Interview with Cassandra Calabrese, DO, and member of the Foundation’s COVID-19 Vaccination Committee
The Sjögren’s Foundation understands that many patients continue to have questions about COVID-19, new variants, and the safety and effectiveness of the vaccine.
While we are all tired of being cautious about COVID-19, now is not the time to let down our guard! The new variant of Omicron called BA-5 is the most infectious variant yet and as Sjögren’s patients, we must stay vigilant about the vaccine, masking, and hand washing. It is also worth looking at the timing of your last booster shot to determine your best plan to stay safe. Vaccination and boosters are still our best defense to either not contracting COVID-19 or if you do, being able to avoid serious infection and possible hospitalization.
In better news, there are now excellent tools in our toolbox to treat symptomatic COVID-19, including 2 oral antivirals (PAXLOVID™ and molnupiravir) and a monoclonal antibody called bebtelovimab. These treatments are all indicated for persons with risk factors for getting extreme sickness with COVID-19, which includes age of 65 or older, various co-morbidities (like chronic lung disease, diabetes, and others) and those on immunosuppressive medications. If you are concerned you might have COVID-19, it’s important to quickly do a rapid home test as well as call your doctor to see if you are eligible for one of these treatments.
To help us understand more about BA-5 and what we need to do now, Dr. Cassandra Calabrese is answering some questions to guide us to our best plan as Sjögren’s patients.
Q. Dr. Calabrese, can you explain what the new COVID-19 Omicron BA-5 variant is and how prevalent it is in the US? Is this the only variant now?
BA.5 is currently the dominant circulating variant in the U.S. as well as worldwide, making up about 80% of cases. It is a subvariant of omicron. The remainder of cases are due to other Omicron subvariants, like BA.4.
Q. What is recommended, in terms of vaccines/boosters and safety protocols to avoid contracting this variant?
It is recommended to be up to date with COVID-19 vaccines and boosters, which remains challenging given the ever-changing recommendations, and because recommendations differ based on immune status (immunocompromised vs. not).
Currently, for non-immunocompromised persons, it is recommended to receive the initial 2 mRNA vaccines (Pfzier or Moderna), followed by a 3rd booster dose as well as a 4th booster dose. For immunocompromised persons, it is recommended to receive 3 initial mRNA vaccine doses, followed by a 4th and in some cases a 5th dose (boosters). The 5th dose recommendation is based off the concept that vaccine protection wanes over time, but there are very little data demonstrating benefit of getting a 5th dose in immunocompromised persons. It is not wrong to get a 5th vaccine if recommended but have not told any of my patients to chase after this 5th dose quite yet. Click here to learn if Sjögren’s or your medications make you immune compromised.
Q. It’s been over six months since my last booster shot, do I need another one? What if I got a booster 3 months ago or have had COVID-19 in the last few months?
The answer to this question must factor in a couple things, with the most important being has the person had COVID-19 infection. For persons who have received 3 or 4 vaccines plus having COVID-19 infection within the past 6 months, that infection essentially counts as an “immune boost,” in which case I have been recommended patients to hold off for the “Fall booster.”
Q. Do the current Pfizer and Moderna vaccines/boosters protect me against this variant?
While the currently vaccines are not formulated to specifically protect us against BA.4, all the vaccines currently protect us against severe COVID-19 infection.
Q. What is the new Novavax vaccine? Is it interchangeable like getting either Pfizer or Moderna booster?
It is very exciting to have a new COVID-19 vaccine with a different platform/technology, but Novovax is currently recommended only for initial vaccines series, not as a booster. This would be for people who have not yet received any COVID-19 vaccines. I suspect that one day it will be available as a booster. For now, it is a great option for anyone who has not been vaccinated against COVID-19 due to allergy or contraindication to one of the other vaccines.
Q. Is EVUSHELD™ an option for protecting me against BA-5 and does it matter if I’m taking biologic? What if I got EVUSHELD 3 or 6 months ago?
Evusheld is an IM injection of 2 monoclonal antibodies designed to provide protection against COVID-19 infection for up to 6 months. it is authorized for use in immunocompromised persons on medications that blunt COVID-19 vaccine responses (like RITUXAN® [rituximab] and CellCept® [mycophenolate mofetil]), as well as persons who have contraindications to receiving COVID-19 vaccines. If you received Evusheld, there are now recommendations to receive another dose after 6 months. So far, it appears to be protective against BA.5.
Q. Any statement about immune compromised to help guide people?
I encourage my patients to maintain common sense by practicing good hand hygiene, masking in crowded public spaces including at airports and on airplanes, and surround themselves with smart, vaccinated persons. Unfortunately, at this point it is not reasonable to except to never get COVID-19, so being aware of exposures, symptoms, knowing when to test and who to call to ask about treatments like PAXLOVID™ is very important.
Q. Is it important to be continue wearing masks? How effective is masking and hand sanitizing for protecting us against current variants?
YES! We need to continue to wear masks and washing/ astatizing our hands to protect ourselves and our community.
Q. What is your personal safety protocol, and what would you add to a protocol for a Sjögren’s patient?
Again, I encourage my patients to maintain common sense by practicing good hand hygiene, masking in crowded public spaces including at airports and on airplanes, and surround themselves with smart, vaccinated persons. Unfortunately, at this point it is not reasonable to except to never get COVID-19, so being aware of exposures, symptoms, knowing when to test and who to call to ask about treatments like Paxlovid is very important.
Thank you Dr. Calabrese for keeping us informed about COVID-19, vaccines, and new therapies that help us stay as safe as possible. View all the Foundation's COVID-19 Updates for Sjögren's patients and General Vaccine Information.