Q&A with Dr. Wohl: What to expect from Omicron-specific COVID boosters

This article was first published by North Carolina Health News on Sept. 12, 2022 and is republished here under a Creative Commons license. Story by Anne Blythe.

David Wohl, an infectious disease specialist at UNC Health, went to a CVS pharmacy last week and rolled up his sleeve for one of the new Omicron-specific vaccines.

North Carolina now has the updated Moderna and Pfizer-BioNTech COVID-19 vaccines that specifically attack the Omicron BA.4 and BA.5 subvariants.

The U.S. Food and Drug Administration amended the emergency use authorizations for the Moderna and Pfizer-BioNTech COVID-19 vaccines on Aug. 31 to include bivalent vaccines created by the companies to attack the Omicron subvariants, as well as the original coronavirus strain.

The Pfizer vaccine is available to anyone 12 and older. The Moderna vaccine is for anyone 18 and older. You can find a site in your ZIP code area here.

Wohl has a knack for breaking down medical and scientific information that can sometimes be complicated into language that’s much easier to understand. He has done that throughout the pandemic.

So North Carolina Health News checked in with him to find out more about the updated vaccines and where we stand now in the battle against COVID-19. Here’s some of what we learned.

This interview has been edited for length and clarity.

NC Health News: What’s your routine at this point in the pandemic?

David Wohl: I wear a mask indoors when I’m around others, and I wear an N95. Since Omicron started, I just do it. This is a much more catchy virus, and so I’m optimizing my protection.

I wear an N95 when I’m in public spaces, indoors, and private spaces indoors outside of my bubble. Home, of course, my wife, my kids, I don’t wear a mask. We’re pretty careful. My 80-year-old mom who comes over to visit, we test her on the porch before she comes into the house, and we test ourselves because we don’t want to give it to her, unknowingly. So we all test and then we can have dinner together when she comes over every few weeks.

I’m about to go to Africa on Sunday. I will wear an N95 on the plane all the way there. I will wear it when I arrive and once I get to our UNC research house, the five other folks who live there will test and we’ll all test together and we’ll create a bubble. So I don’t go to Home Depot without my N95, I don’t go to Whole Foods without my N95, I’m not in a car with people. I don’t eat indoors at restaurants right now. 

(Wohl was scheduled to fly to West Africa several days after our interview to spend time with researchers at UNC Project Liberia, which studies Ebola virus survivors and the viral hemorrhagic Lassa fever.)

NCHN: Will we see a surge of cases as the weather gets colder and people make plans to travel for the winter holidays?

Wohl: I feel that, and hope that, we’ll have a more muted rise than we had previous winters and I think that’s a consequence of hundreds of thousands of people catching BA.5 every week in the United States and thus being protected and people getting vaccinated. I think there’s going to be a pretty good uptick of the new vaccine. When I went to CVS, they told me they were booked out. So I think that we’re going to have a lot of immunity as long as BA.5 sticks around.

NCHN: What was your experience with the updated vaccine?

Wohl: I’m so excited. I have had reactions to every vaccine so far, and so I was really concerned because I’m in the hospital taking care of people and I really wanted to get vaccinated before I travel and I wanted to get it as soon as possible. 

I was really worried yesterday that I was going to feel crappy. I took Tylenol the night before, right before I went to sleep. I woke up in the morning, took Tylenol, and I felt slightly, maybe tired, but then I was good and I’ve not had any problems since, just my arm is a little sore, but nothing else. And I worked out yesterday. I’m at work today, fully functional. So of all the shots, this has been the best, and I think people should take Tylenol after they get their shot and the day after. There’s no data that I know of that shows that that interferes with anything.

NCHN: Should we expect to get a COVID vaccine every six months now?

Wohl: I think it’s going to be every year and let me tell you why. I had to stop going on Twitter. There’s good things and bad things. Some of it is really useful. Some of it really tells you stuff, like, ‘Oh, I didn’t know about that article.’ 

But the problem is people are so critical. 

I understand why people are saying that’s a white flag, we’ve given up. But when you think about it, you know if we take it every year, it’s not like we’re protecting 100 percent of the population. That’s not the goal. We reduce the risk, and it’s practical. 

It’s very hard to get people to take a vaccine every six months. We don’t know that that’s the greatest idea in general, but if it’s annual, like your flu shot, then a significant portion of the population will now be better protected in sort of a rolling fashion. I see this as sort of a risk reduction and a pragmatic way of doing it. And you know, we should develop mRNA flu vaccines and give them both together. That just seems to make a lot of sense.

NCHN: At a Sept. 6 briefing with reporters, experts, said they expected that it would be routine in the years to come that people get a COVID-19 vaccine once a year, similar to the flu shot. Some public health advocates worry that the Biden administration’s messaging ignores the many curve balls that COVID-19 has thrown us throughout the pandemic. Is this just surrendering?

Wohl: So I don’t think this is defeatist at all, and I think there’s a very pragmatic approach that could be instituted just like we’ve done for flu. 

Flu vaccine is not a hundred percent effective. It reduces significant amounts of death, even when it’s 40 percent effective, tens of thousands of people’s lives are saved. They just don’t know it. You and I, maybe our lives were saved because someone took their flu vaccine that was only 40 percent effective.

NCHN: We’ve seen people who have been vaccinated and gotten boosters get COVID. Some people have described the vaccines as “leaky,” meaning they haven’t been as effective as initially touted to prevent COVID infection. How do you convince people to keep taking a shot? 

Wohl: I believe the vaccines do protect you from infection, they just don’t protect you as well as we’d have liked. I also believe that, let’s say, that the virus never mutated, the virus was the same from Wuhan and never changed. I don’t know that we understand yet whether or not the vaccine would have protected us from infection from the original. 

