Dr. Peter Chenhong (3:29)

In the past, it was just very simple. It was simply those who were six months and older, regardless of health status, regardless of health, access to talking to a provider. It was pretty straightforward. You can go up to Walgreens or cvs, roll up your arms, and you can have it.

Juana Summers (3:48)

I think one thing that a lot of people, including myself, I have to say, are wondering is just how big of a risk is Covid right now?

Dr. Peter Chenhong (3:55)

Well, Covid is existing in two worlds, and I think that's why it's hard for most people. It's not a big issue, not like 2020. But for some people, it's like it's 2020 all over again. Those are the people I'm still seeing in the hospitals. They tend to be older, particularly older in 75, and they might have gotten a lot of vaccines early in the pandemic, but didn't get one in the last year or so.

Juana Summers (4:19)

All right, I want to bring in our first listener question, and this is a topic that we got multiple questions about. Let's hear from Karen Moore. She's 68, lives in Wisconsin.

Peter Sagal (4:28)

I know that all of us over age 65 need to be vaccinated twice a year. How does the FDA deem that an under 65 adult is high enough risk.

Juana Summers (4:40)

To be worthy of getting the vaccine? So just simply put, why ages 65 and older?

Dr. Peter Chenhong (4:45)

Well, that's the people who are still driving deaths and hospitalizations. It's kind of like influenza in a way, or other serious respiratory illnesses. Even though the rest of the population have very high immunity, those who are older than 65 have an immunity that drops very quickly. And that's why we need to continue to remind the immune system at least once a year. If you can do it twice a year, that's even better. But once a year is the minimum time. I think person older than 65 should have their immune system. Remember what Covid looks like.

Juana Summers (5:20)

All right, I want to bring in another listener question now. Doctor, this is Sarah Corsi. She's 36 years old and lives in Maryland. What counts as a pre existing condition? Given this new guidance for anyone under 65, my son had reflux as a baby and I have been diagnosed as pre diabetic. Are these pre existing conditions? Do I qualify for my booster? So just to scope this out here, what health problems constitute the ability to get a COVID vaccine if you're outside of those age groups that are listed?

Dr. Peter Chenhong (5:49)

Yeah. So it's estimated that up to 30 to 60% of Americans, when you look at the old criterion anyway, would have a pre existing condition. They include things like obesity or asthma or even depression, diabetes. Certainly the problem is we are not really sure if that will be ratified by the new advisory board to the CDC in the upcoming meeting. And secondly, even if you have a comorbidity and you're younger, how is it going to be enforced? Would the pharmacist just allow you to attest it and check off a box? Would you be needing a prescription? So those are the questions that I have. But again, you know, we will get more information in the upcoming weeks.

Juana Summers (6:35)

This is a question that we actually got from James Holsey. He's 61 and from Missouri on that same theme.

Dr. Peter Chenhong (6:41)

Will a doctor's prescription be sufficient or will additional documentation be required?

Juana Summers (6:46)

I mean, we know that for people who are outside of the FDA's recommendations, they may be able to get a shot prescribed by their doctor. But is that enough?

Dr. Peter Chenhong (6:52)

Yes, you can get a prescription from your clinician to get a vaccine, what we call off label. But there are several issues with that. First of all, you need to have somebody write you the prescription. Secondly, the pharmacist has to accept that they probably will. But again, we need more guidance. But yes, the idea is that clinicians can give several things off label, historically speaking, but it depends on the clinician, depends on the pharmacist. So there are a lot of what ifs in that statement. There would be some variability and that's why a simpler rule is oftentimes better in the vaccine world. But nevertheless, some people will be able to get it that way.

Juana Summers (7:35)

I want to move to a different population. And this is a question that's come up a lot in my own social circles. Let's hear from 41 year old Bridget Valdez Kogel. She lives in Washington State. Are we able to get our children vaccinated with the new version of the COVID 19 vaccine this fall? Now, Valdez Kogel has two kids and we heard from a lot of parents who are really concerned about whether or not they're going to be able to get their young kids vaccinated. What would you say to parents like.

