan, public health physician and epidemiologist at Boston College. The epidemiologist said it was fair to be “cautiously optimistic” that three doses would suffice for the time being but said a fourth dose will likely be necessary. Jesse Goodman, director of Georgetown University's Center on Medical Product Access, Safety and Stewardship and an attending physician on infectious diseases, said he was still not convinced.
6 Foods That Help Digestion—and 8 You May Want to Skip, According to Experts:
First the foods that you should avoid if you have digestive issues.
1. Both high-fat and fried food can overwhelm the stomach, resulting in acid reflux and heartburn. "The body can only handle so much at one time," Jessica Anderson, RD, a diabetes educator with the Texas A&M Health Science Center Coastal Bend Health Education Center, in Corpus Christi. High-fat food also can result in pale-colored stool, a phenomenon called steatorrhea, which is essentially excess fat in the feces. A lot of people with irritable bowel syndrome need to stay away from foods high in fat, she says, including butter and cream because they can cause digestive problems.
2. Chili Peppers: This staple of spicy cuisine can irritate the esophagus and lead to heartburn pain. This can be a particular problem for people with irritable bowel syndrome or those who already suffer from chronic heartburn, Tim McCashland, MD, a gastroenterologist at the University of Nebraska Medical Center.
3. Dairy: You need calcium in your diet, and an easy way to get it is from dairy products such as milk and cheese. But, for the lactose intolerant, these can cause diarrhea, gas, and abdominal bloating and cramps. Lactose intolerance, a common problem, occurs when people don't make enough lactase, an enzyme that breaks down lactose (the sugar found in milk). Celiac disease, Crohn's disease, and chemotherapy can damage the intestines, which also can lead to lactose intolerance. If you're lactose intolerant, staying away from dairy is probably your best bet.
4. Alcohol: Alcohol relaxes the body, but, unfortunately, it also relaxes the esophageal sphincter. This can lead to acid reflux or heartburn. Drinking also can inflame the stomach lining, impairing certain enzymes and preventing nutrients from being absorbed, Anderson says. Too much alcohol can cause diarrhea and cramping, but unless you have a gastrointestinal disorder, moderate amounts of alcohol shouldn't irritate the digestive tract. The Dietary Guidelines for Americans suggest no more than two drinks a day for men and one for women.
5. Berries and Seeds: Berries are good for your health, but ones with tiny seeds—like raspberries, blackberries, or even strawberries—can be a problem for people who have diverticulitis, or pockets that develop in the intestine (usually the large intestine) that become inflamed or infected. "The theory is that the seeds will obstruct the [pockets] and pose a risk of infection," Dr. McCashland says. "It's never been proven in a study but it's always been theorized." If you find that seeds from berries, as well as other seeds like sunflower, pumpkin, or flax irritate your intestines, stay away from them.
6. Caffeinated and Carbonated liquids: Coffee, tea, and carbonated beverages not only over-relax the esophageal sphincter, which keeps stomach acid confined to the stomach, but they also can act as diuretics, which can lead to diarrhea and cramping, Jessica Anderson says. Caffeinated beverages can be a particular problem, especially for people with gastroesophageal reflux disease (GERD). If you have GERD or heartburn, you should avoid mint tea; it can, however, also calm the stomach, Anderson says.
7. Chocolate: Chocolate itself may not be the true villain here, Anderson says. For people with milk allergies, for example, the real culprit in chocolate is the milk content. For people even without lactose intolerance or dairy allergies the caffeine content in chocolate can also stimulate cramps, bloating, or diarrhea for those with IBS.
8. Corn: Fiber-rich corn is good for you, but it also contains cellulose, a type of fiber that humans can't break down easily because we lack a necessary enzyme. Our evolutionary ancestors were probably able to break it down with bigger, stronger teeth, Anderson says. If you chew corn longer, you can probably digest it just fine, she says. But wolf it down and it may pass through you undigested, and cause gas and abdominal pain.
Foods that help with digestion:
1. Yogurt: You have trillions of bacteria in your gut that help you digest food, and yogurt contains some types of these healthy bacteria. (Although not all yogurts have them—check for "live and active cultures" on the label.) "Yogurt has bacteria, which replenishes the normal flora within the gastrointestinal tract so it's healthy," Dr. McCashland says.
2. Kimchi: A Korean favorite usually made with cabbage, radish, or onion, along with lots of spices. The main ingredient is usually cabbage, which promotes the growth of healthy bacteria in the colon. And cabbage is a type of fiber that's not digested, so it helps eliminate waste, keeping bowel movements regular, Anderson says. Sauerkraut is good for the same reasons. This dish can be spicy, however, so it might not be a good option if you've found that spicy foods trigger digestive problems for you.
3. Lean Meats: If you're going to eat meat, go for chicken, fish, and other lean meats—they'll go down a lot easier than a juicy steak. "Red meats tend to be fattier," Anderson says. "Your body can handle lean meats and fish and chicken a whole lot better than prime rib. And lean meats and fish have not been associated with an increased risk of colon cancer like high-fat red meats have”.
4. Whole grains: whole-wheat bread, oats, and brown rice, are a good source of fiber, which helps digestion. "If there's one thing America lacks, it's fiber," Anderson says. "We need 20 to 30 grams a day and we maybe get 12. "Fiber also can help you feel full and lower cholesterol, but it can cause bloating, gas, and other problems in people who quickly ramp up their intake—it's better to take it slow when consuming more. And wheat grains are a no-no for those with celiac disease or gluten intolerance.
5. Bananas: They help restore normal bowel function, especially if you have diarrhea (say, from too much alcohol). And they restore electrolytes and potassium that may be lost due to runny stool. This fruit also has lots of fiber to aid digestion. "A banana a day is what I always say," Anderson says.
6. Ginger: This spice has been used for thousands of years as a safe way to relieve nausea, vomiting, motion sickness, morning sickness, gas, loss of appetite, and colic. But it's best to consume it in moderation. High doses of ginger can backfire; more than 2 to 4 grams per day can cause heartburn.
Until next time stay safe and stay healthy.
James A Vito, D.M.D.