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Does Harvey get a flu shot? A COVID shot? Both? Neither? - (10/12/2021)

By Dr. Ron Gasbarro

Harvey came into the pharmacy and said to the pharmacist, "My wife gave me an ultimatum. Either I get a flu shot or the COVID booster shot – or both. Or I'd better give her a good reason why I don't need either one." To the pharmacist's knowledge, Harvey has never received the flu vaccine. And he gave Harvey both COVID shots when those vaccines came out earlier in 2021. 

Harvey is 67 and is in good health. The only reason he balks at getting any vaccine is that he is stubborn. His family is close one. His parents, 88 and 90 years old, live down the street from him and his wife. He has three grandchildren under age 10. The pharmacist said, "You know you are not going home without a Band-Aid on your arm." "I am only in the mood for one shot right now. To make the wife happy, which one should I get today?" Harvey asked. 

How would the pharmacist choose one vaccine for Harvey today? We know that both the flu and COVID viruses spread through the air. The difference is that COVID is more contagious than the flu, with more super-spreading events occurring quickly. While a person with either disease can develop symptoms within 24 hours after exposure, a person with COVID might not experience symptoms for 14 days after being infected. That means the person could be spreading the COVID virus to countless more people before realizing he or she is ill.

Because the COVID-19 virus is new to humans, the totality of its characteristics is still unknown. For example, people who die from influenza are usually the elderly with other serious medical problems, such as heart disease. Yet, we have seen healthy young adults die from COVID. Also, we do not know how a COVID infection will continue to affect a person in the long run. For example, the flu usually resolves itself within weeks after the first symptoms develop. However, we have seen a condition termed "long COVID," in which patients continue to have severe symptoms weeks or months after contracting the virus. These symptoms can be respiratory or associated with "brain fog," a drop in mental clarity. Whether such symptoms persist years after the acute phase of COVID has passed will not be known until they happen. 

Everyone 6 months and older can get a flu vaccine. Right now, only people over 12 years of age can receive a COVID shot. Hence, Harvey's grandkids got the flu vaccine but cannot get the COVID shot until the FDA approves it for their age group. Harvey then asked, "If I got both COVID shots last spring, do I really need the booster shot?" The pharmacist explained that we cannot pinpoint precisely when the first vaccines will wear off. And like the flu virus, COVID keeps mutating. The Delta variant is now the dominant type of COVID, accounting for more than 99% of US cases. Scientists have discovered that it is more transmissible than earlier variants, resulting in more sickness and death among those not vaccinated. So, yes, the booster could save lives. 

"Remember that the purpose of the COVID-19 vaccination program is not to eliminate the virus," the pharmacist told Harvey. "The reason to get the vaccine is to reduce hospital stays, severe complications, and death. This includes those loved ones with whom you come in close contact," he said. "You say that because I have elderly parents as well as unvaccinated grandkids, the booster will protect me against the Delta COVID variant, too," reasoned Harvey. "OK. I'll get the COVID booster now!" "Why not just roll up the other sleeve too and get the flu shot at the same time? This flu season is predicted to be nasty," declared the pharmacist. "You tricked me, Doc!" said Harvey. "I’ll take both shots. But at least the wife will be happy, and we will all be safer!" 


Ron Gasbarro, PharmD, is a recovering pharmacist and writer-in-residence at Rx-Press.

 


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