‘We’re in a much better place’ than last year

In fall and winter, look for children’s vaccines, boosters, mixing-and-matching, more testing

As the days shorten and people come indoors, what should we expect as we head into our second COVID-19 autumn and winter?

Last year, Thanksgiving and Christmas triggered a pandemic spike. Over holiday season 2020, California’s daily case counts climbed as high as 54,000. In contrast, the state is now reporting about 5,500 new cases a day.

While nothing is certain, there is more optimism. “We’re in a much better place than we were last year,” said UC San Francisco epidemiologist Dr. George Rutherford.

“I think we’ll see a small to moderate winter surge,” Rutherford predicted. It won’t be as pronounced as last winter’s pandemic but may mimic the smaller spike in cases experienced in August, he said.

Why? There’s growing immunity — and several pending steps by federal authorities to fight the virus. While there are still pockets of unvaccinated people in the Bay Area, overall vaccination rates in some counties for residents 12 and up have surpassed 80%. Statewide, 71% of eligible Californians are fully vaccinated. This populationwide protection is expected to climb still higher once children are eligible to get shots.

Here’s a look at what the

“It’s an important advance. The number of COVID-19 hospitalizations is right up there with the worst of the childhood infectious diseases. We want to extend the existing technology — not just to protect them from getting sick, but to prevent transmission.”

— UC San Francisco epidemiologist Dr. George Rutherford on the vaccine for children ages 5-11

months ahead will bring.

Children will start to be vaccinated

On Thursday, Pfizer submitted clinical trial data to the U.S. Food and Drug Administration to authorize emergency use of its vaccine for kids ages 5 to 11. Pfizer’s data shows that the vaccine is safe and triggers a robust immune response in kids.

The agency will meet on Oct. 26 to consider this plan — suggesting we may see a decision and distribution of the vaccine for kids between Halloween and Thanksgiving.

The pediatric vaccine is not as straightforward as it sounds. It will hold onethird the dosage of the vaccine for older youth and adults, according to Pfizer. This likely requires dilution and perhaps a different formulation.

If successful, that move would help protect another 28 million Americans.

“It’s an important advance,” said Rutherford. “The number of COVID-19 hospitalizations is right up there with the worst of the childhood infectious diseases. We want to extend the existing technology — not just to protect them from getting sick, but to prevent transmission.”

Waning immunities will get a boost

There’s concern that as immunity levels in communities start to subside, there will be a new resurgence of cases. So far, only Pfizer’s vaccine has been authorized for booster doses. And it’s offered only to older and other vulnerable Americans, such as people with medical conditions or jobs that place them at higher risk of exposure. There are no imminent plans to expand the eligible population.

Americans are welcoming this third shot, according to new Centers for Disease Control and Prevention data. Of the 6.6 million shots given from Sept. 30 to Oct. 6, more than 2.6 million of them were booster shots, compared with 2 million first doses and 2 million second doses.

Next week, on Oct. 14 and 15, an FDA committee plans to discuss Moderna and J&J booster vaccines. If authorized, these vaccines may be offered to a narrower group of people than the Pfizer vaccine. That’s because overall immunity after the initial round of Moderna and J&J vaccines seems to hold up better over time than the Pfizer vaccine.

There will be more mixing-and-matching of vaccines

Also next week, the FDA committee plans to discuss whether people should be allowed to get a booster shot of a different vaccine than the one they originally received.

So-called “mixing and matching” of vaccines — getting a first dose of Pfizer, followed by a second dose of Moderna — is already used in Europe and other places, so it will likely be approved in the U.S. In fact, there have been recent studies suggesting that using two different vaccine technologies — getting both the J&J and Pfizer vaccines, for instance — may offer more vigorous protection than sticking with one type.

That could boost convenience. It could also assure better protection on university campuses, where a large number of Chinese and other international students have gotten the Sinovac or Sinopharm vaccines, which work less well than their foreign counterparts.

Pharmaceutical companies don’t conduct mix-andmatch clinical trials; they only research their own product. So the National Institutes of Health has structured a giant comparison study to help answer the mix-and-match question.

There will be more testing

Earlier this year, we thought vaccinated people couldn’t spread the virus. That’s changed.

“For now, testing and knowing your status is going to be extremely important to keep businesses and schools running,” said Dr. Michael Mina, an epidemiologist at Harvard University’s Department of Immunology and Infectious Diseases.

This past week, the FDA authorized a new COVID-19 home test that is expected to double the nation’s limited supply of nonprescription tests. The FDA’s emergency use authorization of ACON Laboratories’ Flowflex COVID-19 home test means that tens of millions of additional tests will soon be available. While the consumer price is not yet known, large retailers such as Walmart, Amazon and Kroger have agreed to sell at-home tests at the cost they pay for them.

Production could double to 200 million monthly tests by February, according to the FDA. That could be enough to supply the schools and companies that carry out President Joe Biden’s “vaccinate-ortest” mandate for businesses with 100 or more employees.

It’s important to test yourself promptly before traveling or attending an event, said Mina. Currently, many places allow testing up to three days before.

“That’s like going through a TSA security checkpoint at the airport and then being allowed to go back home for three days and repack your bags,” he said. “Then when you come back, you don’t have to go through security again. That’s not a good way to screen.”