As Omicron Spreads, CDC Says Adults 18 and Older Should Get a Booster

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Some epidemiologists reportedly posit that Omicron might be a way out of the COVID-19 pandemic if the variant’s symptoms are mild, as some initial reports indicate.

At first—that is, back in August—it was for the immunocompromised. Then it was for anybody 65 and over and the immunocompromised. Just last week, it became for all adults over 50, though some experts wondered why COVID-19 booster shots shouldn’t be approved for all adults over 18. Period. Well, on Monday—as scientists the world over attempt the measure the implications of the Omicron variant of COVID-19, and the growing concern, expressed even before Omicron, that the United States might be facing a fifth wave of the disease—the Centers for Disease Control and Prevention (CDC) updated it guidance on just who should get a booster shot. Now, the agency recommends that all adults 18 and older get a booster.

Rochelle Walensky, MD, the CDC’s director, issued the recommendation. “Everyone ages 18 and older should get a booster shot either when they are 6 months after their initial Pfizer or Moderna series or 2 months after their initial J&J vaccine,” Walensky said in a statement. “The recent emergence of the Omicron variant (B.1.1.529) further emphasizes the importance of vaccination, boosters, and prevention efforts needed to protect against COVID-19. Early data from South Africa suggest increased transmissibility of the Omicron variant, and scientists in the United States and around the world are urgently examining vaccine effectiveness related to this variant.”

Of course, a booster shot is just that: a booster. Its effectiveness has been well documented, but it’s a moot point for people—and that includes many health care employees—who don’t get vaccinated in the first place.

“I strongly encourage the 47 million adults who are not yet vaccinated to get vaccinated as soon as possible and to vaccinate the children and teens in their families as well because strong immunity will likely prevent serious illness,” Walensky said in the statement. “I also want to encourage people to get a COVID-19 test if they are sick. Increased testing will help us identify Omicron quickly. And finally, to stop the spread of COVID-19 we need to follow the prevention strategies we know work.”

Those strategies include the three pillars of nonpharmaceutical protection against infection: hand hygiene, social distancing, and wearing a mask.

However, the need for vaccinations and now boosters continue to face pushback. And as Infection Control Today® (ICT®) has reported, infection preventionists (IPs) often find themselves in the position of trying to convince their vaccine hesitant health care coworkers to get the jab, which often involves countering the torrent of misinformation surrounding COVID-19, vaccines, and booster shots. ICT® has also reported on how IPs and other health care professionals need to battle compassion fatigue in the face of the epidemic.

As Rebecca Leach, MPH, BSN, RN, CIC, a member of ICT®’s Editorial Advisory Board (EAB), wrote in ICT®’s October issue, when faced with COVID-19 surges fueled mostly by the unvaccinated “does this perceived nonadherence affect providers’ ability to be compassionate to patients? If the means to prevent infection is freely available and people voluntarily refuse it, then do not take other measures to protect themselves and prevent infection, how can health care workers maintain professionalism and treat all patients equally?”

The short answer, provided by Leach, is that IPs and all health care workers have to treat all patients equally. They are not here to judge, but to serve. And this is not a new issue. The lifestyle choices that many people make—overeating, smoking, drinking, drug addiction—could also cause compassion fatigue, but those patients deserve the best possible care.

Still, the COVID-19 pandemic and its aftermath—an aftermath that might extend for decades, if fears about long COVID pan out—raises a host of ethical questions, as Kevin Kavanagh, MD, and another member of ICT®’s EAB, put it in a recent interview. Kavanagh said that “one person with COVID-19 can spend months in the ICU, which would prevent 10 or 20, non-COVID-19 cases from going to the ICU, whether it’s for a coronary bypass, or just angioplasty, or getting a cancer procedure. You have 10 or 20 times the number of patients that can’t get care for other serious illnesses.”

As the Washington Post reports, there may be a silver lining here. Scientists might be about 2 weeks away from determining the severity and transmissibility of Omicron. Meanwhile, some initial reports indicate that Omicron’s symptoms are mild. If that proves to be the case, Omicron might be a way that the world can shake lose of the more societal-altering effects of COVID-19—lockdowns, travel restrictions, mandates of all sorts—and make it to a new normal.

Tony Blakely, MBChB, MPH, PhD, a professor of epidemiology at the University of Melbourne, tells the Washington Post that if Omicron causes less severe symptoms “that may actually be a good thing because it means that as it washes through populations, you’ll have less morbidity and mortality.”

Catherine Bennett, BSc, MAppEpid, PhD, the chair of epidemiology at Deakin University, tells the newspaper that “if we had something more infectious, something capable of outrunning Delta, that had a better profile when it came to virulence or disease causation, then that would be one of those small mercies.”

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