Thread by @celinegounder

1/ With the emergence of the Omicron variant, my stance on boosters is shifting.

If Omicron is truly immune-evading, we can likely overcome that immune evasion with boosters (similar to what was seen with Beta).

https://twitter.com/celinegounder/status/1465114209390407684

2/ Boosters would buy us time to develop 2nd generation COVID vaccines specific for Omicron.

But risks remain:
- FALSE SENSE OF SECURITY: your risk of SARS-CoV-2 infection is proportional to levels of transmission in the community, no matter how many boosters you get

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3/
Other risks:
- COMPLACENCY: we need a multi-pronged approach; vaccinations alone will not control SARS-CoV-2, at least not in the short term

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4/ Other risks:
- GROWING INEQUITY: while we cannot say that low vaccination rates in Africa directly led to the emergence of the Omicron variant, we know that allowing the virus to spread & replicate increases the risk of variants emerging

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5/ We need to (in this order of priority):
- vaccinate the unvaccinated in the US & globally
- boost residents/staff of long-term care facilities & other high-risk settings
- boost others

6/ We also need to:
- scale-up use of rapid testing
- scale-up genomic & wastewater surveillance in the US & globally
- make testing + antiviral treatment widely, easily available for free

7/ We also need to:
- invest in improving building ventilation & air filtration (this does not depend on individual behavior)
- change culture around mask-wearing: we should consider masks part of LIVING with COVID, at least at certain times & in certain places

8/ We also need to pay special attention to immunocompromised populations:
- solid organ transplant recipients
- people on immunosuppressive chemotherapeutics & drugs for autoimmune/other conditions
- patients living with HIV/AIDS

9/ These patients are more likely to experience prolonged infections during which the virus is more likely to mutate and SARS-CoV-2 variants are to emerge.
nejm.org/doi/full/10.10…

10/ Highly immunocompromised persons should be considered a high priority for:
- vaccine boosters
- monoclonal antibody pre-exposure prophylaxis (not yet available)
- combination antiviral post-exposure prophylaxis & rapid treatment (not yet available)