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Covid-19 booster shots are here, and so is the angst over who gets one

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Americans have reached the booster angst stage of the pandemic—and the Centers for Disease Control and Prevention’s announcement on Friday backing extra shots for some people, but not all, has left many with more questions than answers.

In August, with the Delta variant surging and breakthrough infections rising, the Biden administration indicated boosters would be widely available in the U.S. starting this month. After heavy debate among scientists, the CDC ultimately endorsed boosters for a narrower group. Yet its guidance left plenty of room for interpretation about who qualifies, doctors say.

“The patient portal is being overrun with emails from patients,” says Mark Fierstein, a primary care physician at NYU Langone Ambulatory Care Lake Success in New York. “There’s a lot of questions. The confusion is because every day someone comes out and says something a little different.”

“The booster conversation has people’s heads spinning,” says Laura Morris, a family physician in Fulton, Mo. She says some patients have been asking about boosters all summer, including whether they’re really necessary. Several asked about them Friday; she gave two patients, both in their 70s, the extra shots.

The CDC said Pfizer vaccine recipients who are 65 and over, as well as people ages 50 to 64 with certain underlying medical conditions, should get boosters. It also laid out other groups of people who may get boosters, based on their risk levels and potential benefits, prompting a host of new questions and decision-making. For recipients of the Moderna and J&J vaccines, the FDA and CDC have said that they need more time to review data.

Lucy Ballentine, a 33-year-old in Washington, D.C., is pregnant. Pregnancy and her age likely put her in the category of people who the CDC said “may” receive a booster, but the agency didn’t explicitly say they “should” receive a booster. Ms. Ballentine says she’s interested in getting a booster shot but has questions for her midwife. She wants to know whether she should get one before she gives birth, or wait until after.

If her midwife says she should get it while pregnant, Ms. Ballentine says, “I want to pass on as many antibodies as possible.”

The biggest gray area now is for people ages 18 to 49, doctors say. “That is definitely the group that probably needs to have the most counseling and probably we need to take a closer look at what their individual risk is,” says Dr. Morris.

In that group, doctors say it’s important to look at occupation, where people live and work, who they are commonly exposed to, and their health. Dr. Morris says she has a healthy patient in that age bracket who cares for her mother who is severely immunocompromised. She wanted a booster earlier this week but Dr. Morris told her to hold off; now, she says she’d recommend that the patient get one.

Cameron Wolfe, associate professor of medicine in the division of infectious diseases at Duke University health system, says the guidelines give doctors a lot of flexibility for 18- to 49-year-olds. “We’re going to use this in a fairly permissive fashion. If someone is interested and tolerated the first two doses and it’s been six months, I think this is open,” he says.

Some of the questions to consider, he says: “What sort of work do you do? Who’s at home with you who might be at higher risk? Can you afford a couple of weeks off if you get sick? How did you tolerate the first two doses? Have you had Covid before?”

Many people who don’t obviously qualify now are anxious to know when they will. Lauren Lipowicz, a 41-year-old real-estate agent in Lower Merion, Pa., is eager for a booster and will ask her doctor when she might be eligible.

“I want it now,” she says, adding that she won’t get one until she qualifies. “I don’t have an underlying condition and I don’t believe I qualify for having a high-risk job, but if they tell me I can, then I will be the first in line,” she says. She got Covid in August 2020, and got vaccinated this year. “I don’t want to ever have to go through that again,” she says of the virus.

Erica Aikey, a 20-year-old Boston University student who received her second Pfizer shot in June, wants to know when, or if, boosters will be available for people her age. She is eager for an extra dose of protection, she says. “I’m in in-person classes, in a big city,” she says. “I’d like to put myself in a healthier position.”

Some people are seeking out boosters regardless of their status. Pharmacies and vaccine clinics don’t always scrutinize booster-seekers and some doctors have more permissive views on boosters.

Lucy McBride, a Washington, D.C., primary-care physician, says despite her counseling that the mRNA vaccines from Pfizer and Moderna are working very well in preventing severe Covid-19 in most people, some of her patients have decided to get a booster anyway.

“People are sensing the ambiguity and the abundance of vaccine and just deciding on their own to go get it,” says Dr. McBride.


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