So much confusion. So many questions. Conflicting public health messages from on high. Do CDC and the FDA even talk? Is the White House trying to take control again? That didn’t work last time. Do I need a booster? Can I travel? I wear a mask everywhere again, but I think that might be a little overkill. Where was our “summer of George” (Seinfeld reference)? What is going on? How much longer can this last? I’m not sure I can answer all the current questions about Covid, but I think we can attempt to arrive at some clarity on at least some issues. Just bear in mind that this pandemic is a nightmare and dealing with Covid’s ramifications will always entail a level of uncertainty. I am going to try and cover some of this as succinctly as possible and, at the end, offer my summary and some advice of how I am now approaching Covid and how I view the risks.

Boosters – As of this writing, all the news reports and headlines are focused on the who, what, and when questions surrounding booster shots to enhance antibody levels against the virus. There is pretty persuasive data (the Israel data and the Mayo Clinic data) that show that an immunized individual’s Covid antibody levels decrease over time and that those levels are increased to robust levels with an additional vaccine shot after, perhaps, 6-8 months. Beyond that, the science is not clear. For example, the data show a significant (statistically and clinically) difference in antibody levels over time in people receiving the Pfizer vaccine (lower) verses people vaccinated with Moderna (higher). Also, it is unclear how lower levels of antibodies affect a person’s risk of infection, hospitalizations, and death. From a public health perspective, what is the main goal of our Covid immunization program? Is it to reduce infection or to reduce serious illnesses and hospitalizations and their impact on our health care delivery system? Since the immunization goal has never been clearly articulated, it becomes impossible to correctly evaluate the importance of boosters in the overall program. If at the current antibody levels, vaccinated people may occasionally become infected but rarely suffer serious illness or require hospitalization, then perhaps a national program of booster shots in unnecessary. Conversely, to limit Covid illness at any level, boosters will be required, but for whom? the elderly? those with certain chronic conditions? certain occupations? only those with Pfizer and J&J shots? What should be the timing of those shots? I can think of at least 20 additional questions. We are dealing with complex issues with little data on which to base our answers and policies.

CDC and FDA – Yes, they talk to each other. Maybe not with great affection, but they are in continual communication on the issue of Covid. They have representatives at each other’s Advisory Committee meetings and they attempt to coordinate their policy statements. Although there is some overlap in their respective areas of authority on vaccines, in my opinion they’ve handled the initial vaccine authorizations and, so far, the Pfizer booster authorization extremely well. It is true that the CDC Director did not follow her Advisory Committee’s advice exactly as they proposed, but that decision is her’s to make and she certainly followed the spirit, if not the precise letter, of the advice. Please remember when you are reading or hearing about the CDC’s or FDA’s actions around Covid and vaccines that both of these agencies are making decisions and policies with little data and that is a very difficult position for a scientific agency. With all that said, when this is all over, CDC will need to undertake a hard assessment of the Agency’s actions throughout this pandemic and make substantial improvements. Not a great track record this time around and this country requires a strong CDC.

Summary – The Pfizer vaccine boosters will be available to those over 65, high risk people, and those in certain occupations almost immediately. People in the same groups who have received the Moderna shot will be able to start receiving their boosters sometime in the next months. I would guess J&J will also be soon, but I really haven’t seen any data about J&J antibody levels. I believe the time requirement will be 6 months after you received your second vaccination for all boosters. Within 4 months, boosters will be available for everyone depending on the rollout.

I am fully supportive of the President’s mandated vaccinations for all Federal employees and military personnel and his encouragement of large companies to also mandate employee immunization. I have absolutely no patience for the unvaccinated morons who live among us. I want nothing to do with them, including social interactions and conversation. The only solace I take from all of this is that, perhaps, we are seeing a type of Darwinism at work.

If you are vaccinated, you have excellent protection from Covid, even without a booster. The data do show that vaccinated people can still spread the Delta variant and that fact has caused a lot of consternation in the media and in the population. However, although you as a vaccinated person can spread Covid, you have a much less chance of ever being infected in the first place and an infinitesimal chance of being hospitalized. That’s the important reason for vaccination in the first place. Keep your eye on the prize! In New York City, only 0.33% of the vaccinated population have become infected with Covid. In an Idaho hospital systems ICUs, 52 of the 53 patients were unvaccinated. These miracle vaccines have phenomenally reduced your risk from Covid and the boosters will only enhance that protection.

I am vaccinated. I wear my mask in certain situations (grocery, other stores, medical offices), but not everywhere. When I eat out, I try to eat outside but I don’t panic if I am seated at an indoor table. If my sister decides to have the family Christmas party this year back in Pennsylvania, we will get on a plane and enthusiastically attend. With or without a booster, I intend to live my life. I take some precautions, but I don’t live under a rock. I would recommend to everyone that you assess your own comfort level in regards to Covid risk and your health status, based on fact not headlines or fear, and then move forward.

Good luck. We’re in better shape than you might believe.

Stay safe. Stay informed. Get the shot.

p.s. – Why in a commercial for motorcycle insurance does a Black man of about 30 sing a song that was released when I was 5, about 60 years ago? Who the fuck writes this stuff?