We don’t know how fully because new variants popped up within months of the vaccine being rolled out. We had Alpha, then we had Delta very soon thereafter. So I think these experts have to think of the alternative scenario where no new variant came out. Would the vaccines that were 95 percent effective continue to be around that level of effectiveness had the virus not changed?  And maybe it would have waned somewhat, but probably what we’re seeing is mostly a waning of effectiveness, a leakiness, because of new variants that are popping up. 

So what if BA.5 sticks around? Let’s say it sticks around for a few months. Let’s say through the winter, and you have BA.5 immunity. Who’s to say it’s leaky?

When we talk about leakiness, I think we have to be careful. Are we talking about the variant that’s circulating now? Or the variant that’s coming down the pike?

NCHN: Pharmaceutical companies in India and China have received approval from those countries for intranasal vaccines. CanSino Biologics, a Chinese company, developed a nasal spray. Bharat Biotech International, which is headquartered in India, developed a nasal drop vaccine. Should the U.S. start looking into nasal vaccines?

Wohl: Absolutely. … The concept of Warp Speed is right, even if we don’t like the name. We need to work at a fast pace to do things that are remarkable and, in some ways, we did do that. The vaccines are good proof of that. The therapeutics, Paxlovid, remdesivir, molnupiravir, the monoclonal antibodies. This is good news for us. These are very important tools. 

The nasal vaccine should be a priority for our government. Like it should be up there with Ukraine. Like we need to get nasal vaccines that are highly effective, people are going to like them better, … even if you have to take them with a shot, that would just be so awesome if we could have better protection against infection. That’s the gap that we have right now. We need that. This should be a high priority. They should be talking about it left and right.

NCHN: The nasal vaccines often are more appealing to people who won’t get a shot because of a fear of needles. They also target the mucus, a front line of defense for keeping bacteria and other particles that can be harmful from entering the body. How do the nasal vaccines offer a different kind of protection?

Wohl: So the antibodies that we make for the injected, the cells that make them are in our blood. The blood cells, … will make antibodies when triggered by exposure to the germ. So that’s great, but the germ has to get into the place where the blood can see it. 

When you do a nasal vaccine, there’s a whole bunch of cells that live in the lining of our shiny surfaces (mucus membranes) of our body and they make a different kind of antibody. It’s called the IgA, and that’s an antibody that’s in our secretions, it’s in our shiny surfaces, and that could be a first line of defense if they’re already primed and triggered to attack the germ before you get the germ. 

So it doesn’t mean that all nasal vaccines are better. We know that with flu there are nasal vaccines, but we don’t think they’re necessarily better than injectable vaccines. But in this particular virus, it could well be that this is a very good way to protect ourselves, and we’d have to do the research. I’m not saying it’s a slam dunk. I’m not saying it’s a home run. But we have to research it. Can we find a more effective vaccine that’s given intranasally? That also allows it to be given much more easily than a shot.

NCHN: Will we see an evolution of COVID-19 vaccines in the months and years ahead? Perhaps a variety?

Wohl: I do believe nasal vaccines have a real promise for us. You know it would be nice to have, maybe, a perimeter protection, like at the nose or the throat, and nasal vaccines can do that. The other thing you could do is not target the spike protein. The spike protein is changing, but there are some conserved parts of this virus that are not changing, and we need to be able to develop immunity that targets that, and I think that’s another thing that’s going to be really key. So we’re just at the beginning. 

I’m pretty psyched that I just got a bivalent vaccine that has BA.5 antibody-generating mRNA in it. And as long as BA.5 is around, I feel like I’m going to be pretty well protected against BA.5. 

I don’t think it’s going to be that leaky any time soon as long as BA.5 sticks around. But the vaccines do protect us from getting sick. The good news is your neighbors are getting sniffles. Some of your friends are getting colds and coughs. Some of them are in bed for a couple of days or three or four days, but they’re not in the hospital. They’re not on oxygen, they are not on life support, they’re not on ECMO. And that’s because we have great immunity built up over time due to vaccines that protect us from severe disease. And that’s no small thing because when you have a lot of people in the hospital, that’s when society starts to shut down.

NCHN: Why is it that some people who get COVID even after being vaccinated and boosted get a quick case of the sniffles or a headache and no other symptoms while others get what can seem like a horrible cold or a harsh case of flu?

Wohl: I got the shot, my third shot, and I was in bed. I was like, as if,  ‘why am I doing this? I am taking the shot not to get sick, but now I am sick.’ But the good news is, I was only sick for 24 hours, not even, and I got better quickly and I didn’t get long COVID, and I didn’t risk getting on life support in the hospital. 

Sometimes what I think we are feeling when we get COVID is the virus doing something to us and a lot of it is our body reacting to preventing us from making us sick like back in the olden days before we had vaccines. So it could be a sign of somebody’s immune response being really strong. It could be a good thing. Maybe your immune system revved up. You had a fever. But you didn’t get short of breath. You didn’t get low oxygen level because your immunity was kicking in and you felt it.

NCHN: Doctors have encouraged people to get a vaccine, and used the potential of getting long COVID, as a reason to get the added layer of protection. Some people with long COVID lose their sense of smell and taste for months after testing positive for the virus. Others are short of breath, complain of brain fog, and overall fatigue. Why are the symptoms so wide-ranging?

Wohl: All of us are different. We think of our immune systems, our innards as just being monolithic, but they’re just as different as our faces, and our bodies. So everyone is very individual and our immune systems are particular to us. So different people have different makeup. Some people are reacting one way. Some people are reacting in a different way.  The conditions are all different. There will be people who get fatigue, some people will get headaches. We don’t understand exactly why. But we do know that it happens.

North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.