COVID-19 is here to stay, and that reality is changing how public health officials talk about COVID vaccines for fall, 2023.
Rather than thinking about new COVID-19 doses as “boosters,” public health experts now think of the shots as annual doses that they hope will protect as many people as possible from the newest variants.
As we prepare for colder weather, cases of COVID-19 may increase again, just as they have in past years. Public health experts expect similar patterns with COVID-19 as we’ve seen with flu. It’s normal for flu cases to spike each fall and winter.
New to the vaccination conversation this fall is respiratory syncytial virus, or RSV. Three new vaccines have been approved for RSV since the beginning of May.
The hope is that, with widespread acceptance of this year’s flu and coronavirus vaccines and strategic adoption of the new RSV vaccines, the United States won’t see a repeat of the “tripledemic” of late 2022 and early 2023. Here are some questions and answers about the state of the coronavirus in the United States and the status of the coronavirus and RSV vaccines.
Will there be another wave of COVID-19 cases in fall, 2023 or winter, 2024, as there has been every fall and winter since the disease emerged?
No one can say for sure, says Dr. Michelle Barron, senior medical director of infection prevention and control for UCHealth and a professor of medicine and infectious diseases at the University of Colorado School of Medicine on the Anschutz Medical Campus. But, she says, the Southern Hemisphere’s experience often foreshadows what happens here. (View UCHealth’s updated COVID-19 information page.)
“They did see a surge during their fall-winter season of COVID, in addition to flu and RSV, so I think we anticipate – at least we’re planning for – something similar to happen in the Northern Hemisphere.”
What’s the status of COVID vaccines? When should I get my next dose?
In June, U.S. Food and Drug Administration advisors settled on the then-dominant XBB.1.5 variant as the basis for this fall’s annual COVID-19 vaccine. Like all circulating variants, it’s a descendant of the BA.2 omicron strain.
Pfizer, Moderna, and Novavax are now making millions of doses. Assuming FDA approval, the U.S. Centers for Disease Control and Prevention is expected to recommend who should get the new vaccine by late September. The most recent coronavirus vaccines, released in fall 2022, were recommended for everyone above the age of six.
As of early August, the CDC estimated that about 10% of U.S. cases stemmed from XBB.1.5, down from about three-quarters of cases in April. The EG.5 variant accounted for about 17% of cases as of early August and appeared to be on track to become the dominant strain in the coming weeks. But if history is any guide, its reign, too, will be brief.
Will the fact that the prevailing coronavirus strain by this fall won’t be XBB.1.5 impact the new COVID vaccine’s effectiveness? Should I still get another dose?
While a perfect match would have been ideal, the emerging variants are all related – many of them the children of XBB.1.5 – and that’s grounds for optimism.
“The immunogenicity that you’ll get from the vaccine is good enough to protect you from what’s circulating now, and, if there’s a new-cousin variant that’s circulating in the fall, that the vaccine will still be pretty protective,” Barron said.
Are people still being hospitalized for COVID in 2023?
Yes, but many fewer people need to be hospitalized now compared to the most difficult periods of the pandemic. UCHealth hospitals had 36 coronavirus hospitalizations as of late August, compared to an omicron-wave peak of 434 in Jan. 2022. Nationally, 9,056 people were hospitalized for COVID-19 in the week ended Aug. 9, according to CDC data. That’s a 12.5% increase over the week before, but far below the omicron variant peak in January 2022, when there were around 150,000 U.S. hospitalizations a week.
Are COVID-19 vaccines worth the risk of potential side effects?
Yes. In the United States alone, coronavirus vaccines averted an estimated 3 million deaths, 18 million hospitalizations, and more than $1 trillion in health care costs during the first two years of the pandemic alone. Millions of long COVID cases were avoided, and research suggests that those who ended up with COVID-19 or long COVID had milder cases if they’ve been vaccinated.
Given the billions of coronavirus vaccine doses administered since early 2021, the side effects are well documented. They are generally mild, and more serious ones, such as myocarditis – inflammation of the heart muscle – are exceedingly rare.
What is RSV, and who’s at risk?
RSV is a respiratory illness that’s riskiest for the old – particularly those 75 and older with have conditions such as cardiovascular disease, diabetes, or chronic lung disease – and the very young.
When did RSV vaccines become available, and who can get them?
The FDA approved the RSV vaccines Abrysvo and Adrexy in May 2023 for those over 60. The following month, the FDA approved Beyfortus, a monoclonal antibody. In early August, the CDC recommended that infants less than 8 months old receive the Beyfortus, and that those ages 8 months to 19 months also receive it if they are at risk of severe RSV disease.
What’s the story with the flu vaccine?
The CDC published its 2023-2024 flu-vaccine recommendations in late June and said that everyone six months and older should be vaccinated. It’s most important for adults over 65, children under 5 and those with weak immune systems to be sure to get their flu shots.
The CDC estimates that those who got the 2022-2023 flu vaccine were 40% to 70% less likely to be hospitalized for the flu and related complications than those who didn’t.
What will flu vaccines cost me?
Flu shots typically are covered for those with health insurance. Federal and corporate programs should cover the uninsured. Uninsured children will be covered through the CDC’s Vaccines for Children program.
Can I get the coronavirus, flu, and RSV vaccines at the same time, assuming they’re available and I’m eligible?
Getting the coronavirus and flu vaccines simultaneously was shown to be safe last year. Health officials expect the same to hold true for those who want to add RSV during the same visit.
Whatever vaccines you’re eligible for, get them as soon as you can, Barron says, because it takes a couple of weeks to take full effect.
What other vaccines (shingles, pneumococcal) should people think about?
Barron says now is the time to sit down with your provider to talk about what vaccines may be available. There are also online resources such as the CDC’s vaccinations and immunization page, where you can link to an online vaccine assessment tool that can recommend vaccines based on our age, travel plans, and other factors.
“There are so many good vaccines out there,” Barron said. “Many people may be eligible for new pneumonia vaccines, based on their age or some underlying conditions. The shingles vaccine offers excellent protection.”
This article appeared in UCHealth Today, a publication of UCHealth, the hospital associated with the University of Colorado School of Medicine.
