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The COVID-19 Booster

While waiting for my flight to Fort Worth in the Miami airport, an announcement sounding like it was borrowed from a dystopian movie came over the PA system: “Please social distance and wear a mask while awaiting your flight. Working together, we can adapt and we will survive.” Those words ring in my ears as I tell myself that the end of the world is unlikely to come today.

The most powerful weapons against COVID infection have been the three major vaccines from Pfizer, Moderna and Johnson & Johnson. No other treatment or prevention strategy comes close. The only event that causes better protection is infection by coronavirus and survival; however, telling everyone to just get infected is not a strategy anyone should recommend. It would lead to unnecessary deaths and COVID long-haulers.

That doesn’t mean the vaccines are 100% effective and have not caused harm. I have several patients and a family member that have experienced moderate to severe vaccine effects. Nevertheless, these events are highly unlikely for any given person receiving the vaccine.

As of the week of October 18, all three COVID vaccines now have a booster. The FDA has signed off and final CDC guidelines will arrive soon, but most of us in the medical community are encouraging boosters for the right groups. What remains to get up to speed on is who is eligible and when they should boost their immune systems.

For those who received the J&J vaccine single shot, a second dose of any of the three

vaccines is recommended 2 months after the first shot.

Those who received Pfizer or Moderna should get a bookster at six months if they are over

65 or have an underlying condition.

The mix and match strategy can be helpful to those who reacted poorly to the first round or under special considerations. Young men who took the Moderna vaccine experienced a higher incidence of heart inflammation. They should consider one of the other two.

Particularly for those who receive the J&J shot, receiving a Pfizer or Moderna booster offers amplified benefits since the vaccines’ mechanisms of action are different. It is like wearing a belt and adding suspenders.

The Moderna vaccine booster is half the dose of the first, but the J&J booster will be the full amount.

I recommend the booster for everyone who qualifies unless you had a severe reaction to the first. In that case, please visit your physician.


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