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New Vaccines for COVID, Influenza, and RSV

Hello patients, et al,

September 12, 2023, after several months, the Advisory Committee for Immunization Practices (ACIP, part of CDC) had a meeting reviewing Covid vaccines and their updated recommendations.

• There is now a new monovalent vaccine that covers the newest strains for Covid.
• Not surprisingly, they recommend the new vaccine.
• The vaccine is investigational, and presentations from Moderna and Pfizer today explained that the vaccines seemed to work in the labs. There is no “clinical data” available yet because they’re too new.
• So we don’t know for sure that the vaccine is safe or not safe, and effective or not effective.
• Covid “burden” is still low compared to other times over the past three years, but several thousand people still die every year.
• In just the past few weeks, there have been increased numbers of patients presenting with the newest strain of Covid.

I’m not anti-vax but…

As you know, I have written several emails over the past couple of years, starting in early 2020 about Covid-19.  In the earliest days of the epidemic, our WellMax clinic was one of only three sources in the Greater Palm Springs area to have vaccines, medications and masks. Masks were not available and people were panicking. We had many patients and families of patients drive over 100 miles to get a vaccine from us, because they weren’t available near them.  Our office provided well over 1,000 vaccines and gave away thousands of masks.  But the situation is different now.

New Covid Vaccine

There have been new bivalent Covid vaccines available for several months. Patients are asking if I recommend it.  I do not recommend it.

The main point of this email is that the newer bivalent vaccines don’t appear to work very well.  And now literally today the CDC said we should toss them out and not give them.

The very new monovalent vaccine protects against the newer strain XBB.1.5 but already the dominant strain is different. It’s called EG.5.  If you’re confused by all these strains, so are most doctors.  There have been over 20 new variants.  The CDC is saying the new monovalent vaccine released this week also helps against EG.5 but at the meeting today I didn’t hear any evidence for that.

Here is a fun fact: there are two big studies that suggest that not only are the bivalent vaccines that were available for the past year not effective, but patients with a history of taking more vaccines appear to have a HIGHER incidence of illness!

 I was very skeptical of this news at first, but I have read the study and I will insert a link here to the article: scroll down and see what I highlighted.  If you link to the article, look at “Figure 1”: it shows that the more vaccinations a person received, the HIGHER the risk of getting Covid.  There are theories about why this could be, but the observation doesn’t change.  This study was from the Cleveland Clinic and reviewed over 50,000 employees so the data is good. The authors are not anti-vax people. They are not condemning government or big pharma. The authors describe in their discussion of these results that another study in Europe showed the same thing: more vaccines received are associated with higher rates of Covid in that group.

Nevertheless, COVID-19 infections (new strains) are increasing very recently month after month. We have been diagnosing Covid more in the past month than in the previous six months. The good news is that the new Covid strains are not nearly as bad as the 2020 delta strain.  None of our patients needed hospitalization.  My 23yo son got it after a Carnival cruise last month (as did his friends).  He was pretty miserable for a few days.  Several patients over 80yo got it.  They did not have any problems, but the flu symptoms lasted a few days.  It has been reported that Paxlovid works just as well for new strains of Covid as for old ones (which is somewhat, if you catch it early).

Pulse oximeter: have one in the house.

I recommend that now, before you possibly get sick this winter with any illness, that you get a pulse oximeter. This is the little gadget that you put on your fingertip, that reports a number. Be ready in case you get Covid, influenza or RSV. If you call us and say that you feel terrible, we will ask for a covid test result and ask you for this “oxygen saturation” number. If it’s less than 92%, you may need oxygen.  If it reads, for example, 95%, then we will recommend lots of fluids and rest.  And in some cases, we will prescribe Paxlovid, but it interacts with other medications and is not a benign treatment.

Dr. Doriana and many others believe that zinc and vitamin C help prevent disease and decrease symptoms in those who get sick. I’m not certain of that, but these are simple measures that can’t hurt for the next few weeks.

RSV and Influenza Season

In addition, there are influenza and RSV infections (seasonal) expected over the next few months.  I am recommending the flu vaccine, especially to health care workers. I am only recommending the RSV vaccine for anyone with heart or lung problems sometimes (on an individual basis).

RSV vaccine is new this year.  Last year, the RSV incidence was TEN TIMES what it was in previous years.  So a vaccine was made urgently.  I have these reservations about taking this RSV vaccine now.

1. This is “an investigational vaccine” made with the new technology that was used for the Covid vaccine:

mRNA-1345 is an investigational RSV vaccine that consists of a single mRNA sequence encoding for a stabilized prefusion F glycoprotein. The vaccine uses the same lipid nanoparticles (LNPs) as in the Moderna COVID-19 vaccines.

2. In general, one can see seasonal epidemics in the southern hemisphere since they just had winter there.  Unlike last year, they did NOT have ten times the incidence of RSV in the southern hemisphere so it’s unlikely that an RSV epidemic will come this year (but it might).

3. The vast majority of people who get RSV, if they get it at all, will experience it as a bad cold and recover without incident. Therefore, I will not be personally recommending this new experimental RSV vaccine to most patients, nor will I be taking it.  The CDC is recommending it for patients over 60yo and many (not all) insurance companies will pay for it.  We will not carry it in our office but it is available at most pharmacies, just like the new Covid vaccine and this year’s influenza vaccine.   If you have asthma or heart disease, the benefit of the vaccine outweighs the risk.

Influenza Vaccine

The best way to prevent flu and its potentially serious complications is by getting a yearly flu vaccine. Even when flu vaccination does not prevent illness entirely, it has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick. This is especially important in the elderly and in those with heart or lung disease.

September and October are the best times for most people to get vaccinated.  I WILL be getting an influenza vaccine! Most pharmacies have them and will give you one free.

Be safe this season. We look forward to seeing you for annual screening and we hope we don’t see you sick!

Daniel Cosgrove, MD

Bryan Young, NP

Jennifer McGrath, RN