Though San Diego County public health clinics began vaccinating those without health insurance this week, and some retail pharmacies have the new coronavirus booster shot available, arrival of new doses remains somewhat behind expectations as October arrives.
UC San Diego Health, Sharp HealthCare and Scripps Health have not yet begun broad vaccination campaigns for patients, with Scripps indicating it plans to begin administering COVID-19 boosters at its Health Express clinics and primary care offices in mid-October.
Kaiser Permanente sent a memo to its members late last week indicating that coronavirus booster shot appointments would begin Thursday, Sept. 28, but only for those age 12 and older with access for younger residents to be booked “as we receive supply.”
Though the White House urged the public to get vaccinated after the U.S. Food and Drug Administration approved new boosters on Sept. 11 for those age 5 and older, news accounts have documented canceled appointments in the past two weeks. An analysis from STAT, a health industry publication, notes that 2023 marks the first year that the nation’s vaccination system transitions “from a single-payer program to a system where a variety of private and public insurers are covering the cost of vaccine doses.”
Dr. Wilma Wooten, director of Public Health for San Diego County, said late last week that there have also been some logistical issues involved in making the transition from the government purchasing and allocating vaccines to a more commercial rollout.
“There are ample supplies, just there’s an issue at the manufacturer level pushing them out,” Wooten said, adding that the county received its initial booster supply last week.
The most recent coronavirus data indicates that the region’s current test positivity rate — the share of tests that come back positive — hit a seven-day average of 12.6 percent in San Diego County on Sept. 14, continuing a gradual increase after falling to about 3 percent in early May.
Across the region, 160 patients were said to be in hospital beds with coronavirus infections. While that number is more than seven times greater than the 21 hospitalized patients on July 2, it remains far below 2023 and 2022 January peaks greater than 400 and far, far below the 1,685 in hospital beds filled with COVID-19 patients on Jan. 7, 2021.
This year’s booster contains but a single reference strain of the coronavirus named XBB.1.5. This particular subvariant is said to prompt immunity to the most commonly circulating types today, including EG.5, which according to recent wastewater monitoring, made up about 30 percent of virus detected on Sept. 12.
There were fears that the vaccine would not do much to get in the way of BA.2.86, a highly mutated strain that started to show up in variant-detection programs this summer. Thus far, though, the latest mutant has not supplanted its cousins, which are also descendants of the original Omicron variant.
Joshua Levy, a computational biologist heavily involved with the local wastewater analysis effort and a member of the Kristian Andersen lab at Scripps Research, said in a recent email that 2.86 just hasn’t been up to the job of knocking out its competitors.
“There are quite a few factors that contribute to virus fitness,” Levy said. “In this case, the new mutations have allowed the virus to escape host immunity, but in so doing, have decreased the ability of the virus to bind to the ACE2 receptor, which it needs in order to infect cells.”
David “Davey” Smith, chief of infectious diseases and global public health at UC San Diego, said he agreed with that assessment, but added that BA.2.86 is likely to spread more quickly as more gain immunity to EG.5 and other similar subvariants now holding sway.
“As soon as you start increasing the overall population’s resistance to those other Omicrons, then BA.2.86 is going to win, even if it doesn’t bind to the receptor all that well,” Smith said.
For now, though, he added that the vaccine should offer good protection to what’s currently going around. And the booster comes as those age 60 and older and pregnant women are also now eligible for respiratory syncytial virus vaccination in addition to seasonal flu vaccination.
The U.S. Centers for Disease Control and Prevention states that “coadministration” of all three vaccines during a single visit is acceptable. Smith said many tend to want to spread out the shots.
“Most people do want to space out their vaccines, and I space mine out personally,” Smith said. “But if you’re one of those people who just want to get it over with, that’s not a problem for these vaccines unless you’re getting one of the high-dose versions.
“For people living in the San Diego area, my current recommendation is to get the RSV vaccine first if you’re eligible, then the COVID-19 booster and then the flu.”
The new COVID-19 booster, he added, should be given at least three months after a person’s last booster shot. For those who have had a coronavirus infection in the past one to three months, natural immunity is probably still strong, making it OK to wait.