Dr. Peter Chenhong (8:00)

Bridget at this time? We believe that kids 18 and under will be able to have vaccines in the updated formulation. However, you need to have a conversation with your health care provider first and that's called informed decision making or shared decision making. So if people don't have access to healthcare provider, it may be a little bit more difficult. It will be seen how the pharmacists will interpret that conversation to be able to give that vaccination. You may have many people getting vaccinations again in the pediatrician's office like before. The other issue around that is payments. We know that the FDA likely has already approved those who have comorbidities who are younger. But for healthy kids, even after a conversation, it may not be covered very easily by insurance. It needs to be seen whether or not various insurance companies will accept this.

Juana Summers (8:59)

I want to bring in one more question, and this one comes from Jeffrey Seaman in Indiana. He is 62.

Michael Osterholm (9:05)

I care for my wife who has several diagnoses that make her vulnerable for Covid complications. Are caregivers under 65 eligible for Covid and flu vaccines? Also, are nurses and health aides eligible for vaccines?

Juana Summers (9:21)

Doctor, how do people who care for or work with vulnerable immunosuppressed populations fit into this current FDA COVID vaccine guidance?

Dr. Peter Chenhong (9:28)

That's a great question. Right now if you're a healthcare worker, you're under 65, you have no comorbidities, you will not be able to get the vaccine unless you have a prescription and it's prescribed off label. This is different from some other countries. The American Academy of Pediatricians do recognize that people who live in households with immune compromised or vulnerable population should be a group that should get the vaccine. But again, that's not what is available under the current FDA guidance.

Juana Summers (10:03)

And then I do have to ask you a basic question that we got from a lot of people. How can a person actually go about finding a COVID vaccine in their area?

Dr. Peter Chenhong (10:13)

Again, that guidance is going to be changing as different alliances get set up. The west coast, the east coast, conglomerations, health systems, et cetera. But you know, right now it's going to be the same system we've used, depending on your area, you know, looking at Walgreens or cvs, talking to your health care systems. And again, it's very confusing right now. And you know, we're looking for guidance as in the next few weeks we've.

Juana Summers (10:42)

Been able to offer a lot of advice to specific listeners, questions. We've talked about a lot of specific guidance. But before I let you go, doctor, I just wonder, do you have any words of wisdom for people out there right now who might feel confused or lost given a lack of clear guidance?

Dr. Peter Chenhong (10:59)

Again, what I try to tell my patients is that although it seems that a lot of things are changing and they are, some things are not changing. And that's really Those who are 65 enrollment, it's very simple. You can still get your vaccine. It will be covered. Please get the vaccine. I'm seeing people like you in the hospital and it's completely preventable. And the next pearl is don't forget about early antivirals. Even if you couldn't get a vaccine and you're very sick, we still have Paxlovid remdesivir. We can give those easily. You need to get an early diagnosis. And the third pearl is don't forget the ABCs of just any respiratory virus prevention. Wearing that mask if it seems risky, thinking about ventilation, washing your hands, and staying home if you're sick.

Juana Summers (11:45)

Dr. Peter Chenhong is an infectious disease expert with the University of California, San Francisco. Thank you so much for coming on and answering some of our questions.

Dr. Peter Chenhong (11:53)

Thanks so much, Juana.

Juana Summers (11:57)

This episode was produced by Briana Scott. It was edited by Courtney Dorning. Our executive producer is Sammy Yenigun. It's Consider this from npr. I'm Juana Summers.

Peter Sagal (12:15)

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Michael Osterholm (12:46)

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Peter Sagal (13:04)

Want to hear this podcast without sponsor breaks? Amazon prime members can listen to Consider this sponsor free through Amazon Music. Or you can also support NPR's vital journalism and get consider this plus@+npr.org that's plus.npr.org.